State-of-the-art cardiology in rural Portugal

Learn how a provincial hospital turned into one of Portugal's most renowned centers for heart disease. And why distance doesn’t matter.
Manuel Meyer
Published on February 25, 2022

The Hospital do Espírito Santo de Évora is not only improving healthcare in the Portuguese province of Alentejo, it is also becoming a leading hospital for cardiovascular interventions in Portugal. This attracts doctors and patients from all over the country to the remote southern region.

<p>Holm oaks and olive trees as far as the eye can see. Black bulls and sheep graze in the rolling hills that stretch to the horizon. In the center of the landscape rises Évora with its whitewashed houses, churches, and monasteries. The medieval town in the rural Alentejo province of southern Portugal has been a UNESCO World Heritage Site since 1986. It seems like time has stood still in Évora.</p>
The rural Alentejo province of southern Portugal.<br><br>
Filomena Mendes, PhD
Part of the provincial Hospital do Espírito Santo de Évora (HESE), a former monastery, even dates back to the 16th century. Ancient tiles adorn hallways and rooms to this day. Yet this is one of the most modern and innovative centers for interventional cardiology in the country. The milk glass door with the inscription CRIA is like a gateway to the future of medicine. The four letters stand for Centro de Responsabilidade Integrada Cérebro-Cardiovascular do Alentejo (Integrated Cardiovascular Center of Alentejo).
Hospital do Espírito Santo de Évora (HESE), Évora, Portugal.<br><br>
Hospital Espirito Santo
When planning the new cardiovascular center, HESE's board initial concern was to ensure equal access to quality care. While state clinics were constantly being modernized in metropolitan areas such as Lisbon or Porto, thereby improving medical care, little happened in the provinces for years. “Rural Alentejo has a very elderly population. Strokes and heart disease are the most common causes of death here. That is why they wanted to increase the capacity and be able to offer patients the same professional care as in other regions.&nbsp;<br><br>For the ambitious project, HESE's board succeeded in hiring the nationally renowned interventional cardiology specialist Professor Lino Patrício, MD, from the Lisbon University Hospital de Santa Marta. As chief physician, he took over the management of the new cardiology center. But something was still missing: a strong partner to provide the center with the latest technology and the best imaging quality. The cath lab needed to be optimized for surgeries to treat conditions such as coronary artery disease, heart valve defects, and cardiac arrhythmias.
<p>Professor Lino Patrício, MD, heads the cardiology center in Évora.</p>
Professor Lino Patricio
<p>The board of HESE and Patrício finally found the right partner in Siemens Healthineers. In 2018 they entered into a <a href="Value%20Partnership">Value Partnership</a> with the company for a period of eight years. But this long-term cooperation goes far beyond the simple provision of medical technology devices and imaging systems, explains Ivan França, CEO of Siemens Healthineers Portugal: “We maintain the devices, update them with the latest software, and train employees in the use of the systems. In addition, we help to optimize clinical operations and make them more efficient through spatial planning and by standardizing and digitalizing work processes.”<br><br>Siemens Healthineers is also supporting research activities and collaboration between the cardiovascular innovation center and the University of Évora to train future specialists, a collaboration which did not exist to this extent before. It is not only the patients who benefit from this: Hospital board also hopes to attract young talents to HESE through the advanced training and research projects.<br></p>
Value Partnerships are enduring, performance-oriented relationships. An innovative business models helps to increase enterprise-wide value in order to meet immediate and future goals.
A multidisciplinary team with an optimized workflow can best address patient needs.<br><br>
Trained employees
<p>The Value Partnership also includes an efficient financial model that made it possible to set up and equip a second cath lab. The cardiovascular department of HESE now has totally new treatment options, twice the capacity, and an extended service portfolio at its disposal.&nbsp;<br><br><br><b>Value Partnerships encompass individually tailored services. In Évora, for example, the workflow has been optimized to improve the patient experience.</b><br></p>
Patients from Alentejo no longer need to be referred to Lisbon, 150 kilometers away, for angiographies or catheter-based implantations. “Now we can not only perform a larger number of interventional cardiological examinations and procedures, but also complex coronary and vascular angiographies,” explains Patrício. In Évora, they can now also insert stents in coronary heart disease patients and replace aortic valves.</p><p>Research, training, and the latest innovation technologies – these were all important factors for Patrício in realizing his vision of the future of cardiovascular interventions in Évora. In modern interventional cardiology, in particular, there are areas of overlap in which specialists from different departments can work together and learn from one another, says Patrício. “So as well as using the latest technology, we also take an innovative approach to our work – one that’s unique in Portugal. In our center, physicians from various fields, such as cardiology, vascular surgery, and neuroradiology form a multidisciplinary team.”

