State of play of SHD in Spain – Interview with our experts Prof .Rodriguez-Roda Stuart and Prof. José Luis Zamorano-Gomez

  • As an introductory word, in recent months, the COVID-19 pandemic has highly impacted patients living with cardiovascular diseases (CVDs), including patients living with structural heart diseases (SHDs). What is the most important lesson learned from COVID-19 in the context of SHD?

Pr. Rodriguez-Roda-Stuart : the COVID 19 pandemic has had a significant impact on patients with cardiovascular disease, as it has placed the Spanish health system in a situation of serious overload. As a consequence, care for cardiovascular diseases has been affected, including SHD patients. Patients were also reluctant to go to hospitals during this period, leading to a 40% reduction in percutaneous coronary intervention for acute coronary syndromes and an 81% reduction in structural valve intervention[1],. Data from January to September 2020 showed a statistically significant global decrease of 13% in the number of cardiac surgeries compared to the same dates in 2019, with a 12% increase in waiting lists.

What have we learned? Whilst health systems are not and cannot be prepared for an exceptional situation like the pandemic in 2020, we still cannot delay attention to urgent diseases and excessively delay the detection and treatment of patients with SHD.

Pr. Zamorano Gomez: The main lesson is that we need certainly common actions. Only by acting together we can build stronger healthcare systems and responses, and also better better solve important problems.

  • Prevention through early detection are cornerstones in the treatment of cardiovascular diseases, such as structural heart disease. However, until now, most policy addressing cardiovascular health mostly focus on a healthy lifestyle (e.g. fast food abuse or lack of physical exercise). What should change to broaden the policy addressing non-preventable CVD such as SHD? What challenges do you find from a health care perspective to achieve these changes?

Pr. Rodriguez-Roda-Stuart : It is true that cardiovascular health is linked to a healthy lifestyle, but it is not sufficient when it comes to SHD. SHD do not only require a healthy lifestyle but also more awareness for the general population, the establishment of early detection programs as well as the improvement of patients access to care.

  • One of the main problems when treating structural heart disease is the lack of knowledge of the general population), as symptoms are usually taken as normal characteristics of old age. What could be improved to raise awareness on the importance of check-ups and the identification of symptoms? What specific role for national governments, for HCPs, and for the EU?

Pr. Rodriguez-Roda-Stuart : It is true that many of the symptoms are attributed to age and it is not easy for patients to distinguish them from SHD. This is why frequent visits to the outpatient clinic are essential to carry out regular check-ups aiming for early detection. But primary care has collapsed for 2 years. It is essential to provide outpatient clinics with the necessary means to recover their capacity to care for elderly people. At national level, the diffusion of programs on health could make the population more aware of the importance of medical check-ups. At a European level, investments should be made to provide national health systems with the necessary tools to improve primary care and detection methods.

Pr. Zamorano Gomez: We should work towards putting the patient central to all care. This is not only to be achieved through innovation, but there is a key role for patient-centered education and communication. Additionally, if we want to invest in health the best way to do it would be to investing in prevention. Prevention proves itself very efficient and should be put alongside treatment as a priority in SHD care.

  • Recently, you signed a joint letter together with several medical societies and patient organisations urging the Spanish Ministry of Health to foster European action on tackle structural heart disease. The Minister of Health responded and confirmed that the New Strategy on Cardiovascular Health Disease in Spain will address structural heart diseases, making Spain one of the first EU countries to include specific measures on SHD in their cardiovascular health plans. What can we expect from this new Spanish strategy? What can other EU countries learn from this?

Pr. Rodriguez-Roda-Stuart : The response from the Minister of Health has been positive to the letter that requested the Ministry to lead a joint action on SHD and cardiovascular health in the elderly, together with the European Commission. At the same time, SHD, despite being one of the leading causes of hospital death, is not the only health problem that has been uncovered by the pandemic. The priority of our health system is to provide the highest levels of health to the population, whilst remaining sustainable and economically viable. We hope that the new cardiovascular health strategy, which is currently in the process of being developed, will prioritise SHD, spur collaboration between authorities and healthcare professionals, and implement effective and efficient solutions for the population,.

Pr. Zamorano Gomez: It is good news that the Minister of Health expressed to seek for better health plans and an optimal Health system for the population. The Cardiovascular New Strategy has been long expected by patients and healthcare professionals, and this is a big step towards better prevention and quality of care for patients.

  • One of the issues you raised in the letter was the need for a stronger European cooperation through a Joint Action on SHD. The new 2022 EU4Health Work Programme for the first time introduces a Joint Action on CVD prevention, including innovative best practices on early detection. What should be the cornerstone of such a Joint Action?

Pr. Rodriguez-Roda-Stuart : As well specified in its objectives, the aim of this Joint Action is to “improve the understanding of, and the early detection of age-related structural heart diseases and therefore to reduce mortality and incidence”. If we get closer to this goal, we will be able to validate best practices to improve early detection of age-related heart diseases and thereby increase the capacity of national authorities to implement approaches to improve the early detection of structural heart diseases, and ultimately improve health outcomes for European citizens.

Pr. Zamorano Gomez: 3 fundamental pillars would need to focus on, cooperation, solidarity, science with patient-centricity at the very core.

  • To conclude, as a member of the EU SHD Coalition – what is your wish for 2022? What would you want the SHD Coalition to achieve by the end of the year?

Pr. Rodriguez-Roda-Stuart: I believe that European and national authorities are aware of the negative impact of structural heart disease on health, which is a giant step forward. Over the next few months, it is now necessary that they begin to materialize in guidelines for SHD and patient registries.

Pr. Zamorano Gomez: It could be great to work on a communication plan that involves patients who could share their point of view for a care when suffering from SHD.

[1] according to a study of participants in the heart attack code registry of the ACI-SEC5, prioritizing urgencies and emergencies