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P
rofessor Mahen Varma, Fellow of the Royal
College of Physicians UK and Ireland and
Past President of the Irish Cardiac Society
has long been an influential figure in the
development of cardiac healthcare on the
island of Ireland. Professor Varma (Class of 1969)
spoke to RCSI Matters about the evolution of cardiac
care, the benefits of cross-border collaboration and his
work with the Irish Cardiac Society.
Born in Durban and educated in grammar school in London,
Professor Varma studied at RCSI in Dublin in the sixties.
Dublin was a different city then, he says: "The city had a very
relaxed and laid-back atmosphere. I remember front doors
were often left unlocked. The people, of course, were very
friendly and it was an easy city to settle in to."
Training in Dublin and Belfast (under the late Professor Frank
Pantridge), Professor Varma graduated in Medicine from
RCSI in 1969 and obtained his PhD in Trinity College Dublin
in 1975.
PIONEERING CORONARY CARE
In August 1982, he took up a Consultant appointment in the
Erne Hospital, in Enniskillen, Co. Fermanagh, establishing
a Coronary Care Unit (CCU) in the Erne in December 1982.
At the time, Fermanagh had one of the highest rates of
coronary artery disease in Northern Ireland.
Shortly after, in 1983, he set up a mobile coronary care
service to treat heart attacks in the home prior to admission
to hospital. He recalls: "While CCUs became standard all
over the country subsequently and have been superceded
since, they were a vital service at the time in ensuring that
victims of heart attacks could be treated quickly. The unit
consisted of a doctor and coronary care nurse who would
drive to the patient's home."
The initial mobile CCU service evolved over time, with the
introduction of a screening and intervention programme
for heart disease. He recalls: "The unit worked in tandem
with a sister project in Kilkenny carrying out screening for
heart disease, compiling height, weight and blood pressure
data and giving dietary advice. The Fermanagh unit, which
was funded by the Northern Ireland Chest Heart and Stroke
Association (the equivalent of the Irish Heart Foundation in
the South), was the first in the region to examine cholesterol
risk."
By the mid-eighties, it became the first unit in Europe to
administer clot-busting drugs in the home after a heart
attack (pre-hospital thrombolysis). Another first was achieved
when it became the first unit in the UK where cardiac nurses
administered pre-hospital thrombolysis in 2002.
The statistics give some indication of what was achieved.
In 1984, 4.27% of the population of Fermanagh which
equates to 246 patients, died of coronary disease. By 2011,
1.25% of the population of Fermanagh which equates to 72
patients, died of coronary disease a reduction of 30% from
1984. It was very much the result of a team effort, Professor
Varma emphasises: "What made all of that possible was the
commitment of staff and colleagues who were unstinting in
their encouragement and support, and totally dedicated to
their work."
Cardiac consultant advocates all-island
approach to healthcare
Professor Mahen Varma
24
RCSI MATTERS