Last week I reached what I think is a fairly significant milestone in my career, as on Wednesday it was ten years to the day since I started my consultant cardiologist job in Bournemouth. A decade has gone in the blink of an eye, yet when I think back, so much has changed. I was appointed to lead and develop the heart failure service, as it did not exist prior to that. In fact, the job came about following an external review triggered by poor outcomes for heart failure patients in a national audit. I was appointed alongside a nurse and my secretary, and off we went. The outcomes of local patients with heart failure are now very good indeed, and as a trust we are now the seventh largest heart failure service in the UK in terms of patients numbers. I won’t bore you with the details of all the service improvement projects my (now much larger!) team and I have delivered over the ten years, but I certainly look back with pride at the achievements.
What I will tell you about however, in this moment of reflection, are the stand out advances in the world of cardiology in the last decade. Not every one of these will be relevant to you right at this moment in time, but if you’re over 40, I highly suspect at least one will affect you or a member of your family in the next decade such is their impact. It makes sense – ten years ago the world had just seen the iPhone 6. If you see one now they look rather dated compared to today’s model. So it is in healthcare.
Imaging and diagnostics
Regular readers will know I myself had a CT coronary angiogram last month. The level of detail that modern scanners can image a person’s coronary arteries is now incredible, with an incredibly low radiation dose. They can look inside stents, take pictures in patients with AF, or pacemakers.
The technology available compared to ten years ago is phenomenal. Not only can we see a narrowing in a heart artery, we can determine using cutting edge software whether that narrowing is actually causing a problem with blood flow for that patient. We can also assess the entire ‘plaque burden’ in a person’s heart, giving them a bespoke, individualised assessment of their risk.
As such, CT is now the first line investigation for most patients with chest pain. Old fashioned treadmill tests are largely a thing of the past, and far fewer patients need to have a conventional invasive angiogram, thereby reducing risk.
Echocardiography, using ultrasound to image the heart, has seen similar advances. We can now use something called ‘strain mapping’ to assess the movement of individual parts of the heart with great accuracy. We can measure not only how strongly the heart squeezes, but how well it ‘relaxes’ during each heartbeat also . This is incredibly important when assessing patients who are breathless, and may have ‘stiff hearts’ contributing to their symptoms. 3D echocardiography is now fairly standard, meaning assessment of heart valves is more accurate and detailed.
Cardiac MRI can now routinely give us measures of inflammation within the heart. Our understanding of patterns of what we call gadolinium enhancement has improved such that in a patient with reduced pumping of the heart, we can often tell the cause of the problem by doing this advanced scan. We can pick up cases of myocarditis far more readily enabling better treatment. The same goes for a condition called amyloid. Cardiologists used to think this was very rare, but now appreciate it is actually very common (I would guestimate that personally I diagnose at least one case very fortnight). Not only that, we have new treatments available for that condition which are star-trek levels of science (more of that in the medicines section).
I’m conscious of the length of this post, and I have many areas yet to cover. As such, I have decided to do a mini blog series over the next few weeks. As you will see, over the past decade, cardiology has undergone a quiet revolution — from powerful new drugs that transform heart failure outcomes to imaging techniques that reveal disease before symptoms even start. In this blog series, I’ll explore how advances such as CT coronary angiography described today, SGLT2 inhibitors, and RNA-based lipid-lowering therapies are reshaping how we detect and prevent heart disease. We’ll look at breakthroughs in heart valve and rhythm management, the rise of AI-assisted imaging, and how tools like polygenic risk scores and advanced lipid testing are bringing truly personalised heart health within reach. Whether you’re curious about cutting-edge diagnostics, the future of prevention, or how these developments could apply to you, stay tuned — the pace of change in cardiology has never been more exciting.