Professor Patricio Lino

<p>His goal was to soon have teams from different disciplines working together on specific cases. These synergies allow them to develop completely new treatment and surgical methods. Patrício admits that this multidisciplinary work is a challenge for everyone but says it has great appeal too. He has already managed to attract renowned medical specialists to Évora – mainly from Lisbon – who wanted to take part in the “pioneering project.” Thanks to this combination of innovative technologies and eminent specialists, the collaboration with Siemens Healthineers is helping HESE to establish itself as a leading hospital for cardiovascular treatment in Portugal.<br><br>Upon entering into the partnership with Siemens Healthineers, Prof. Patrício stressed the need to develop a telemedical care. Remote monitoring allows hospital staff to care for patients in their homes before and after an intervention. For instance, Francisco Antonio Rosa from Lisbon was eager to be treated at HESE. He suffered from a heart valve defect, and in Évora he had a new aortic heart valve implanted through <a href="transcatheter%20aortic%20valve%20implantation%20(TAVI)">transcatheter aortic valve implantation (TAVI)</a>. In addition, the waiting lists for surgery were much shorter here than in urban centers such as Lisbon or Porto. The 84-year-old Portuguese says that the distance to Évora was not an issue.</p><p><br></p>
A biological prosthetic heart valve is implanted through a small access by catheter.
Francisco’s wife assists him with the daily routine checks.<br><br>
Francicsco´s wife help him with daily routine checks
<p>Every day for many weeks, Rosa used the devices he had been loaned to record his weight, blood pressure, blood SpO2 levels, and heart rate. He then sent the data using a smartphone app to HESE, where three clinical staff members are assigned exclusively to evaluating patients’ vital signs using the telehealth software.<br><a href="Remote%20monitoring" target="_blank"></a><br><a href="Remote%20monitoring" target="_blank"></a><a href="Remote%20monitoring" target="_blank">Remote monitoring</a> of patients in their homes has significantly improved the quality of medical care, especially in a sparsely populated region like the Alentejo, explains Sandra Nunes, radiology technician and responsible for data analysis. Alentejo occupies a third of the area of Portugal, but just 700,000 people live here – 22 people per square kilometer. Many older heart patients are not mobile. “But we are in constant contact with them via the exchange of data and we call them as soon as we notice changes in the parameters,” says Nunes.</p>
Telehealth empowers physicians and patients to interact virtually with each other anytime and anywhere just in minutes.
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The healthcare technicians check the vital data transmitted by remote care control.<br><br><br>
healthcare technicians checking vital data
Remote monitoring has made contact more personal and direct, which gives older patients in particular more confidence and security, explains senior nurse Marisa Serrano. “We also get to know the patients much better thanks to the thorough pre-operative check-up, which makes the admission and surgical preparation much quicker and more efficient.” Working in the new, multidisciplinary cardiovascular center is very demanding and requires a lot of team spirit, but it also makes the job much more exciting, varied, and interesting than before, says Serrano. “And we are constantly learning and developing professionally,” she adds. At nursing conferences, nurses from other parts of Portugal are increasingly asking her about how Évora has become a leading hospital for cardiovascular interventions. “That makes me proud, of course,” says Serrano.
Francisco received his procedure earlier than scheduled after his vital data got worse.<br><br>
Francisco receiving his procedure
The future of cardiovascular intervention has only just begun, believes Patrício. The Hospital do Espírito Santo de Évora will move into a brand-new building at the end of 2023. “In addition to two cath labs, we also want to set up a hybrid room for surgical and interventional procedures,” he says. Siemens Healthineers will actively support the relocation of all devices to the new building and ensure they are operational. Patrício can hardly wait for the day when patients are being treated in the ultramodern hospital, and the workplace becomes even more attractive for the new team.

By Manuel Meyer

Manuel Meyer reports from Spain and Portugal for Ärzte Zeitung (a German newspaper for physicians and other medical professionals) and other media outlets. He is based in Madrid.