Desmond Julian, who died on Boxing Day 2019 aged 93, was widely regarded by his peers, nationally and internationally, as the leading British cardiologist of the last 50 years. This recognition was based principally on his concept of coronary care units and his seminal role in establishing the value of large multi-centre randomised clinical trials in identifying the evidence to support best practice in the management of ischaemic heart disease.
Eugene Braunwald, the doyen of American cardiology for the latter half of the 20th century described the concept of the coronary care unit as one of the ‘ten advances that have defined modern cardiology.’ For Julian, the concept was the summation of thinking deeply about the early mortality associated with myocardial infarction and utilising the technological developments he had seen as a research fellow at the Peter Bent Brigham hospital in Boston in 1958.
Subsequently, soon after appointment as Senior Registrar at Edinburgh Royal Infirmary, he started a programme of open-chest cardiac massage. Remarkably his first successful patient was a medical colleague. On recovery, this colleague, who had trained at John Hopkins hospital told him of the work of Kouvenhoven who had proposed closed chest cardiac massage just a few months earlier. With developing awareness as to what might be possible Julian proposed that patients with myocardial infarction, at risk of cardiac arrest, should be cared for in an area with full monitoring and support for rapid resuscitation. This approach was published in the Lancet in 1961 and is credited as the first to support the creation of coronary care units.
In 1961 Julian moved to Sydney where he developed his concepts and saw his ideas being applied in the USA. Encouraged by R M Marquis he returned to Edinburgh in 1964 and established the first CCU in Europe. The first year of the programme demonstrated its potential and as the decrease in mortality continued the opening of CCUs became worldwide. This early success was recognised when, with Michael Oliver, he was invited by the WHO to organise the world’s first international conference in coronary care in 1967. At this time Oliver suggested that he should look at the value of large multi-centre clinical trials to identify optimal outcomes for patients with myocardial infarction. He enthusiastically pursued this suggestion in the following decades and became recognised as the international leader in conducting and analysing multi-centre trials in ischaemic heart disease. It was a field in which the combination of his considerable intellect, diplomacy and other personal qualities ensured the respect of international colleagues as collaborators.
In 1975 Julian left Edinburgh to become Foundation Professor of Cardiology at the University of Newcastle. For the following three decades and beyond - long into retirement - he progressively became a major and influential figure in world cardiology. Those who worked with him in his early career in Edinburgh were aware of his extraordinary energy and capacity for multitasking. He had a lifelong commitment to educating as well as teaching and has a legacy based on over 20 textbooks as single author, editor or co-editor, and an immense number of peer reviewed articles.
In 1986 he became the first Director of the newly re-constituted British Heart Foundation. He used this position as a forum to influence research, prevention of heart disease and patient education. Recognition of his major achievements came with appointment as CBE and in numerous honorary degrees and fellowships around the world. In 1998 he received the Gold Medal of the European Society of Cardiology, and in 2005 the American College of Cardiology’s International Service Award ‘acknowledging his outstanding contributions to enhancing cardiovascular care and education throughout the world.’
Those who trained with Desmond Julian in Edinburgh respected and admired not only an outstanding clinician and teacher but an individual of modesty, humility and the highest personal and scientific integrity. All who were privileged to have known him would recognise these as characteristics which defined his life and his career.