Cardiology

About the Observatory

The Cardiology team aims to offer comprehensive and excellent cardiology care to people living in the area of ​​influence of the Moisès Broggi University Hospital Complex (Sant Joan Despí Hospital and Hospital General de l'Hospitalet).

It does so with the will to be a modern and entrepreneurial service, able to offer quality specialized cardiology assistance, based on a territorial, open and dynamic organizational model, centered on the patient and accessible to the population, in coordination with others health services of the same hospital and other levels of care in the territory such as primary care and the Bellvitge University Hospital, which is its third-level reference center. Likewise, it wants to integrate the care activity with undergraduate and postgraduate teaching and with clinical-epidemiological research in cardiovascular matters.

The progressive aging of the population, the increase in risk factors and chronic diseases, as well as the fact that in recent years the prognosis of myocardial infarction has improved significantly due to the best treatment administered in the acute phase, has made manifest the need to attend to a growing population of patients with chronic cardiovascular diseases. In order to successfully address this challenge, we have opted for the integrated care of Cardiology in primary care, which means a change of organizational model on a territorial basis, centered on the patient, which facilitates coordination between the levels of care and which allows the health professionals to work as a team and share responsibility in addressing the population with cardiovascular diseases. In this way, the patient can be cared for in the best healthcare environment and by the most suitable professional based on their needs. Another fundamental aspect to face this challenge with guarantees is to manage to involve the population and patients so that they actively participate in the management of risk factors and the self-management and care of their pathology, as well as in making decisions about their illness . For this reason, every year we organize Heart Week throughout the territory, together with the health professionals of the primary care teams and the technicians of the town halls. The Cardiology Service has SEC-Primary accreditation from the Spanish Society of Cardiology.

The Cardiology Service, which serves the reference population from the age of 15, has been organized into different specific teams to offer assistance at the Hospital de Sant Joan Despí and the Hospital General de l'Hospitalet in the areas of hospitalization, emergencies, surgical care and ambulatory care. In this way, there is a team for the hospitalization floor - Emergency - Intensive Care Unit; the cardiac imaging team and cardiology testing room; the Rapid Diagnosis Unit team; the cardiac stimulation team and finally the Multidisciplinary Heart Failure Unit team, which has received accreditation from the Spanish Society of Cardiology as a Community Heart Failure Unit. The service is also characterized by initiating and participating in multidisciplinary care projects, such as the Heart Failure Unit, the Vascular Risk Unit, the Cardiac Rehabilitation Unit, the Cardio-Oncology Unit, as well as the Integrated Cardiology-Care Unit itself Primary

The service has a close and fluid relationship with the Bellvitge University Hospital, which is its tertiary reference centre. At the Hospital de Sant Joan Despí, fortnightly Heart Team sessions are held, where clinical cases of patients are discussed and arrhythmologists, cardiac surgeons and hemodynamicists participate.

  • Update date: 01.01.2024

Head of Service

Members

In this section appear the professionals of the Integral Health Consortium who have authorized the display of their personal data.

  • Update date: 01.01.2024

Units and benefits

Hospitalization

Conventional inpatient cardiology clinical assistance is located in unit 2 of the Hospital de Sant Joan Despí Moisès Broggi. A medical team of four specialists works there with residents from other specialties, in addition to the nursing team and assistants. The annual volume of admissions is about 1.700, mainly for myocardial infarction, angina, heart failure and heart rhythm disorders. Likewise, around 1.650 interconsultations are carried out annually for patients with cardiac pathologies who are admitted to the center in charge of other medical and surgical services.

Emergencies

There is a cardiologist in the emergency department of the Hospital de Sant Joan Despí Moisès Broggi every working day from 8am to 18pm, as well as on Saturday mornings from 30am to 8pm. At Hospital General de l'Hospitalet, from Monday to Friday there is a consultant cardiologist who can attend to patients in the emergency department. Since November 15, there is a 2020-hour cardiology on-call during weekends and public holidays throughout the year.

Surgical care

The Cardiology Service is in charge of implanting more than 250 devices a year (DDD, VDD and VVI pacemakers, subcutaneous Holter ECG), around 30% in the ambulatory major surgery regime.

Outpatient care

Rapid Diagnostic Unit (UDR). The Hospital de Sant Joan Despí Moisès Broggi and the Hospital General de l'Hospitalet have a high-resolution cardiac pathology consultation, which allows echocardiograms to be performed in the same office and cardiological tests on the same day (exercise test, Holter ECG). All the first visits referred to Cardiology in hospitals are made in the UDR. Around 2.450 visits are carried out annually (first and subsequent visits).

