Today, September 29th, World Heart Day, Sant Pau celebrates it from the perspective of a hospital that has witnessed the development of Cardiology. It was the first center in the country to successfully perform a heart transplant in 1984 and the first to establish a specialized research institute specifically focused on the research and treatment of cardiovascular diseases. Currently, it continues to be an advanced reference in Cardiology research, with ongoing development of new therapeutic procedures, advancements in basic Cardiology knowledge, and care for cardiac patients. It pioneers programs aimed at improving the cardiovascular health of its users, such as the SCA (post-acute coronary syndrome prevention and education program) launched this year, which monitors around 300 patients annually.
The SCA program is an outpatient initiative for early monitoring of all patients admitted to Sant Pau Hospital with an acute myocardial infarction. It involves very close and early monitoring to control all risk factors for individuals admitted with a heart attack, such as hypertension, cholesterol levels, smoking, obesity, diabetes, stress, and more.
“The SCA program started with the collaboration of Nursing and Cardiology staff, back in February. We train between 5 and 10 patients from the hospital’s reference area who have been admitted due to a myocardial infarction on a weekly basis,” explains Dr. Miquel Gual, coordinator of the SCA program and associate of the Cardiology Service at Sant Pau. “At present, the program accommodates all these debut patients, meaning those who have had a first myocardial infarction, and therefore, we work with the goal of acting quickly. As the program grows, other groups with ischemic heart disease, angina, or other types of myocardial infarction will be included,” Dr. Gual specifies.
The program addresses a need arising from the improvement of treatment techniques or revascularization of myocardial infarctions. This advancement results in increasingly shorter hospital stays for this condition. Patients enter the hospital with a very severe condition, but the majority of these patients recover satisfactorily, leading to shorter hospitalizations. Consequently, patient awareness of the disease is low.
“In addition to this, while they are hospitalized, the time available for training, education, and initiating prevention measures to prevent the recurrence of ischemic diseases is also very limited. Consequently, it is necessary to restructure the post-hospitalization phase, organize, gather, and follow up on all patients with infarctions, and maintain an educational program to develop cardiovascular lifestyle habits,” states the program coordinator, who estimates that they will annually follow up with between 250 and 300 patients.
One of the key aspects of this initiative is ensuring continuous care, meaning the educational program, with a significant role played by specialized Nursing staff in cardiovascular care. “The program is finite, lasting six months; patients enter, but they also have to leave. A key factor that we believe is very important is to establish this continuous care, with a continuous flow of patients. Once the initial hospital phase is completed, we get in touch with each responsible person at each primary care center in the Sant Pau reference area, thus maintaining the flow of patients and facilitating direct and continuous communication between hospital professionals and primary care professionals,” Dr. Gual adds.
The age profile of patients admitted with myocardial infarctions ranges from around 50 to 70 years, as there is currently a selection of patients with the onset of cardiac diseases, meaning those who have experienced a first episode. The majority of the population is relatively young, regardless of gender. “This means that there is still a percentage of patients who are actively employed, and thanks to this early and comprehensive treatment monitoring, they can, among other things, return to their work activity earlier than usual,” concludes Dr. Miquel Gual.
Cardiology is one of the five strategic areas of the Sant Pau Hospital Research Institute – IIB Sant Pau and serves as a clear example of translational medicine, aiming to find answers to unmet needs directly emerging from the patient’s bedside “through research that encompasses preclinical genetic studies in cellular models to the most advanced clinical research. This is crucial for translating research results into therapeutic solutions for patients,” says Dr. José Guerra, from the Arrhythmia Unit of the Cardiology Service at Sant Pau.
With this goal in mind, they also promote knowledge transfer by fostering the creation of spin-off companies. “In this regard, a few years ago, we began investigations to discover new therapeutic targets that could address the remaining needs in the clinical field. One example is the research on cardioprotection we have been conducting in recent years, which has resulted in the creation of a company with several investors,” explains Prof. Lina Badimon, director of the Area of Cardiovascular Disease Research and the Molecular Pathology and Therapeutics Research Group of Atherothrombotic and Ischemic Diseases at IIB Sant Pau. “This is an example of how we want to provide solutions to patients through research.”
Specifically, this spin-off company is working on the development of an intravenous statin that will be useful for patients who require high doses of this medication, which is currently administered orally, which is not always sufficient “for patients undergoing transplantation, undergoing oncological treatments, or undergoing surgery.”
This year, IIB Sant Pau has launched a cross-cutting research program in Women’s Health and Gender to promote a gender perspective in all its areas and research groups. Created within the framework of the Responsible Research and Innovation (RRI) Plan, the program is an example of joint work between IIB Sant Pau and Sant Pau Hospital and is currently implementing actions to promote the incorporation of a gender perspective into research content and to encourage specific gender research to address existing knowledge gaps, by providing the necessary means and resources to facilitate it.
It should be noted that, in fact, Sant Pau Hospital was one of the first Catalan centers to create the Health and Gender Commission, which impacts healthcare, research, and teaching.
In Cardiology, there are increasing projects that incorporate the gender perspective from their initial planning. There is also growing evidence of significant differences in the evolution and clinical manifestations of various cardiovascular disorders and the impact that these variables can have on prevention and treatment. Several examples exist in this regard. The group led by Prof. Badimon is developing a personalized medicine project in a national cohort with a genetic diagnosis of familial hypercholesterolemia, where gender specificity is a goal to identify and determine the importance of new molecular biomarkers. Another notable initiative is the RETROVE program, which seeks mathematical algorithms to define individual risk of venous thrombosis, as well as a study analyzing the use of beta-blockers in patients with atrial fibrillation based on gender.
In the field of cardiovascular health, Dr. Elisa Llurba, in collaboration with researchers from the Perinatal and Women’s Medicine Research Group, the Biochemistry Research Group, and the Cardiovascular Diseases Group, is leading three studies funded by the Carlos III Health Institute on the impact of different reproductive processes on cardiovascular health at three key stages: before pregnancy in women undergoing assisted reproduction, during pregnancy, and 3-6 years after childbirth. The objective is to study how placental-origin diseases can impact maternal and neonatal cardiovascular health.
