Medical Forum journalist Eric Martin sat down with Dr Michelle Ammerer, an interventional cardiologist from Western Cardiology – based at St John of God Subiaco Hospital and Sir Charles Gairdner Hospital – to talk about the changes that have taken place in interventional cardiology, and the latest treatments available to doctors and their patients.
Dr Ammerer is one of the very few female cardiologists in Perth and has been recognised as one of the leaders in interventional cardiology, working for nearly two decades in this field – a career decision she credits to the ‘amazing’ team working at SCGH.
“I was really fortunate as a medical student in my last year of training and early on in my intern and junior years to work with the cardiologists at Charles Gairdner Hospital, and they had great personalities. They were good at their work, and I got to see what they actually did in the cath lab operating – which was absolutely amazing,” she said.
“The skill they had in saving people’s lives with the work they did was incredible, I was pretty much inspired from then on to do cardiology, and after my fellowship, I returned as the first female cardiologist at Charlie’s.
“I never really set out to have that as something on my CV, but that is just what happened. I’ve also spent a lot of time on the board of the Heart Foundation, and I’ve worked with them for 14 years on a campaign raising awareness of heart disease in women, as well as a lot of other aspects of heart disease.
Dr Ammerer explained that as an interventional cardiologist she was on the ‘after-hours’ roster at SCGH.
“We’re open 24 hours a day for heart attacks – we get to the hospital as quick as we can and open arteries day and night,” she said.
“When patients come in with heart attacks to hospital now, they actually have the ECG done on the ambulance stretcher at home, and the ambulance officers send the ECG to the hospital.
“And if it is a certain type of heart attack, the bigger kinds, such a patient doesn’t go to the ED often anymore, we bring them straight to the cath lab and operate immediately. We’re standing there, scrubbed, ready to act – it’s very acute medicine and that’s a big, big role that I’ve had for a long time.”
Dr Ammerer noted that every ten minutes an Australian was having a heart attack, making coronary heart disease the single leading cause of death in men and women, with 306,000 years of healthy life lost in 2022.
“There’s a lot to improve on, and while there has been a gradual and steady decline, the COVID pandemic resulted in people not coming to hospital, too scared to have their chest pain attended to, and the rate of death from heart disease subsequently went up from 2020,” she said.
“Alcohol consumption went up, food consumption went up, people’s waists went up – they couldn’t exercise, so they didn’t, and that hugely impacted on heart disease as well.
“But if we pick up coronary plaque earlier, we can aggressively manage risk factors, which can then reduce its accumulation, and we’re picking up a lot of disease earlier these days with calcium scores, done on low-risk CTs and CT coronary angiograms, which will also identify calcium and soft plaque.”
She explained that the main aim of early treatment was trying to suppress CAD’s progression through lifestyle and medication.
“The hardest thing is to change behaviour… and there’s a huge role for GPs. There’s a lot that can be prevented, and risk factor management is so important because it takes time and often multiple appointments, measuring progress and reinforcing what’s going on,” Dr Ammerer said.
“Similarly, lipid targets are important because that’s one of the main arms we have for treatment. And unfortunately, we know that 50% of patients in Australia actually aren’t meeting those targets, but if you’re on a medication, you want to be harnessing all the benefits of being on it.
“Sometimes we see patients reluctant to be on a higher dose, they don’t like the number of milligrams being higher. But it’s not about that – it’s about the result – and if they’re tolerating their medication, they should be reaping the rewards by being on the dose that achieves the target level.
“As cardiologists, we don’t really care about the dose. We care about you meeting the target, because that’s where the evidence is that we’re going to be doing you benefit.”