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Cardiology Practice in Portugal

Professor Rafael Ferreira describes below the training of cardiologists in Portugal, continuous medical education (CME) and clinical practice in his country.
Professor Ferreira represents Portugal in the Council for Cardiology Practice.

Training of Specialists

Portuguese cardiologists accomplish a Hospital Internship of Cardiology at the hospitals
of the National Health Service (NHS). Annual admission to the internship is made
through a public application, the number of vacancies being previously defined by the
Health Department. The internship can only take place in those Departments of
Cardiology classified as “Apt for specialist training” by the College of Cardiology of the
Portuguese Medical Association (PMA).
The internship consists of one year of internal medicine and four years in cardiology that

  • Clinical cardiology (hospital ward, general emergency and outpatients)
  • Intensive cardiac care
  • Non-invasive techniques: electrocardiography (conventional, stress-ECG and
  • Holter recordings), echocardiography and Doppler, nuclear cardiology and MRI
  • (optional) Invasive techniques: hemodynamic and interventional cardiology
  • Cardiac pacing and electrophysiology
  • Training in paediatric cardiology
  • Cardiac surgery.

A final examination, both theoretical and practical, completes the internship and awards
the title of cardiologist acknowledged by both the Health Department and the PMA.

Continuous Medical Education

Continuous education at an official level is defined by the Hospital Career. Certified
cardiologists apply for a 5-year position as “Hospital Assistant”. At the end of the 5-year period their performance is evaluated by an examination which, if passed, allows them to become "Consultants in Cardiology". The exam values the clinical activity developed along the period, but special relevance is given to clinical investigation and published articles. After five years of fulfilment as a Consultant, the cardiologist can apply for the position of “Head of Department”, the highest position in the hospital career.

In Portugal physicians are not obliged to obtain recertification since it is taken as
granted that such a desideratum is accomplished throughout the hospital career which
includes almost all registered Portuguese cardiologists.

The Portuguese Society of Cardiology (PSC) plays an important role in the continuous
education of cardiologists. There are almost 800 cardiologists registered in the College
of Cardiology of the PMA (which is mandatory) and around 700 of these are members
of the PSC. Nurses and Technicians may also be accepted as aggregated members and there are about 200.
The annual congress of the PSC assembles more than 2,000 health professionals and it is a unique opportunity for an update on the main themes of clinical cardiology as well as
for presentation of the original investigations in the field of cardiology including basic research. PSC has, on the other hand, one association (APAP - Portuguese Association of Arrhythmia and Pacing) and 16 working groups and nuclei that organize meetings on different topics in their own area of interest throughout the year.

Clinical Practice in Cardiology

Cardiology practice as far as it concerns hospital admission, intensive cardiac care,
invasive techniques and cardiac surgery is almost entirely performed in Public Hospitals.
Recently some private institutions have begun to develop a network of hospitals in the
main centres – Lisbon and Oporto – with a large capacity in the field of invasive
Out-patient cardiology and non-invasive tests have a relevant ambulatory component.
The NHS has agreements with various private institutions and physicians to perform
non-invasive tests in private offices and clinics. The quality of the tests is under the
control of the College of Cardiology of the PMA.

Data on cardiology practice in Portugal (2007) can be found hereafter:

  • Interventional Cardiology is performed in 19 hospitals of the NHS. A specific competence in this technique is given by the College of Cardiology of the PMA after intensive training in reference centres. The number of procedures in 2007 was 10,500 (primary angioplasties numbered 1,900). The total number of catheter examinations in these centres was about 26,600.


  • Adult Cardiac Surgery is performed in eight Cardiac Surgery Departments in the country. The number of coronary surgeries decreased from 2,730 in 2004 to 2,390 in 2007; in the same period the number of isolated valve surgeries increased from 1,600 to 2,100. As far as the combined surgery is concerned the number of procedures increased from 475 to 600. Paediatric cardiac surgery is performed in five centres in the main University Hospitals. In Lisbon the Red Cross Hospital also has a good performance in this area. The total number of procedures increased from 560 in 2004 to 690 in 2007.


  • Cardiac Transplantation. There are 4 centres of cardiac transplant in the main university centres. Coimbra is now the most active one with more than half the total of the 45 transplants performed in 2007.


  • Pacing. There are more than 40 institutions in which pacing is a routine technique. This means four centres per million population. In 2007 there were 7,632 procedures – 80% were first generator implantations and about 20% were battery replacements. There was a significant increase in physiological pacemakers. Isolated atrial stimulation systems still account for only a few implantations. VDD systems with a single electrocatheter are increasingly used. Mention should also be made of the increase in the use of rate responsive pacemakers ( AAIR/VVIR/VDDR/DDDR).


  • Invasive Electrophysiology (data from 2006). There are 19 centres in Portugal (15 in public hospitals and four in private institutions). Operators in this technique have a specific competence given by the College of Cardiology of the PMA after intensive training in reference centres. The total of EPS was 1,805, and 75% of the patients were submitted to ablation therapy. 738 ICDs were implanted – 230 (34%) together with resynchronization systems. This means 67.4 ICDs per one million inhabitants, a number which is considered low according to European standards. 12 centres implanted more than 10 ICDs a year. Only five centres fulfil the criteria to be a training centre.