At the University Hospital Centre Zagreb cardiology already began to stand out as a subspecialization when the Internal Medicine Clinic was opened, and the Institute for Cardiovascular Diseases itself was founded in 1974 and headed by Academician Vladimir Goldner. Forty-four years later, after many successes and the foundation of the first Laboratory for Heart Catheterization in Croatia, the institute became a referral center for heart failure and transplantation cardiology headed by Academician Davor Miličić. The Clinic for Cardiovascular Diseases is in many ways the leading cardiological institution in Croatia that performs the most complex treatment procedures for cardiological patients. The Institute for Intensive Cardiac Care, Arrhythmia, and Transplantation Cardiology continuously provides basic care as well as highly sophisticated medical procedures for patients from the Republic of Croatia and abroad. Ensuring high-quality care is certainly facilitated by the technological solutions and devices available at the institute, but it is made possible by highly specialized and educated healthcare professionals, especially 43 nurses headed by Danijela Grgurević, BN, who has headed the nursing service since 2010. Nurses participate in all the diagnostic and treatment procedures as equal members of the multidisciplinary team involved in the care for cardiological patients, including care after percutaneous coronary intervention, pre-transplantation processing and post-transplantation care, managing the patient before and after implantation of long-term mechanical circulation support, caring for patients on extracorporeal membrane oxygenation, temporary electrode and pacemaker implantation, and performing percutaneous tracheotomy, pericardiocentesis, and many other such procedures that cardiological patients require. Nurses also actively participate in the work of the Croatian Association of Cardiac Nurses, and the president and founder of that organization Ana Ljubas, MSN, also spends part of her working hours at the coronary unit. As part of the leading institution in the Republic of Croatia, our nurses have a duty to continuously adapt to innovations and new guidelines in the field in order to provide the best possible evidence-based care.
U Kliničkom bolničkom centru Zagreb kardiologija se kao supspecijalizacija počela izdvajati već pri osnivanja Klinike za unutarnje bolesti, a sam Zavod za bolesti srca i krvnih žila osnovan je 1974. godine s akademikom Vladimirom Goldnerom na čelu. Četrdeset četiri godine nakon niza brojnih uspjeha te osnivanja prvog Laboratorija za kateterizaciju srca u Hrvatskoj, postaje referentni centar za zatajivanje srca i transplantacijsku kardiologiju s akademikom Davorom Miličićem na čelu. Klinika za bolesti srca i krvnih žila u mnogočemu je vodeća kardiološka ustanova u Hrvatskoj u kojoj se provode postupci najsloženijeg liječenja kardioloških bolesnika. Zavod za intenzivnu kardiološku skrb, aritmije i transplantacijsku kardiologiju svakodnevno osigurava temeljnu skrb i visoko sofisticirane medicinske postupke za bolesnike iz Republike Hrvatske, ali i iz inozemstva. U osiguravanju kvalitetne skrbi svakako pomažu dostupna tehnološka rješenja i uređaji, ali njezina su osnova visoko specijalizirani i educirani zdravstveni djelatnici, osobito medicinske sestre / tehničari koji pružaju izravnu skrb bolesnicima. Trenutačno u Zavodu rade 43 medicinske sestre / tehničara na čelu s Danijelom Grgurević, bacc.med.techn., koja ih vodi od 2010. godine. Medicinske sestre / tehničari sudjeluju kao ravnopravni članovi multidisciplinarnog tima u svim dijagnostičko-terapijskim postupcima zbrinjavanja kardioloških bolesnika koji uključuju skrb za bolesnike nakon perkutane koronarne intervencije, predtransplantacijsku obradu i posttransplantacijsku skrb, zbrinjavanje bolesnika prije i nakon ugradnje dugotrajne mehaničke cirkulacijske potpore, skrb za bolesnika na izvantjelesnoj membranskoj oksigenaciji, postavljanje privremene elektrode i elektrostimulatora, perkutanu traheotomiju, perikardiocentezu te još mnogo drugih postupaka koje kardiološki bolesnici zahtijevaju. Također aktivno sudjeluju u radu Hrvatske udruge kardioloških medicinskih sestara, čija je osnivačica i predsjednica Ana Ljubas, mag. med. techn., koja dio radnog vijeka odrađuje u koronarnoj jedinici. Kao vodećoj ustanovi u Republici Hrvatskoj zadaća je sestara kontinuirano pratiti inovacije i nove smjernice kako bi se osigurala najbolja moguća skrb utemeljena na dokazima.
Many successes can be tied to the Clinic for Cardiovascular Diseases since its founding. Today the Institute for Intensive Cardiac Care, Arrhythmia, and Transplantation Cardiology is composed of the Department for Intensive Cardiological Care with 8 beds, the Department for Cardiological Transplantation with 9 beds, and the Department for Arrhythmia with 9 beds, for a total of 26 beds where more than 2300 patients are hospitalized annually. Croatia has one of the most developed networks for interventional treatment of acute myocardial infarction in Europe, and the Institute for Intensive Cardiac Care, Arrhythmia, and Transplantation Cardiology is the institution responsible for patients from the Varaždin County and Bjelovar-Bilogora County.
The Department for Intensive Cardiac Care is equipped with a modern monitoring system that simultaneously monitors patients at a multi-monitor central station that continuously tracks invasive arterial and central venous pressure measurements. In addition to the patients on stationary monitoring, 40 patients at other departments of the Clinic for Cardiovascular Diseases are also monitored telemetrically, which provides them with freedom of movement and continuous cardiac rhythm and frequency tracking with remote monitoring.
