Transforming lives on the cardiac unit at Salisbury District Hospital

“We offer a wide range of diagnostic and therapeutic services,” Consultant Cardiologist Dr Tim Wells says.

“These vary from simple investigations in outpatients to very complex interventional procedures which may take up to a couple of hours.

“Investigations include exercise stress tests, echocardiogram, treadmill tests and ECG monitoring to more sophisticated tests such as cardiac CT and myocardial perfusion scans.

“Then there are invasive tests and treatments which include diagnostic coronary angiography, invasive imaging of the inside of coronary arteries, angioplasty with stents and pacemakers which can be simple, or complex pacemakers such as implantable cardioverter-defibrillators and heart failure pacemakers.

“The more complex stent procedures can now be done for patients who would previously have had to have coronary artery bypass surgery.

“These interventional services have only been going on at SDH for six years – prior to that people had to go to either Southampton or Bristol.

“We do the vast majority of our invasive tests and treatments as day cases. If you come to the unit for an angiogram and stent, we make a tiny incision in your wrist and access the artery from there – we are one of the only units in the UK to offer this type of procedure without having to undress for it which makes patients more relaxed and they feel less institutionalised – something that they’re very happy about.

“In terms of devices, most pacemakers get done as day cases while defibrillators tend to be a high risk group of patients and tend to be kept overnight.

“Pacemakers are for patients who have problems with a slow heartrate. Pacemakers can be combined with defibrillators to treat arrhythmias, an irregular heartbeat which is too fast or too slow.”

The team of cardiac doctors comprises five consultants, two specialist registrars, two trust grade doctors and two junior doctors who cover the wards on rotations as part of their training.

The department which has a six-bed coronary care unit and an 18-bed cardiology ward also includes senior sisters, nursing staff, therapists, social workers and clerical staff.

The Salisbury Cardiac Suite is where the lab-based procedures take place such as angioplasty and stents while the cardiac investigations unit is where physiologists do the outpatient tests such as echocardiograms, treadmill tests and the monitoring of defibrillators.

“We do 500 angioplasty (where a balloon is used to stretch open a narrowed or blocked artery) and stent procedures a year – of which some are for acute heart attacks,” Dr Wells said. “In 2015 Salisbury had the oldest population in the UK treated with stents.”

On average the department also undertakes 1,000 diagnostic angiograms, 250 pacemakers, 60 complex devices, 200 stress echocardiograms and 175 transesophageal echocardiograms each year.

“Our cardiac CT service is relatively new, we’ve been doing it for 14 months,” Dr Wells says. “We are expanding it significantly – we did 120 in the first year and hope to double that to 250 this year.

“Physiologists do 2,500 pacemaker and device checks a year – if you have a defibrillator put in you don’t always have to come into hospital to have it checked, as it can be checked remotely, downloaded via your telephone line.

“This saves a lot of elderly patients time who like it as some would otherwise have to travel great distances.

“Checks for a pacemaker routinely take place once every six months or twice a year for devices. If a patient is high risk, it takes place three or four times a year.”

Every year, physiologists also do 6,200 echocardiograms a year, 3,000 patient monitors, 400 treadmill tests and 200 radionuclide myocardial perfusion scans for patients with coronary artery disease.

“We are seeing increased activity across the board for everything,” Dr Wells says. “There has been a huge increase over the last three or four years in outpatients.

“One of the things we do is if somebody is on holiday we don’t cancel clinics - we cross cover so we manage to keep down waiting lists.

“As a result not only is the local population increasing in referrals but there is a huge number coming from areas that previously hadn’t referred to us.”

“With the right to choose where you are treated, people often choose us because we have very good waiting times.”

Dr Wells whose A-levels were in Maths, Biology and Chemistry, graduated from medical school at Guys and St Thomas’ in 1997 and became a consultant in 2007. He has been at SDH for ten years.

He said: “What attracted me to Cardiology is that it is a very varied speciality which requires a mix of medical and surgical skills and it is where you can perform procedures that can significantly improve the quality of patient’s lives.

“For example, if someone is having an acute heart attack and they are about to die in front of you, you save them by opening up the blocked coronary artery and putting a stent in. It can be very satisfying.”