Transforming heart attack treatment

In the 1960s, treatment for people who had suffered a heart attack was limited to bed rest and pain relief. As a result, most of these patients died within a year and many others went on to suffer long-term health problems, such as abnormal heart rhythms and heart failure.

It was Desmond Julian, BHF Professor of Cardiology at the Freeman Hospital in Newcastle between 1974 and 1986, who radically changed how heart attack patients were cared for. As a visiting junior doctor in Australia he was one of the first people in the world to propose coronary care units, which have since transformed care for heart attack patients across the globe. He recognised that heart attack patients needed to be treated differently to general patients and came up with the idea of a specialised unit for cardiac care.

At the time, the lack of treatments meant that after a heart attack, many recovering patients developed a life-threatening abnormal heart rhythm, leading to cardiac arrest (in which the heart stops pumping blood around the body). In the early 1960s few heart attack patients - even those in hospital - survived a cardiac arrest. One reason was that they were being looked after on general medical wards, scattered throughout the hospital, which lacked the skills and equipment at hand to deal with a life-threatening cardiac emergency.

Pioneering care for heart attack patients

On his return to Edinburgh in 1964, the BHF funded equipment for Dr Julian to set up a coronary care unit, working with Dr (later BHF Professor) Michael Oliver. Dr Julian showed that having heart patients on one ward, monitoring them continuously, and having the right equipment and staff on standby for emergencies increased survival rates. His measures included:

• Continuously monitoring electrocardiograms (ECGs) so any dangerous heart rhythms could be spotted sooner
• Training staff in cardiopulmonary resuscitation (CPR), and
• Having defibrillators at hand, so that if a cardiac arrest did happen, the patient had the best chance of being revived.

Despite initial opposition to this approach, including concerns that rushing patients to hospital by ambulance and surrounding them with monitoring equipment would “frighten people to death”, the Edinburgh coronary care unit immediately proved its worth. In its first year the unit reduced deaths by more than 30 per cent. Soon hospitals around the world were following their example and further improving survival rates.

Since the 1960s the annual number of deaths from heart attacks in the UK has more than halved, thanks in part to Professor Julian’s vision and the work of the coronary care units now established throughout the country.

First published 1st June 2021