After 3 years of research in heart failure, in 1999, I helped initiate the pilot heart failure nurse liaison service in Glasgow. This service was taken up by the British Heart Foundation and rolled out throughout the country. This model of care is now the standard for integrated primary and secondary care of this condition, as recommended by NICE.
My specialist training was in London (University College London and the Royal Free Hospital). My training covered all aspects of cardiology and general medicine. I took a special interest in advanced echo techniques, such as stress echo. I was one of the first cardiologists in the country to use 3D transoesophageal echocardiography (TOE).
I was appointed as a Consultant Cardiologist in 2006 at Colchester Hospital and when the Essex Cardiothoracic Centre opened in 2007, I started complex imaging services there. In 2016, I started working with Ipswich Hospital to help with their complex imaging services.
I have over 20 years experience of reviewing patients in cardiology clinics. These clinics cover the whole spectrum of adult cardiology. During my 3 years of research, I ran a weekly dedicated heart failure clinic. I also helped set up a pioneering Rapid Access Chest Pain Clinic, which had on-line booking and reported – 10 years before Choose & Book! I have a particular interest in the diagnosis of angina and in 2010, with the publication of new NICE guidance, I led the redevelopment of chest pain clinic services in Colchester and Essex.
In 2012, I set up a nurse led Heart Valve Clinic. This is one of very few such clinics in the country (11% of District Generals in 2014) but is now recognised as the optimum model of care for patients with heart valve disease.
I also have over 20 years experience of managing cardiology inpatients. I am passionate about improving the inpatient services at Colchester and have led the re-organisation of our team to provide rapid Cardiology review of emergency admissions, working towards a 7-day service. In 2010, I introduced a new inpatient heart failure service with close links to the community service. This inpatient service was praised by the National Heart Failure Audit in 2013.
In 2006, I set up Colchester’s stress echo service and its transoesophageal echo service (until then patients had to go to Barts or the London Chest Hospital). I perform TOE studies in our cath-lab and stress echo in the cardio-respiratory department. When the Essex Cardiothoracic Centre opened, I helped set up and develop the special echo department there performing complex echo (stress echo, bubble studies, contrast and 3D TOE) for patients throughout Essex. I was the first cardiologist in Essex to use cycle stress echo at the Centre.
I teach stress echo and transoesophageal echo to trainees at Colchester and the Essex Cardiothoracic Centre. I run a regular transthoracic echo session and lead the department’s audit and training meetings. I am fully accredited in both transthoracic and transoesophageal echo by the British Society of Echocardiography. I have lectured nationally on echo for the society and I am an active member of their Education Committee, co-authoring several national guidelines – see publications.
CT Coronary Angiography
In 2010, I attained level 2 accreditation in Cardiac CT – this level allows me to perform and report CT coronary angiography and calcium scoring tests. In line with best practice guidelines, I report these scans jointly with my radiology colleagues. Initially, I reported these at the Essex Cardiothoracic Centre but in 2012, I led the repatriation of this service to Colchester. I have continued to actively participate in learning and training in this new technology and have reaccredited in 2014 and again in 2017. For several years now, I have given lectures in London and Essex at level 2 courses.
I have a regular cath-lab list for coronary angiography at Colchester Hospital and train junior doctors in this technique. For many years now, I have performed coronary angiography almost entirely from the wrist (radial approach), rather than the traditional technique from the groin (femoral approach). This give a better patient experience and has less complications such as bleeding. I have also introduced new single catheter techniques to Colchester and worked closely with our cath-lab manager to improve the patient experience by allowing patients to eat and drink beforehand (no overnight fasting) and develop new protocols for safer aftercare following radial cases (Helix bands and “patent compression”).
On my regular cath-lab list at Colchester, I implant both single chamber and dual chamber pacemakers and train junior doctors in pacemaker implantation. In 2010, I implanted the first MRI safe pacemaker in Essex – the subsequent MRI that the patient had led to an academic publication.
Wearable Heart Monitors
Heart monitors can be worn for between 1 to 7 days and the ECG recordings analysed for abnormalities. A new monitoring device (The Zio patch) can be worn continuously for 2 weeks. I provide many hundreds of clinical reports on these readings for local GPs and my own patients each year.