Thanks to the foresight of the cardiologists working in the Division of Cardiology, Stellenbosch University (SU) today boasts a centre of excellence that is highly regarded locally as well as abroad.

The Division of Cardiology in the Faculty of Medicine and Health Sciences received a huge boost in 2014 with the establishment of SUNHEART. Amidst very limited mainstream funding, the centre's unique private funding model has paved the way for much greater access to cardiology services and training in the Western Cape.

The entire division has since been transformed, while the number of training posts has more than doubled and several outreach facilities have already been established.

Other institutions nationwide are currently looking at the possibility of implementing aspects of this model, says emeritus professor Anton Doubell, who was head of the Division of Cardiology for 25 years. He retired at the end of December last year, but is still involved in the division in a part-time capacity and funded by SUNHEART.

One can rightly be proud of the quality staff members at the Division of Cardiology, says Doubell. “We have become a centre of excellence for research in cardiac imaging, valvular heart disease and pericardial disease – research fields in which we are internationally renowned."

Doubell, who was director of SUNHEART until his retirement, and Alfonso Pecoraro, SUNHEART's chairman, played a leading role in the implementation and operation of this centre.

Other models were first looked at, such as creating an entity outside SU, but after thorough research there was consensus that SUNHEART should be a centre at SU, explains Pecoraro. He joined the division in 2013 as a consultant.

As a result, a non-profit centre was established, and the private sector approached for financial support.

It was a recipe for success from the start, with local as well as overseas donors. “The overall focus was on access for colleagues who wanted to study cardiology, but also improved access for patients to cardiac care," says Pecoraro.

Until SUNHEART came on the scene, cardiology in South Africa was limited to the big centres, het emphasises.

SUNHEART's business plan was based on first investing in infrastructure with the aim of improving access to cardiology services and creating more opportunities for training in cardiology. During the first year the majority of the more than R10 million acquired was invested in infrastructure. Thereafter the focus shifted to human resource development, the improvement of research output and the establishment of a cardiology outreach programme.

According to Pecoraro, the entire Division of Cardiology was basically redesigned. “At the outpatient clinic we did not have enough space to see patients or train students. Walls were torn down and the entire outpatient division was rebuilt."

And in order to help more patients more cost-effectively, the first radial suite in Africa was established at outpatients. Access to the vascular system at the wrist (radial artery) now makes it possible to perform cardiac catheterisation more safely and to offer it as an outpatient service via the radial suite. “Previously patients had to stay in hospital for two nights to get stents. The new facility allows them to be admitted and discharged on the same day.

A state-of-the-art lecture hall has also been set up at the hospital to facilitate training. Here tutorials can be offered to undergraduate and graduate students with the help of optimal digital facilities and at the same time be televised to online audiences.

Next in line was the construction of a research centre in collaboration with the British Society for Echocardiography. This centre was the core of one of SUNHEART's flagship projects, Echo in Africa. Through this project thousands of children have already been taken through the research centre and tested for heart disease. The establishment of the research centre, coupled with the larger number of postgraduate students – especially PhD students mediated by SUNHEARTS scholarships – has given the research output considerable momentum. This greatly contributes to the department's status as a centre of excellence.

The last infrastructure pillar involves the establishment of mini-cardiology centres according to the hub-and-spoke model at Tygerberg's referral hospitals.

A large number of patients who would otherwise have had to come to Tygerberg, can now be treated at outreach facilities in Khayelitsha, Paarl, Worcester, Somerset West (Helderberg Hospital), Bellville (Karl Bremer Hospital) and Eerste River respectively. “This system is to the benefit of both the patients and the health system. Patients can be treated in die comfort of a nearby hospital, transport costs are saved and the level of care at these hospitals is also improved," says Pecoraro.

In terms of human resources, the big problem is that there are not enough cardiologists in South Africa and that training opportunities are limited, emphasises Pecoraro.

When Doubell became head of the department 25 years ago, he was one of only two cardiologists in the department, while there was only one training post. Currently there are four full-time and three part-time cardiologists as well as eight young colleagues in training. No less than five additional training opportunities for cardiologists were created directly by SUNHEART.

In addition, thanks to SUNHEAR, SU and Tygerberg Hospital now have an electrophysiology service and training programme, which for a long time was limited to Groote Schuur Hospital in the public sector. “The person we identified for this, as well as a technician who had to be trained, went overseas for training for six months," says Pecoraro. Apart from the fact that both are still funded by SUNHEART, R5 million worth of additional electrophysiology equipment has also been purchased."

As far as the PhD programme and the funding of PhD students are concerned, one SUNHEART bursary holder has already obtained his doctorate and four are currently working on it. It is expected that a further two will graduate with their PhD this year.

The outreach programme speaks for itself, adds Pecoraro. “By decentralizing cardiology services we have created a unique model that not only deals with training, but also provides access to advanced services for the man on the street. We have now set up the sixth outreach facility. Annually more than 500 patients use the outreach system directly and up to 3 000 indirectly from some component of it. The dedicated staff at the outreach facilities, who have acquired additional knowledge and skills through the outreach programme, now play an important role in providing advanced cardiology care at these facilities. It is one of our biggest successes."

The SUNHEART initiative has empowered the Division of Cardiology to take its rightful place as a centre of excellence on the African continent, equivalent to cardiology centres of excellence worldwide, emphasizes Doubell.