In 1961 the Lancet published an article by Desmond Julian that led to hospitals worldwide creating coronary care units for the first time. It was one of the most important initiatives in 20th-century cardiology, helping many more patients survive.
Julian, who has died aged 93, was then a young cardiologist at the Edinburgh Royal Infirmary. He posited in his Lancet article that many more coronary patients admitted to hospital might live if they could be treated in a dedicated unit, where their heart could be monitored with a system that sounded an alarm if the rhythm changed, and where trained staff and equipment were available to resuscitate them.
At the beginning of the 1960s the outlook for coronary patients was grim. Around a quarter of those who had a heart attack died before they even reached hospital. Those admitted were scattered across general wards, given morphine for the pain and left to rest. If they had the misfortune to experience another cardiac arrest, it might go unnoticed. One of Julian’s contemporaries said he regularly found that one of his coronary patients had died quietly in the night.
If a member of staff did spot a patient having a heart attack, a porter had to fetch the defibrillator, which was more than 1.5 metres (5ft) tall and heavy, from wherever it was in the hospital. It is vital to apply a defibrillator quickly, to restore normal heart rhythm, and many patients were not treated in time. An estimated 25% of coronary patients admitted to hospital died within 30 days.
Julian wanted to bring in new practices. He had spent a year in the US at the Peter Bent Brigham hospital in Boston (1957-58), where he had seen a demonstration of an electrocardiographic machine that monitored a patient’s heart rate, sounding an alarm if it detected an abnormal rhythm. He thought it would make sense to cluster his coronary patients together in a dedicated unit with easy access to this and other equipment, and with trained staff on hand to care for them.
Resuscitation techniques were also changing. At the beginning of the 60s the standard way of doing emergency CPR (cardiopulmonary resuscitation) was to open the chest surgically and manipulate the heart. It was known as open chest cardiac massage and could be done only by a trained doctor, which restricted its use. However, in the US, at the Johns Hopkins hospital in Baltimore, Dr William Kouwenhoven discovered a new technique: resuscitation by rhythmically pressing on the chest (the type of CPR we know today). It was a great step forward as it was not invasive and it was a technique that everyone could learn.
Julian found out about this type of CPR in an extraordinary way. In May 1960 a visiting physician had a heart attack in the Edinburgh Royal Infirmary and Julian opened his chest and massaged his heart. Julian wrote: “By a remarkable coincidence, our resuscitated physician was an alumnus of Johns Hopkins and, shortly after his recovery, he showed me a note in the hospital bulletin about Kouwenhoven’s work.” Part of Julian’s mission to improve treatment for cardiac patients was to train staff in the new technique.
In 1961, the year Julian submitted his article on coronary care improvements to the Lancet, he moved to Sydney, where he ran a cardiac research laboratory. The coronary care units, as he had envisaged, started to spring up across the US, and in 1964 he returned to Edinburgh as a consultant to set up a unit there, the first in Europe.
In its first year of operation, an extra seven of every 100 patients survived, compared with a similar group of patients the year before. It became standard practice worldwide to treat patients in coronary care units, so much so that by 1964 no new general hospital in the US could get accreditation without one. Julian went on to organise the world’s first international conference on coronary care in 1967, and in 1969 became an adviser on coronary care to the World Health Organization.
Julian was born in Liverpool. His father, Frederick, was a doctor and his mother, Jane (nee Galbraith), a teacher. He attended a Quaker school in Reading and studied medicine at St John’s College, Cambridge, and the Middlesex hospital medical school in London, graduating in 1948. He spent the next three years doing national service in the Royal Naval Volunteer Reserve, before returning to London.
He said he had been inspired to study cardiology when his father had a heart attack in 1954. He became a medical registrar at the National Heart hospital in 1955, and was a senior registrar at Edinburgh from 1958 to 1961.
In 1956 Julian married Mary Jessup and the couple adopted two children, Claire and Paul. They were living in Sydney when Mary died after a car crash in 1964. Julian returned to Edinburgh, where he dovetailed a cardiology career at the Royal Infirmary with caring for his two children. Much later he met Claire Marley, who was running the press office at the British Heart Foundation, and the pair married in 1988.
In 1975 Julian left Edinburgh to become the British Heart Foundation professor of cardiology at the University of Newcastle upon Tyne, where he stayed until 1986, becoming the charity’s first medical director (1986-93). He was also the president of the British Cardiovascular Society (1985-87). His many awards included the European Society of Cardiology’s gold medal.
In 1993 Julian stepped down from the BHF, but remained as busy as ever. During his career he had seen the potential of large-scale randomised controlled trials to determine the best heart attack treatments, and he had widened the scope of the BHF to include them, overseeing the International Study of Infarct Survival. He continued his research interests into his 70s.
He also wrote prodigiously. He was the founding editor of the European Heart Journal (1975-88) and the author or co-author of more than 20 books, including the standard medical textbook Cardiology (1972), which ran to eight editions.
Julian suffered from heart problems himself, which gave him insights into the issues his patients faced. Taking part in a parachute jump for the BHF, he survived when his parachute failed to open properly, but had a heart attack a couple of days later. However, he lived into his 90s in Hampstead, north London, and, as well as writing, enjoyed gadgets and technology, gardening and walking.
He is survived by Claire, his son and daughter, nine grandchildren and 10 great-grandchildren.
• Desmond Gareth Julian, cardiologist, born 24 April 1926; died 26 December 2019
