This document provides a summary of Dr. José Pablo Sala's 40 years of experience in healthcare in Cordoba, Argentina. It discusses the founding of CERECA, the first cardiac rehabilitation center outside Buenos Aires in 1974. It details the founding and growth of Instituto Modelo de Cardiologia, a private cardiovascular institution established in 1977. Over the years, the institution has pioneered various cardiovascular treatments, published research, and trained over 200 cardiologists through its residency program.

1. DISERTACIÓN DEL DR. JOSÉ PABLO SALA
EN EL HOSPITAL “MEIR MEDICAL
CENTER”, ISRAEL. OCTOBER 12, 2014.
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Good morning. It is a pleasure for me, to
be here with you to share our 40 years of
experience in health care in Cordoba,
Argentina.

3. INSTITUTO MODELO DE CARDIOLOGÍA PRIVADO S.R.L
CORDOBA, ARGENTINA
JOSE PABLO C. SALA M.D. F.A.C.C.
info@imcnet.com.ar
www.imcnet.com.ar 3

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First, let me show you a little bit of my
home city. Cordoba city is located at
Cordoba State in the middle of the
country. It is the second city in Argentina
with a population of 1.4 millions. We have
a lot of history, for example we have a
university that is more than 400 years old.
Here you have some pictures of this
beautiful city and its landscapes.

5. CÓRDOBA
ARGENTINA
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As previously mentioned, we have had 40
years in health care now.

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It all began in 1974, when with two other
Cadiologists, Dr Serra and Dr Balestrini, we
started CERECA, the first Cardiac
Rehabilitation center outside Buenos
Aires, and with the full support from
Professors Henry Denolin and Rene
Favaloro.

15. September 11th 1974
CE . RE . CA
CENTRO DE REHABILITACIÓN CARDIOVASCULAR
1st cardiac rehab center
(outside Buenos Aires)
40 YEARS!!!
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Dr. Henry Denolin was a world expert from
Belgium, a pioneer of Cardiac
Rehabilitation. Dr Rene Favaloro, a
cardiovascular surgeon from Argentina
who was a pioneer of coronary Bypass
surgery.

17. Prof. Dr. Henri Denolin (Bruselas- Bélgica)
1st president of the Rehabilitacion counsil, International Society of Cardiology
Prof. Dr. René Favaloro (Argentina)
CV surgery pioneer
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CERECA started with 6 severe coronary
disease patients who could not undergo
surgical treatment, so we enrolled them in
our program where they performed
exercise under careful monitorization. This
practice was only supported by us. Many
physicians all over Argentina questioned
us and stated that this was not correct.

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As we expected, these high CV risk patients sometimes
had exercise induced angina that required we stopped
the exercise and performed a 12 leads ECG, and waited
for full recovery. We now know that these patients
have ischemic preconditioning, that in the case of an
acute MI it reduces the level of myocardial damage, so
we were preconditioning our patients’ hearts without
knowing it!
In 1975, I was asked to lecture about our first year of
experience at the Deborah Heart and Lung Center, in
New Jersey USA, and right after it I was invited to stay
to create their CV Rehab Program, but I had to go back
to Cordoba.

20. 1974
CE.RE.CA
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We currently have 280 patients in the program. In 40
years our mortality is zero and only 5 patients have
been hospitalized due to hypertension or arrhythmias.
I am one of those 5 patients!!! 2 years ago, I was being
checked before performing exercise and an
asymptomatic atrial flutter was diagnosed. This ended
with my hospitalization, a transesophageal ultrasound
and cardioversion under anesthesia.

22. 1982
CE.RE.CA
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23. 1994
CE.RE.CA
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24. CE.RE.CA 1995
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25. CE.RE.CA
2013 - 2014
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29. CURRENT CERECA STAFF
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In 1976 I presented at the Cordoba's Cardiology
Society the first study in Argentina that looked at CV
risk factors in a supposedly "normal population". I
performed it while working at a public national
petroleum Company "YPF" and I included DATA from
150 patients. Here you can see some of the charts that
I filled out for the study.

31. 1976 CV RISK FACTORS STUDY

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On January 29th, 1977 with my partners, in the
middle of riots that were taking place in Cordoba, we
opened the Instituto Modelo de Cardiologia, a private
cardiovascular institution that would provide “state of
the art cardiovascular treatment” to our patients. It
was not an easy decision but we had no choice, as in
the public hospitals we were working at, the
cardiovascular surgeries results were suboptimal and
the burocracy was in crescendo. We either created our
own institution, or we left Cordoba for good. I
remember very well several conversations we had at
that time with my father.

