The Medical School's Aula Magna hosted the Ibero-American Meeting on Cardiac Rehabilitation Beyond Borders, on the 10th and 11th of April.
Several people responsible for the implementation and development of rehabilitation techniques came to speak of their own experience and involvement, representing their countries of origin. Some have more experience, others have less, but the fact is that they are all connected to Cardiology. They sustain that it needs to be sentient to the diverse mechanisms of prevention, in addition to the conventional cardiac clinical treatments. By invitation of Professor and Cardiologist Ana Abreu, who in recent years has been dedicated to the awareness and training in Cardiovascular Rehabilitation in Portugal and in the rest of Europe, several countries have joined forces. This represents a new era in preventing the arrival and settlement of cardiovascular diseases, thus delaying or mitigating the damages in the lives of patients, many of whom undergo surgical or percutaneous interventions.
Fausto J. Pinto, Director of the School and also of the Department of Heart and Vessels of the North Lisbon University Hospital Centre, hosted and opened this meeting. Over two whole days, several questions that were compared through the reports of professionals were up for debate.
But what are we talking about when we talk about cardiac rehabilitation?
Cardiologist Ana Abreu, who is also coordinator of the Master's Degree in Cardiovascular Rehabilitation at FMUL, explains the need to increasingly debate these cardiac matters. "Nowadays we can't just have the conventional appointment, where we advise against smoking, drinking or eating fats. That can't be our stand any more. We need the help of new, highly specialised teams, not just doctors, to properly convey new messages. Doctors alone cannot change everything, it's impossible. In order to enhance this new approach on rehabilitation and prevention, a large team of people from different areas is needed. We should have centres with a doctor connected to one or more teams”.
China, Cuba, Ecuador, Brazil, France, Argentina, Greece, Romania, Italy, India, Spain and Portugal were present, and we were able to listen to almost everyone.
What started as a South American meeting with Esteban Porrero, a Spanish Cardiologist and founder of the Ibero-American Society for Cardiovascular Prevention and Rehabilitation, has grown and today brings together insights and concepts from around the world. The intention is the same, only more global, as explained by Ana Abreu, “: "To overcome the barriers to cardiac intervention and prevention, looking at telemedicine in general and telemonitoring in particular as solutions of remote assistance and treatment, looking after elderly patients and thinking about other types of home care".
The promoter of this event, Ana Abreu, adds: "It is our state of art, where each of us has already created a network of contacts with professionals (doctors, nurses, physiotherapists, etc.) and intends to create research lines and common publications, developing multidisciplinary education between countries, connecting hospitals and universities in a single project. This meeting allowed us to discuss and provide strategies to each other so that we could stimulate and implement new methods in our own country."
We inquired some of the attending physicians about the status of each country regarding the state of Cardiac Rehabilitation.
Shumlin Shu – Cardiologist, China
"There are more and more doctors in China, especially cardiologists, and this recent concept on Cardiac Rehabilitation is interesting in that it seeks to do some prevention on a secondary level, mainly based on physical exercise. Centres that are only intended for Cardiac Rehabilitation have recently emerged in China, in the last 4 years alone: about 2,000 centres were created, when until then there were only 6. More than 60% of these centres are fully qualified and certified. This is a Chinese cause that spreads across the country, from the largest hospitals to the more local ones. That's why I think we raise public awareness everywhere we go, at hospitals, medical conferences, but also through professionals, and if there is a possibility of teaching not only the people but also doctors themselves, about what rehabilitation means, we'll do it. The treatments for Cardiovascular Rehabilitation are not free and at this moment they are only ensured by those who have insurance. The Chinese government knows that to be healthy, prevention is not enough, it is necessary to maintain that health."
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Daysi Despaigne – Diabetologist, Cuba
"Cardiovascular diseases in women are very important to us. We have a rehabilitation system with more than 30 years of existence. In Cuba, cardiologists have a specific speciality in rehabilitation. The rehabilitation system is the same for everyone: there is a national centre where the rules are planned, investigated and created that later extend to the rest of the country. All provinces in the country have rehabilitation centres, we have 14 provinces and in all of them, the centres work with the Cardiologist and a multidisciplinary team, where there are also nurses, something that is not always the case. Overall figures show that 65% of the patients who need it go to rehabilitation programmes in Cuba."