Cardio-oncology Unit. Since 2015, the Hospital de Sant Joan Despí Moisès Broggi has had a multidisciplinary unit made up of oncologists and cardiologists that allows, jointly, to carry out a comprehensive approach to cancer patients. In this way, an initial cardiological assessment can be made and the type of chemotherapy treatment most suitable for the patient can be decided. It also allows action against possible adverse cardiac effects during rounds of chemotherapy (such as heart failure) and facilitates long-term monitoring of possible cardiac toxicity of chemotherapeutic agents. More than 150 oncological patients are assessed and 300 oncological echocardiograms are carried out each year.

Cardiology external consultations at the Hospital de Sant Joan Despí Moisès Broggi. There are 3 consultations per week to attend, on an outpatient basis, complex patients who have just been discharged from the cardiology unit.

Multidisciplinary Vascular Risk Area. The Cardiology Service participates in a specific consultation for arterial hypertension and cardiovascular disease.

Pacemaker consultation. Face-to-face control visits and through remote monitoring of patients wearing devices (pacemakers, subcutaneous Holter ECG). The type of stimulation is optimized and the status of the generator is checked. Around 1.550 visits are made annually.

Specific consultation of the Heart Failure Unit (UIC)-Cardiomyopathies. In the external consultations of the Sant Joan Despí Moisès Broggi Hospital, patients with severe heart failure or cardiomyopathies who require attention by a cardiologist expert in this pathology are monitored. There are around 300 visits a year.

Integrated Cardiology Care-Primary Care. The Cardiology Service has proposed a new organizational model based on integrated cardiology care in primary care centers in the reference territory of Sant Joan Despí Moisès Broggi Hospital. The aim is to offer an improvement in the quality of care for patients with heart disease. A referring cardiologist was assigned to each of the 19 primary care centers in the territory and since 2014 a cardiologist has been traveling weekly to their primary care center to carry out face-to-face visits, virtual visits and case consultations clinics or continuing education. Around 11.300 face-to-face visits are carried out (3.300 first visits and 8.000 subsequent visits). The Cardiology Service has SEC-Primary accreditation from the Spanish Society of Cardiology. From 2021, 40% of subsequent visits will be online.

Week of the Heart Since 2014, coinciding with World Heart Day (September 29), the service organizes Heart Week throughout the territory of influence of the Hospital de Sant Joan Despí Moisès Broggi and the General Hospital of l'Hospitalet It proposes different health promotion activities distributed among the 19 primary care centers and hospitals. Activities aimed at the community are carried out to promote heart-healthy lifestyle habits such as the Mediterranean diet (talks, practical workshops, healthy snack, children's drawing competition) and to promote the practice of regular physical exercise (popular walking, Nordic walking, cycling popular) and there are also informative talks on prevalent heart diseases (calculation of vascular age, "Take your pulse" campaign, sex after a heart attack, Cardioshow, etc.). These activities are organized jointly by the professionals of the primary care teams, the cardiologists and nurses of the hospitals, and the people in charge of sport and health from the different local councils. During 2018, more than 115 activities took place in which more than 1.900 people participated.

Cardiac Rehabilitation Unit. In 2016, the Cardiac Rehabilitation program began at Hospital General de l'Hospitalet, in groups of 8 people who follow the program for 6 weeks. It is a multidisciplinary program in which a nurse, a dietitian, a psychologist, a physiotherapist, a rehabilitation doctor and a cardiologist participate. About 100 patients a year benefit from it.

Cardiac Imaging Unit.

  • At the Hospital de Sant Joan Despí Moisès Broggi and the Hospital General de l'Hospitalet
    • Transthoracic echocardiogram. Around 9.300 echocardiograms are performed per year (including those in the Rapid Diagnostic Unit)
    • Echocardioscopy. Portable ultrasound to be done at the head of the patient's bed, especially in the emergency department, the hospitalization floor and the day hospital.
  • At the Sant Joan Despí Moisès Broggi Hospital:
    • Transesophageal echocardiogram: 220 cases per year
    • Pharmacological stress echocardiogram with dobutamine or dipyridamole: 200 cases a year
    • Echocardiogram with contrast: 250 cases a year
    • CardioRMN: 350 scans per year, functional, flow study, myocardial viability and myocardial perfusion study with adenosine
    • Cardiac TAC: 225 studies per year of non-invasive coronary angiography

Cardiac test cabinet.