33. January 29th 1977
INSTITUTO MODELO DE CARDIOLOGIA
Dr SerraDr Balestrini Dr Sala Sojo SJ
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My father was considered by my partners and others, a
brillant interpreneur and a very well respected
businessman. It was with his blessing that we decided
to go ahead; Dr Serra at the age of 44 and Balestrini
and myself at the age of 33. Dr Serra made it clear
from the beginning that our institution could not only
cover health care, but it had to have 2 more pillars,
Teaching and Research. It was because of him that in
March that same year we started our 3 year cardiology
residence program.

35. “my father, our advisor”
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Our residents need to have at least one year of internal
medicine in order to apply. By now, we have trained
more than 200 cardiologist distributed all over the
world, in the USA, Canada, Italy, Spain, France, Chile,
Brazil, Costa Rica, Peru, for example. In addition, we
have had foreign residents from Spain, Brazil, Peru,
Paraguay, Honduras, Bolivia, Venezuela, who came to
do their residence with us and return to their native
countries.

37. CARDIOLOGY RESIDENTS
1977-1980 GRADUATION 37

38. DR. MOISES RAUL SUED LICHTENSTEIN
1979- 1982
BEFPORE HE WAS A RESIDENT OF RAMBAM
IN HAIFA
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The Institute, has been a pioneer in Cordoba since its
creation in 1977. We had the first 2 coronary care
ambulances and that same year we were the first to
measure bedside cardiac output in patients suffering
from an acute MI in the CCU.

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We have also been pioneers in Argentina. In 1988
following a group from Kansas USA, we were the first
institution in the country to perform an angioplasty
during an acute MI. We were severely criticized for
this in many national meetings as we were interfering
with the drugs companies that provided thrombolytic
therapeutic options, supposedly the only choice of
treatment at that time.

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5 years later, the first publication that supported this
practice came out in the NEJM and nowadays there is
no doubt at all, that primary PTCA is the best practice
all over the world for treating Acute Myocardial
Infarction.

44. 1st PRIMARY PTCA IN ARGENTINA
JANUARY 1988
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45. 5 YEARS LATER, 1ST PUBLICATION ABOUT PRMARY PTCA
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Our institution kept growing and growing, we had started in 1977 renting
one property downtown Cordoba, and by 1987 we had 13 properties rented
out to cover all our needs.
It was not until 1989 when we moved to our own building where we are
located nowadays. We had bought the land back in 1978 but had to wait due
to Argentina's economic turn downs for 11 years, to be able to fulfill our
dream of our own building. We were able to do so not only to our
continuous effort but also thanks to full support from several patients and
friends who donated more than 500.000US$ by now.
Let me tell you how difficult it is to create a “state of the art” institution in a
developing country such as Argentina. In 1981 the institution almost
disappeared, as we had to go to the banks and mortgage our own houses in
warranty to get loans to make payments and we had to go through a huge
reengineering process.
It is important to mention that our wives have always given us full support,
and this is true, as the three of us, we are still married.
In 1996 with my partners, we decided to open our doors to other specialties.
It was because our patients demanded that we had to expand our horizons
as they wanted to be taken care of in all specialties at our institution.
Nowadays, we can perform from a simple ECG to a heart transplant and we
have almost every specialty but OBGYN and neonatology.

47. CE.RE.CA
IMC 2014
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We have a 10.000 square meter institution; with 72 beds; with
450 monthly hospitalization; more than 14.000 monthly
outpatients and more than 12.000 diagnostic studies. We are a
third level institution fully equipped that receives patients from
all over Argentina.
Let me tell you some details of our daily work that makes a
difference in regards to health care, teaching and research.
When providing health care one of our main accomplishments is
to have performed these 37 years two daily rounds, one at 8am
and another at 5pm, Monday through Friday. The first without
patients and the second at the bedside of the patients. In
addition, every weekend and holidays we perform rounds one
time. Our residents and staff from the ICU, CCU, etc, have to
know about each hospitalized patient’s pathology. Thus, they
need to be alert about 60 patients conditions average, which is
an interesting challenge as we have a bed turnover time of 2.3
days.

