What does Cardiology at Ramón y Cajal Hospital mean? It means commitment
Cardiologists, nurses, and assistants are committed to patients, to the whole cardiac team, to the hospital, and finally, to individual responsibility to reduce the burden of cardiovascular disease. Patients represent our point of starting and ending. Cardiology at Ramón y Cajal is driven by the need to help, to solve patients’ problems, and to take care of their health efficiently and effectively. Patients’ preferences and expectations are in parallel to the received medical care. Patients’ satisfaction is a priority for the team because it impacts on patient’s compliance and continuity of care, resulting in better health outcomes.
Ramón y Cajal University Hospital is a tertiary referral centre with >900 beds and part of Madrid's Public Institute of Health. It is the reference hospital for a population of more than half a million people. The hospital was inaugurated in 1977 and was named in honour of the Spanish physician and researcher Santiago Ramón y Cajal, Nobel Laureate for Medicine in 1906. Since its inauguration, the hospital is supported by a Research Department, the Ramón y Cajal Health Research Institute (IRYCIS) that increases the significance of biomedical research, both nationally and internationally.
Cardiology at Ramón y Cajal consists of a team of 38 cardiologists, 15 fellows, 64 nurses, and 7 assistants, who work together with the enormous responsibility of caring for cardiology patients and the constant spirit of improvement. Patients’ care at Ramón y Cajal is based on three fundamental pillars: (i) the quality of their care by specialized health professionals, (ii) excellence in cardiovascular research, and (iii) the vocation to teach those around them and their own vocation of continuous learning.
First, excellence in clinical care is our main responsibility. More than 50 000 outpatients were evaluated by Cardiology in 2019 and 2400 were admitted to the hospital. Most patients are managed horizontally based on their specific process by defined multidisciplinary teams such as Heart Valve Team, Coronary syndrome, Heart failure, or familial cardiomyopathy team. This model seeks a much more personal and close care for the patients that results in better healthcare data with a significant reduction in mortality rates and shorter hospital stay. An example is the decrease in mortality in STEMI patients in 2019 (up to 1.9%), and a length stay in hospital of <2 days in a third of them. More than 1500 patients followed a cardiac rehabilitation program, improving the efficacy and adherence of secondary prevention strategies.
Cardiovascular Imaging is a Central Hospital Service in which clinical care is combined with the development of cutting-edge technology. In 2019, this unit performed >18 000 echocardiograms with ∼40% performed from Services outside of Cardiology. The equipment is the Research Center of Hitachi (Vector Flow Technology), Toshiba (Hybrid TAC Eco3D), and Philips (Heart Model, True Vue, Navigator) and it is common to see engineers working in collaboration with the equipment.
Interventional cardiology from the perspective of arrhythmias and hemodynamics is continuing evolving. Ramón y Cajal is the national leader in the number of ablations (>600 ablations per year), has different research navigators, and develops cutting-edge technology. In Hemodynamics, Ramón y Cajal installed the first hybrid room in Europe allowing the integration of other imaging modalities (ultrasound, intravascular ultrasound, optical coherence tomography, CT, etc.). We are in the national leading group in structural intervention (213 procedures in 2019) and EP ablations (>500) and we are pioneers of many interventions. We have been the first site in Spain and one of the first in Europe to start implanting devices for percutaneous tricuspid regurgitation.
Cardiology at Ramón y Cajal Hospital is a service with a research vocation. Nationally, we are one of the few services with a basic Cardiovascular Research Unit that helps us in the development of translational research from the laboratory to the bedside. Patents and in vitro and in vivo animal models represent a clear advance for our early phase research studies. They are particularly applied to identify potential therapeutic candidates and to investigate the effect of structural therapeutic procedures.
Recently, we have developed a cross line of research on tricuspid valve disease.
This common project links all the resources of the service (human and technological resources) to a common purpose in which the pathology is investigated from different points of view.
The service works hard and together to attract competitive projects (17 active national and international projects in 2019), to participate in European registries (17 in 2019) and clinical trials (23) and to share their results with the entire scientific society (78 articles published in indexed journals in 2019).
Although clinical attendance is the cornerstone of the Service, our third pillar is education. Self-demanding fellows constantly surround the unit; they encourage us to be betters doctors every day, to appreciate the enormous effort required to be a doctor and stimulate excellence. We appreciate their permanent effort and ability to improve; we owe them our commitment and dedication.
Cardiology at Ramón y Cajal has been rapidly and creatively re-organized since the beginning of the COVID-19 pandemic. This pandemic disrupted routine patient care. In the first months, patients’ fear of COVID-19 infection caused delays in seeking help for the symptoms of myocardial infarction, decompensating heart failure or other serious medical problems. We are aware that patients died at home and others presented to hospital late, after irreversible damage had occurred. Modern cardiology has the responsibility to face this situation, developing innovative ways of delivering healthcare. Cardiology at Ramón y Cajal is now offered remotely through teleconsultations. This approach has been especially useful in the follow-up of patients for the assessment of stability of symptoms, heart rate and rhythm, blood pressure, and weight. In addition, cardiac test results can be explained to patients and the organization of periodic reviews can also be planned without unnecessary visits to the hospital. Home telemonitoring has been promoted for our patients, looking for their self-help, with faster access and better continuity of care.
General practitioners (GPs) who have the first contact with the patient have a direct and daily communication with Cardiology via electronics. This fast communication channel results in a more efficient way to treat patients, solving practical GP doubts, e.g. on patients’ treatments, prioritizing more urgent patients and referring patients to their specialty cardiac units (valve clinic, heart failure, cardiomyopathies, among others).
Lastly, multidisciplinary team meetings are essential for good patient care and are highly recommended by the European Society of Cardiology. Heart Team evaluations for coronary revascularization, valvular pathologies, and endocarditis are routinely performed at Ramón y Cajal. Because they could potentially increase the risk corona virus spreading between healthcare professionals at the current time, video conferencing has been established as a routine and secure form of communication between the teams with great acceptance and success among health professionals.
To conclude, we believe that the integration of all members of a team is the key to lead Cardiology at Ramón y Cajal to excellence in healthcare, teaching, and research.
Conflict of interest: none declared.