    •  At the Hospital de Sant Joan Despí Moisès Broggi and the Hospital General de l'Hospitalet:
      • Stress tests: around 1.300 ergometry tests per year (including those of the Rapid Diagnostic Unit)
      • Holter ECG: about 3.000 24-hour electrocardiographic monitoring
    • At the Sant Joan Despí Moisès Broggi Hospital:
      • Ambulatory blood pressure monitoring (ABPM): 24-hour blood pressure monitoring in 324 patients/year
      • Tilt Test: around 65 tilt tests per year for syncope study
      • Long-term electrocardiographic monitoring (30 days): every year 50 30-day monitorings with smart shirts that detect arrhythmias and heart blocks
      • 6-minute test: every year around 400 6-minute walking tests to assess the functional capacity of patients with heart disease
      • Electrical cardioversions: around 190 electrical cardioversions per year, together with the center's Anesthesia Service.

day hospital Heart Failure Unit. It is located at the Hospital de Sant Joan Despí Moisès Broggi and the Hospital General de l'Hospitalet. It is a multidisciplinary unit recognized and accredited as a Community Heart Failure Unit by the Spanish Society of Cardiology. Annually there are about 1.800 medical visits, 1.000 nursing visits and 950 intravenous treatments (iron therapy, diuretic treatment, infusion of Levosimendan or Dobutamine).

Services that are referred to other centers
  • Nuclear medicine. Each year around 700 Spect (single photon emission computed tomography) of myocardial perfusion are referred to CETIR.
  • hemodynamics About 650 coronary angiograms, 270 percutaneous coronary interventions, 30 AMI codes and 6 percutaneous aortic valve implantations are referred to the Bellvitge University Hospital.
  • Cardiac surgery. About 120 patients are referred to the Bellvitge University Hospital for cardiac surgery (coronary revascularization, valve replacement or repair).
  • Electrophysiological studies and ablations. Around 50 electrophysiological studies and ablations are performed at the Bellvitge University Hospital, and around 30 devices are implanted, such as implantable automatic defibrillators and Cardiac Resynchronization Therapy.
Participation in Commissions
  • Mortality Commission
  • Pharmacy Commission
  • Clinical Practice Improvement Commission
  • Committee on Vascular Risk Area Treatments
  • Update date: 01.01.2024

  • What is angina pectoris? And an acute myocardial infarction? Why do they occur?

    Angina is chest pain that occurs when not enough blood reaches the heart, a situation known as myocardial ischemia (lack of blood to the heart muscle).
    If this myocardial ischemia lasts a long time, myocardial necrosis (death of some heart cells) can occur and this phenomenon is known as acute myocardial infarction.
    The most common cause of angina pectoris and heart attacks is arteriosclerosis, which is the disease that affects the walls of the coronary arteries causing fatty plaques to be deposited inside the walls of the vessel and partially obstruct them or total blood circulation inside. These fat plaques are produced by an excess of cholesterol. The so-called coronary risk factors are diseases that favor arteriosclerosis. The most important are hypercholesterolemia (having high cholesterol), diabetes, high blood pressure and smoking. Arteriosclerosis can also affect other arteries in the body, such as those in the brain (and cause a stroke) or those in the legs.

  • Acute myocardial infarction (AMI)

    AMI occurs due to the occlusion of a coronary artery, which causes a deficit in the supply of part of the heart and is one of the leading causes of mortality worldwide. The treatment that has been shown to be most effective for AMI is to unblock the coronary arteries with the implantation of intravascular devices that keep the arteries open. This system is known as primary angioplasty and the devices are called stents.

  • Heart failure (HF)

    HF is a pathological situation that appears when the heart is unable, for some reason, to expel the blood that reaches it in each cardiac cycle to the extent that it should. In other words, the heart has difficulty in doing its job: providing blood to all the organs and parts of the body in sufficient quantity for them to function correctly. As a result, people with HF feel weak, tired, or have trouble breathing. Daily activities, such as walking, climbing stairs, carrying groceries, etc., can be difficult to do. HF usually appears in the course of various heart diseases. Sant Joan Despí Moisès Broggi Hospital has a specific multidisciplinary unit that was created in 2010 in response to the high rate of people affected by HF and the difficulty it entails for many patients living with and treating it appropriately.

  • What is atrial fibrillation?

    Atrial fibrillation is the most common cardiac arrhythmia. It is characterized by the fact that, instead of a single electrical wave for each beat, the electrical activity of the atrium becomes disorganized and chaotic, generating multiple waves at the same time. In order to understand this, you need to imagine that you throw a stone on the surface of a pond. If only a stone is thrown there, a circular wave is generated, which expands over the surface; on the contrary, if many stones are thrown at it at the same time, multiple waves are generated, which collide with each other; this is what happens with electrical activation in atrial fibrillation. As a result, the atria lose their ability to contract uniformly and, in addition, the activation waves reach the ventricles irregularly. The contraction of the ventricles thus becomes irregular and can be noticed with a pulse that becomes irregular (non-rhythmic): it can be fast – in most cases –, slow or stay within the normal limit. It is also possible to notice that the pulse beats are different from each other, because the heart is expelling different amounts of blood with each beat. With appropriate treatment and monitoring, the prognosis of afibrillation is good and complications are rare. The main complication that can occur in atrial fibrillation stems from the accumulation of blood in the atria due to the lack of contraction. This reservoir favors the formation of clots that, occasionally, can leave the heart, follow the blood circulation and obstruct some of the body's arteries. As a result, part of the body would stop receiving blood and lose its function. This process is called an embolism, and although it can be serious when it happens anywhere in the body, it is especially serious when it happens in the brain.