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Khawer Naveed Sidiqqui - Cardiologist, India
"This concept of Cardiovascular Rehabilitation is quite old but since 2017 it has been further discussed in the Indian guidelines. Still, a lot is missing and it remains a recent topic. A vast majority of our population live in rural areas and we still have huge differences between those who come from the cities and those who belong to more rural settings. It is further exacerbated by the fact that people in India have to pay for their own treatments. Paying for a bypass is a lot of money as it is, but having to further pay for a rehabilitation treatment and then make those regular visits makes everything more difficult. There is a loss of motivation. We are aware that it will take a long time to change the system; at the moment we have only 10/15 Cardiovascular Rehabilitation centres, which is sad, but we have to work with a global vision in order to give more knowledge to people. Maybe we can start with Telemedicine, remotely sensitizing people and the only cost it has is the internet because everyone has easy access to it."
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Nelson Campos - Cardiologist, Ecuador
"I am from Portoviejo, a province on the coast of Ecuador, and Cardiac Rehabilitation is still very scarce, as it was first performed in 2015. At that time, I started a study and was part of the first integral rehabilitation centre in the country. This study ended at the end of 2017 and today I am here to present the summary and its results. The news I bring is good and shows many improvements. Of the 170 patients we observed, all of them started to control their lipid profile and completely changed their smoking habits. My city developed severe anti-smoking policies, with many bans and specific allocations for smoking. This played a major role in the prevention process. The people observed in this study received treatment through our social security. It's now clear that we still have a long way to go."
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Cláudio Gil Araújo - Cardiologist for the last 40 years, he promoted the early stages of Cardiovascular Rehabilitation in Brazil.
"Brazil is a giant country with enormous diversity: we live with excellence and poverty at the same time. The same goes for health, in greater proportions. You might be able to find high-level care, on par with the best in the world. At the same time, you may find entire cities where there is not even a doctor and where they are completely abandoned and die for the most futile reasons. Only 14 states have Cardiovascular Rehabilitation, which means that less than 10% of the population would have access to prevention treatments if they needed them. However, Rio de Janeiro alone has 24 rehabilitation programmes, while the rest of the country does not have all these programmes. If we talk specifically about cardiovascular measures, we are very suspicious about smoking, as only 10% of the adult population smokes. And those with cardiovascular diseases basically do not smoke, which gives us a very positive outlook. We score many points with the anti-smoking measures; however, with nutrition it is not quite the case. For many years, Brazil had a pattern of malnutrition, and nowadays, although it still exists, it is much less evident. Many people have bad eating habits and suffer from obesity, as this pattern comes mainly from the disadvantaged class. On the subject of diabetes and physical exercise, we find ourselves reasonably well positioned. But physical exercise has not yet reached clinical cardiology, as the habit of exercising must last for the rest of one's life. In my presentations, I usually state that before heart medication, we should start with good nutrition, exercise, stress reduction, regular sexual activity and sleeping well. Then, if necessary, take the adequate medications. If you ask me for a conclusive number, only 1 or 2 % of the patients referred actually start rehabilitation. But it's important to say that effective rehabilitation cannot last for 1 or 2 months, as people have to take care of themselves in the long run."
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Suceveanu Mihaela Carmen – Cardiologist, Romania
"We've been developing Cardiovascular Rehabilitation programmes since 1960, so we already have 60 years' experience. My hospital is a great example of this development, following the current guidelines accordingly. We follow a specific programme because we use non-pharmacological treatments. We obviously advocate for changes in lifestyle and doing exercise, but we also support the natural factors that surround us like the use of mineral water. Evidently, we still add the clinical side of Cardiovascular Rehabilitation programmes."
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Ana Abreu - Cardiologist, Portugal
"Five years ago, only 8% of patients with heart attacks were rehabilitated. We are now waiting for the results of a new survey, with the expectation that the results have improved to 20%. The explanation lies in the increase in rehabilitation centres, as well as greater awareness in people. Very soon we will have a National Registry of Cardiac Rehabilitation in the Portuguese Society of Cardiology, which is the result of a lot of hard work in recent years."
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Joana Sousa
Editorial Team