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In regards to teaching, we currently have 27 residents in
Cardiology. Our residents are required to rotate many months in
the ICU and CCU. As they are the only residents we have, they
end up being trained not only in cardiology but also in
Emergency medicine, etc. We consider it the best training they
can achieve because they are able to perform invasive practices
as locating central lines, transitory pacemakers, swan-ganz,
upper airway intubation, etc.
The residency training program covers 1 year rotation through
internal medicine and 3 years through cardiology.
The Residence qualifies as practical training in order to achieve
the Cardiologist certificate. The residents are also able to
complete Academic requirements by attending a Cardiology
postgrade, at a private University which was started by Dr. Serra
in 1985.

51. CARDIOLOGY RESIDENCE 1977 - 2014
• 35 GRADUATIONS
• 205 Cardiologists
• 27 in Training
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Let me share with you something really nice that we
have been doing for the past 10 years. For each
graduation, we invite former residents that left the
institute 25 years before, to share their life experience
after graduation. One very important thing for us is to
see that our institution’s philosophy remains intact!
Later on, I will come back to this and insist on our
philosophy.

53. CARDIOLOGY RESIDENTS
1977-1980 GRADUATION 53

54. 2010-2013 GRADUATION
CARDIOLOGY RESIDENTS
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55. Resident that is about
to start a new life!
25 YEARS AFTER,
shares his experience!!!
2013 Residents Graduations’ Speaches
“THE” same philosophy continues!!!
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In regards to research, our institution has participated
in several international studies and has published
several Cardiology books for peers and for patients.

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One major book we published had an editorial written
by Professor Valentin Fuster who stated that "this is
the reference book on myocardial infarction in Spanish
speaking countries”

59. “…in my opinion, this is the
reference book on myocardial
infarction in Spanish
speaking countries…”
Professor Valentin Fuster
MD PhD
Mount Sinai, NY, USA
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We have also published many articles in national and
international magazines as shown in the slide. Lately
our staff has published in the American Journal
Physiology, Heart Circulation; American Journal of
Physiology, Regulatory and integrative Physiology;
Molecular Cell Biochemistry; Physiological
Measurements; British Medical Journal Open; etc.
This last publication was performed in conjunction
with HARVARD University, University of
MASSACHUSETTS and WAYNE STATE University from
the US.

61. RECENT PUBLICATIONS BY OUR STAFF
• Role of cardiac output versus peripheral vasoconstriction in mediating
muscle metaboreflex pressor responses: dynamic ecercise versus
postexercise muscle ischemia. Am J Physiol Regul Integr Comp Physiol.
2013 Apr 15;304(8):R657-63.
• Muscle metaboreflex induced coronary vasoconstriction limits
ventricular contractility during dynamic exercise in heart failure. Am J
Physiol Heart Circ Physiol. 2013 Apr 1;304(7):H1029-37.
• Altered calsequestrin glycan processing in common to diverse models
of canine heart failure. Mol Cell Biochem 377(1-2):11-21;2013.
• Cardiac output is not a significant source of low frequency mean
arterial pressure variability. Physiological Measurements 34: 1207-
1216; 2013.
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62. RECENT PUBLICATIONS BY OUR STAFF
• Attenuated muscule metaboreflex induced increases in cardiac function
in hypertension. Am J Physiol Heart Circ. Physiol. 2013 304 H1029-1037.
• Cardiac output in not a significant source of low frequency mean arterial
pressure variability. Physiol Meas. 2013 Sep;34(9):1207-16.
• Point of care assessment of platelet reactivity in the emergency
departament may facilitate rapid rule-out of acute coronary syndromes:
a prospective cohort pilot feasibility study. BMJ Open; 4 (1) January,
2014.
• Stimulation of the cardiopulmonary baroreflex enhances ventricular
contractility in awake dogs: a mathematical analysis study. Am J Physiol
Regul Integr Comp Physiol. 2014 Aug 15;307(4):R455-64.
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As we all know, medicine is constantly evolving. Thus,
in 1978 we started organizing scientific courses and
since 1989 international symposiums. We have been
distinguished by the visit of many outstanding
professors and scientists.
To mention a few Professors: Valentin Fuster; S.
Rahimtoola; L. Gould; A. Iskandrian; W. Boommer; W.
Parmley; B. Katsen; E. Beven; P. O'Gara; W. O'Neill;
Barry Franklin; G. Stone; Lawrence Sinoway; Marc
Kaufman; Phillip Levy; etc. This past year we had 8
simultaneous sessions going on and more than 1000
attendees.