Approximately 700 patients are cared for annually, primarily patients with myocardial infarction, malignant arrhythmias, conditions arising after cardiorespiratory arrest, and patients in cardiogenic shock. All these states require rapid diagnostics and treatment, which is also facilitated by a modern catheter implantation laboratory for percutaneous coronary interventions.
Providing high-quality evidence-based care requires adhering to the guidelines by the European Society of Cardiology, which the Institute for Intensive Cardiac Care, Arrhythmia, and Transplantation Cardiology has consistently done, and has consequently become the Referral Center of the Ministry of Health for the Acute and Intensive Treatment of Cardiac Patients and the Referral Center of the Ministry of Health for Heart Failure and Transplantation Cardiology.
Modern treatment methods for patients with heart failure when medication therapy is not effective include invasive procedures such as heart transplants and mechanical circulatory support. The first heart transplantation at the Institute was performed in 1988, and 317 transplants have been performed to date with a one-year survival rate of 80% and a five-year survival rate of 64% (
In patients in whom heart transplantation is contraindicated we use modern methods for mechanical circulatory support that include the implantation of a left ventricular assist device, right ventricular assist device, or a biventricular assist device. The HeartMate II, HeartMate III, HeartWare, Reliant, and Jarvick 2000 devices are used, and a total of 87 heat pumps have been implanted to date (
Witnessed out-of-hospital cardiac arrest caused by ventricular fibrillation or ventricular tachycardia (no pulse) is treated with hypothermia using an endovascular cooling method.
In addition to the advanced methods of treatment provided at the Institute, diagnostic procedures are also available and include pericardiocentesis, pleural punction, abdominal punction, temporary electrode and pacemaker implantation, extracorporeal membrane oxygenation, intra-aortic balloon pumps, and management of patients after transcatheter aortic valve implantation and after thoracic endovascular aortic repair.
Extracorporeal membrane oxygenation (ECMO) is used in patients with life-threatening conditions as temporary circulatory and/or respiratory support and a bridge to transplantation, with >15 patients on ECMO annually. ECMO was introduced in 2011 at the Department for Intensive Cardiac Care, and the cardiological laboratory has participated in ECMO implantation since 2015.
At the Department for Intensive Cardiac Care, nurses participate in percutaneous tracheotomy and bronchoalveolar lavage. Invasive mechanical ventilation is used to manage >100 patients annually, whereas non-invasive mechanical ventilation is used in about 70 patients; high flow oxygen therapy is used as well.
Over 150 central venous catheters are implanted every year, and peripherally inserted central catheters (PICCs) have been applied since 2018.
Over 100 Swan-Ganz catheterizations are performed annually in pre-transplantation processing and management of hemodynamically unstable patients, and a less invasive PICCO monitoring system has been introduced as well.
It should be emphasized that we also manage patients in the terminal stages of heart failure when all treatment options have been exhausted and only palliative care is possible. The palliative approach consists in minimizing invasive procedures and focusing on improving quality of life and preventing and reducing suffering, which is handled by a multidisciplinary team.
The position of head nurse was held by senior nurse Amalija Vukušić, since the founding of the coronary unit until 1997 when she was succeeded by senior nurse Mira Peršić. Danijela Grgurević, BN has been the head nurse of the Institute for Intensive Cardiac Care, Arrhythmia, and Transplantation Cardiology since 2010. There are currently 43 nurses employed at the Institute, of which 22 have a bachelor’s degree in nursing, 10 are attending a nursing course, and 2 are attending a graduate course in nursing. Nursing service is organized so that every shift has 1 shift chief with a bachelor’s degree whose task it is to organize and supervise the work of the whole shift.
The Croatian Association of Cardiac Nurses was founded in 2007 thanks to the initiative of Ana Ljubas, MSN, the current director assistant for nursing of the University Hospital Centre Zagreb and the head nurse of the Clinic for Cardiovascular Diseases at the time who recognized the importance of education and a modern approach to healthcare for cardiological patients. Since its foundation Ana Ljubas, MSN has been the association’s president, whereas Danijela Grgurević, BN has been the association’s secretary until 2018 when the role was taken over by Valentina Jezl, BN.
The Croatian Association of Cardiac Nurses actively participates in all expert meeting and congresses both in Croatia and at the international level as part of the Association of Cardiovascular Nursing & Allied Professions (ACNAP), which works as an independent organization within ESC.
Nurses at the Institute for Intensive Cardiac Care actively participate in all professional events as part of the association with contributions from the field of healthcare for cardiological patients in the form of professional papers and case reports that cover topics from modern care such as mechanical ventilation, hypothermia, and mechanical circulatory support, while also following trends in nursing practice in order to improve patient safety and work quality, with a special emphasis on prevention and monitoring of intrahospital infections. All unwanted events are monitored as well, especially falls, decubitus, and phlebitis.
With a special emphasis on continuous education of personnel and implementation of all technological advancements available to modern medicine into clinical practice, the Institute for Intensive Cardiac Care, Arrhythmia, and Transplantation Cardiology closely follows the most modern trends in the treatment and management of cardiological patients, which makes it one of the leading cardiological institutions both in the country and in the region.