  • Update date: 01.01.2024

In the period 2020-2022, members of the Cardiology Service have published 47 articles in scientific journals, presented 42 posters or oral communications at conferences, 40 presentations or panel discussions at conferences and participated as authors of 2 documents of scientific societies. Likewise, during this period, some members of the team play an active role in national scientific societies and collaborate with the Department of Health.

 

The Cardiology Service participates in international multicenter studies:

  • Principal researcher in the Commander study (Román Freixa): code RIVAROXHFA3001 Multicenter, randomized, double-blind, event-based study comparing the efficacy and safety of oral Rivaroxaban with placebo in reducing the risk of death, myocardial infarction, or stroke in patients with chronic heart failure and significant coronary artery disease after a hospitalization for exacerbation of heart failure.
  • Principal researcher in the Declare TIMI 58 study (Román Freixa): code D1693C00001. Multicenter, randomized, double-blind, placebo-controlled trial to evaluate the effect of dapagliflozin 10 mg once a day on the incidence of cardiovascular death, myocardial infarction or ischemic stroke in patients with type 2 diabetes.
  • Principal investigator in the GLORIA-AF registration program (Román Freixa): Global registry program for long-term oral antithrombotic treatment in patients with atrial fibrillation.
  • Principal investigator in the PARADIGM study (Román Freixa): code CLCZ696B2314 Multicenter, randomized, double-blind, parallel-group, controlled study with active treatment to evaluate the efficacy and safety of LCZ696 compared with enalapril on morbidity and mortality in patients with chronic heart failure and reduced ejection fraction.
  • Principal investigator in the PARAGON study (Román Freixa): code CLCZ696D2301 Multicenter, randomized, double-blind, parallel-group study of active control, to evaluate the efficacy and safety of LCZ696 compared to valsartan, on morbidity and mortality in patients with heart failure (Class II-IV NYHA).
  • Principal researcher in the SULTAN studio (Román Freixa): Prospective observational study for the evaluation of anticoagulation control with vitamin K antagonists in patients with non-valvular atrial fibrillation attended in cardiology clinics.
  • Coordinator of Catalonia and principal researcher in the EMIR study. (Roman Freixa): Observational study to identify risk factors associated with major cardiovascular events in patients with non-valvular atrial fibrillation treated with a direct oral anticoagulant (Rivaroxaban).
  • Principal researcher in the ETNA – AF study. (Roman Freixa): Observational study of patients with non-valvular atrial fibrillation treated with a direct oral anticoagulant (Edoxaban).
  • Principal researcher in the FARAONIC study (Román Freixa): Risk factors associated with the progression of heart failure (HF) in patients with atrial fibrillation treated with a direct oral anticoagulant (Rivaroxaban).
  • Update date: 01.01.2024

The Cardiology Service carries out the following teaching activities:

Undergraduate Education Training sessions are held and practices are coordinated for UB 4th year Medicine students in the Cardiology Service.

Postgraduate training. Training sessions are held and rotation is coordinated by the Cardiology Service of Internal Medicine Residents (MIR) in Family and Community Medicine, Internal Medicine, Geriatrics and Anesthesia.

Continuing Education

The Cardiology Service of the Hospital de Sant Joan Despí Moisès Broggi and the Hospital General de l'Hospitalet carry out weekly and fortnightly continuing education sessions according to the following scheme:

  • Weekly bibliographic session. Tuesday from 8 to 9 am.
  • Biweekly clinical case session. First and third Thursday of the month from 8 to 9 am.
  • Fortnightly Heart Team session. Second and fourth Thursday of the month from 8 to 9 am. A cardiac surgeon and a haemodynamist from the Bellvitge University Hospital are participating and tax cases 'percutaneous interventionism or cardiac surgery' are being discussed.
  • Joint session of the Arrhythmias Unit. monthly A cardiologist specializing in arrhythmias from the Bellvitge University Hospital is participating.
  • Cardiology Service indicators session. quarterly

Likewise, the service organizes continuing education courses accredited by the Catalan Council for Continuing Education of Health Professions and has the recognition of the Catalan Society of Cardiology. They are aimed at family doctors, doctors in the emergency department and medical staff in other specialties. The main objective is to improve skills, update knowledge of cardiology and stimulate the leadership of family doctors in the management of chronic cardiology diseases that are common in the territory, as well as the basic examinations that are required for a correct assessment of the patient

  • Course of chronic cardiological diseases. yearly
  • Heart failure practical course. From primary care to palliative care. biannual
  • Electrocardiography practical course. biannual
  • Update date: 01.01.2024