64. INTERNATIONAL SYMPOSIUMS
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65. 2013 NTERNATIONAL SYMPOSIUM
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66. 2015 SYMPOSIUM, August 7 th
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With my 2 partners we decided that the institute
needed to participate and reach out to the community.
This was the main reason for us to create a non profit
organization in 1981 called FU.C.C.A.D.I.M.,
independent from the Institute but sharing cardiology
and medicine as a target.
The foundation, with the participation of our residents,
has trained more than 22.000 individuals from the
community in CPR. The foundation has performed
different campaigns, for example in 1994 it launched
the program called "Pasos" which means "steps" in
four different strategic locations in the city and once
we ended up having 800 participants.

68. FU.C.C.A.D.I.M. 1980
CPR courses
22.500 individuals trained
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This program would train people to walk and perform
controlled exercise to get in shape, loose weight and
live a better life.
This program was then taken over by politicians but, as
with many things in our country, when the politicians
participate, it disappears...At least people learned that
walking is enough to live a better life, it is not running
but walking what we recommend.

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Many workshops are given every year at FUCCADIM,
such as "CV risk factors control"; for example "eating
well", "why to perform exercise"; "stress
management"; "stop smoking"; "Dyslipidemia";
"Diabetes"; "HTN" etc.

73. CV RISK FACTORS WORKSHOPS
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Moreover, this foundation has reached many poor
remote areas from our state providing food, clothes,
medications, and free health consultations, including
dental and ophthalmologic.
Once we even trained a local nurse for this people as
no doctors' offices were available for many miles, note
that these people have no motor transportation, they
travelled on foot or horses. We contribute to many
poor institutions with kids day campaign and religion
celebrations.
In regards to providing the public with useful
information we have weekly participated during 15
years on a highly ranked radio program.

75. Trips to Provide Health Care to Extremely Poor Areas
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For the last 10 years, we have been hosting weekly a
30 minutes TV program which received two excellence
awards. The institute is constantly consulted by many
journalists on different topics of general interest and
also as we usually have celebrities, we are on the news
almost every week. We also are asked to write for daily
journals.
In addition for the past 2.5 years we have been
dedicated to review every process medical and non
medical at our institution.

77. TV PROGRAM
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We have professionalized every area, we
applied different approaches such as LEAN
Healthcare techniques into optimizing our
processes such as ER and OR patient flow,
etc and we also updated our equipment
with “state of the art” technology.

79. STATE OF THE ART TECHNOLOGY
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We have started exercise programs for our
personnel and also given workshops for
them to learn how to take care of
themselves.

81. EMPLOYEES AND STAFF SEDENTARISM PREVENTION
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We have also started new recreational
activities such as the Family day, Santa
Claus day, etc. We believe that "With
Change comes opportunity" and although
it has been challenging and time
consuming we are proud to see the
results.

83. RECREATION, FAMILY DAY!
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84. RECREATION, FAMILY DAY!
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85. RECREATION,
NEW YEARS’ PARTY!
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86. RECREATION,
NEW YEARS’ PARTY!
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87. NURSES,
RETIRING AFTER 30 YEARS!
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"First comes the patient, then the patient, then
the patient, & then the patient & his family”
We provide a personalized type of health care,
we do not seek for quantity but for quality. In
this regards, this past august our institution
received a full accreditation from ITAES, which is
a national certificating non profit organization
for health care institutions. As just mentioned,
the most important thing for us is our patients
and their families.

89. Our philosophy,
First comes the patient,
then the patient,
then the patient,
& then the patient
& his family
PERSONALIZED HEALTH CARE
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90. • COMMITMENT
• COMUNICATION
• RESPECT & CONSIDERATION
• HUMILITY
• SENSE OF BELONGING
• SOLIDARITY
• CAUTION
• SELF-CRITICISM
• LOYALTY
• ACCOUNTABILITY
• PRUDENCE
TEAM WORK &
RESPONSIBILITY
THERE IS ONLY ONE INSTITUTION , NOT 200!!!
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Last September 16th we were
honored to have our Distinguished
Lecturer:
Dr. José Boris Wolaj
(Research on Basic Neutrophil Function and
Patients Immunocompromised)
SEPTEMBER 16 - 2014

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95. THANK YOU ! 95