Focus on Portugal

ACVC National Representatives

National working group from the Portuguese Society of Cardiology

Dr. Sílvia Monteiro

ACVC Young National Representative

Dr. Sílvia Aguiar Rosa

Interview

What does it mean to be an ACVC National Representative (NR)?

During the last years, the awareness of the specificities of acute cardiovascular care in our country and in Europe has increased, leading to more dedicated and specialised care and units. It has been a privilege to grow as a physician following closely these advances.

Being involved in acute cardiovascular care and acting as ACVC National Representatives makes us more engaged in empowering fellows and consultants on the importance of a comprehensive and dedicated care to acute cardiovascular patients, the importance of keeping our knowledge updated in the field and developing the skills to adapt quickly and effectively to different situations, as the COVID-19 pandemic and its challenges. We take this role seriously, always trying to make the link between ACVC and our cardiology community by encouraging colleagues to submit their work to annual congresses and to take the ACVC certification exam, besides sharing the ACVC Clinical Decision-Making Toolkit for acute cardiac case management.

In summary, being ACVC National Representatives is to be in the field every day to deliver the best care to patients and to motivate colleages for this key area of cardiology.

Furthermore, it constitutes an opportunity to collaborate in national and international studies, surveys and other educational programmes in order to improve our knowledge and clinical practice.

What can ACVC bring to your national working group and vice-versa?

It is of the utmost importance to keep the connection and collaboration between the countries, in order to share knowledge, experience and expertise.

Each country should contribute to the surveys and the studies and provide the conditions to implement national and uniform strategies to improve the health of cardiovascular patients.

On the other hand, ACVC provides information and knowledge, by ACVC educational offer, ESC Clinical Practice Guidelines and position statements, allowing guidance for the complex management of patients in the setting of emergency and acute cardiovascular care units.

This symbiosis has the potential to improve and uniform strategies to further advance cardiovascular patients healthcare.

What does an ICCU look like in your country?

In our country, intensive acute cardiac care (ICCU) is an emerging subspecialty within cardiology that, like any subspecialty, requires training, formal assessment and continuing education in order to acquire specific skills.

However, compared to the current needs, there is a significant shortage of specialists with the combination of knowledge and competences required to work in the highly specialised ICCU environment.

Those working in the ICCU, particularly physicians and nurses, should have relevant experience in cardiac intensive care, preferably gained in internationally recognised reference centres and regularly updated by national or international certification processes, in order to ensure the quality of care provided.

In many of our hospitals this is not yet the reality, as ICCU teams are not as stable and certified as they should, but we are currently working on improving the situation.

Specialisation in intensive care in Portugal can currently be achieved by two pathways: a 60-month medical residency, or a fellowship in intensive medicine (the ‘classic’ pathway of a base specialty plus 27-38 months of intensive medicine).

Given these two possibilities, the question arises as to which is the better model for the subspecialty of cardiac intensive care: fellowship in general intensive care after completing a specialisation in cardiology, or the establishment of a subspecialty in cardiac intensive care based on the training model proposed by ACVC.

In our opinion, the latter option is the better one.

We are aware of the difficulties and challenges that this option presents, but we consider that such a course should be regarded as a priority for cardiology in our country.

Describe the most challenging situation in your country

In Portugal, ICCUs face several challenges: definition of organisational models for CICUs, including close collaboration between cardiology and intensive care medicine, establishment of national referral networks linking hospitals with units with different levels of specialisation, cooperation between centres, training and acquisition of competences.

At the same time, investment is needed in ICCUs and its staff in order to leverage the continuous and sustained development of other essential areas of cardiology (including electrophysiology and interventional cardiology), thus creating a quality-based future for ourselves and our patients.

What would you like to change or harmonise?

Taking into consideration that acute cardiovascular care includes pathologies with a broad spectrum of severity and prognosis, it is essential to define for each type of cardiovascular condition the level of care which should be provided in terms of team, available techniques and infrastructures, in order to improve the quality of care and the outcome, but also to allow efficient allocation of resources.

It is also very relevant for each department to reinforce this ​​cardiology core field, making sure guidelines are known and followed, teams are trained and procedures harmonised, ensuring excellence of care to all critical cardiovascular patients.

The time for change is now.