Dr Balvinder Wasan is a consultant cardiologist specialising in preventative cardiology at Welbeck. We spoke with him about his career journey and what a typical day at Welbeck looks like for him.
Dr Balvinder Wasan is a consultant cardiologist, specialising in preventative cardiology.
He’s an expert in all aspects of cardiovascular disease. His work in Welbeck’s Heart Health centre involves screening high-risk patients, assessing and treating patients with symptoms of coronary disease, and helping them manage risk factors for heart disease.
In addition to his work at Welbeck, he is the lead cardiologist for community cardiology at Guy's and St Thomas' NHS Foundation Trust.
We spoke with Dr Wasan to learn about his career, specialism, and what a typical day working at Welbeck looks like for him.
‘When I was choosing my career, I was drawn to the idea of specialising in a field that involved practical procedures, such as performing angiograms and implanting pacemakers. These interventions can make a significant difference to people’s lives, improving their symptoms and, in many cases, saving their lives.
So, when I qualified as a consultant, I chose to specialise in interventional cardiology.
At the time, I was particularly attracted by the opportunity to treat people experiencing heart attacks, implant pacemakers, and make a tangible difference to patients’ lives. I was also drawn to the fact that cardiology is a speciality that never stands still. It’s constantly evolving, with new treatments, technologies, and approaches continually emerging. That sense of innovation and progress has always been a great attraction.’
‘A couple of years ago, I made the decision to move away from interventional cardiology and focus on preventative cardiology. I had become increasingly interested in the amount of undiagnosed heart disease and, more importantly, in identifying and addressing problems before they develop into something serious.
In cardiology, the most serious outcomes we want to prevent are heart attacks, strokes, and premature death.
The principle behind preventative cardiology is much the same as preventative medicine more broadly. If someone has an underlying risk factor or condition that goes undiagnosed or unmanaged, their chances of developing serious health problems in the future increase. I often say that, rather than treating someone’s heart attack at 2 am, my aim is to stop them from having one in the first place. That is really what preventative cardiology is all about.
There are several well-established risk factors for cardiovascular disease, including high blood pressure, high cholesterol, diabetes, smoking, and a family history of heart disease. What is particularly important is that people can have one or more of these risk factors without experiencing any symptoms or even realising they are at risk.
For example, someone in their mid-40s might feel perfectly healthy, but already have underlying risk factors that could lead to significant problems over the next 10, 15, or 20 years if left unaddressed. By identifying these risks early, we have an opportunity to intervene, manage or treat them and significantly reduce the likelihood of a serious cardiovascular event.
We know that at least 70% of cardiovascular disease is associated with risk factors that are preventable or modifiable through earlier identification and management.
Of course, there’s enormous satisfaction in treating someone who is having a heart attack and potentially saving their life. But, at this stage in my career, I felt that shifting my focus towards preventing those events from happening in the first place was the right decision. I haven’t regretted it for a moment, and I find my work in preventative cardiology incredibly rewarding.’
‘My working days at Welbeck are Fridays and Saturday afternoons.
Every Friday morning we have a multidisciplinary team (MDT) meeting to discuss complex cases. We have a number of cardiologists there, and sometimes we have outside specialists, such as surgeons. This approach has become more common in the last 5 to 10 years, but it really is best practice. If I ever have a patient for whom I would value a second opinion, I take their case to the MDT and discuss it with my colleagues. One of them will say, “Actually, they should come and see me because I can offer them this”, and so forth.
On Friday and Saturday afternoons, I see patients in my clinic for 3 hours. I have a mix of new patients whom I see for 30 minutes, and follow-up appointments that last around 15 minutes. On an average afternoon, I see between 6 and 8 patients.’
‘When someone comes to see me as a new referral, I start by understanding the reason for the referral, assessing their individual needs from a cardiology perspective and deciding which investigations are most appropriate.
For patients attending a follow-up appointment, the focus is usually on reviewing their test results, explaining what the findings mean and discussing whether any further investigations or treatment are needed.
Quite often, I will arrange the investigations, review the results and find that everything is reassuring. In those cases, I can explain to the patient that there’s nothing concerning, put their mind at ease and discharge them from the clinic.
However, occasionally, a patient will present with what we call ‘red flag symptoms’. This might happen once or twice a year, and these are situations where we need to act quickly, investigate urgently and, if necessary, arrange immediate treatment.’
‘Preventative cardiology has advanced enormously over the years, particularly in terms of the investigations and diagnostic tools available to us.
We now have a much wider range of blood tests that allow us to assess cardiovascular risk with greater accuracy. We also routinely use coronary calcium scoring and CT coronary angiography, which allow us to look directly at the arteries and identify calcium build-up, narrowing or other signs of coronary artery disease.
Cardiac MRI has been around for some time, but advances in imaging technology mean that newer techniques can provide us with considerably more detailed information about the heart.
Even echocardiography, which is an ultrasound scan of the heart and has been used for around 50 years, continues to evolve. When I started as a consultant 21 years ago, the information we routinely obtained from an echocardiogram represented the cutting edge of what was possible. Today, much of that would be considered the starting point.
We can now perform highly sophisticated 3D and 4D studies, allowing us to examine specific structures and areas of the heart in much greater detail. We have access to a far wider range of measurements and can gather significantly more information, with improved diagnostic accuracy.
Ultimately, these advances mean we can identify problems earlier, understand them in greater detail and make much more informed decisions about how best to manage each patient.’
‘There are several different aspects of my work that I find rewarding.
I see a lot of patients who have been referred following a health screening, where something unexpected has shown up in their results and caused them considerable anxiety. Quite often, further investigation reveals that there’s nothing significant to worry about. Sometimes, what initially appears to be an abnormal finding isn’t clinically concerning at all.
Being able to explain that to someone, reassure them and tell them that their heart is healthy is incredibly satisfying. Taking away that anxiety and giving someone peace of mind is a very important part of what I do.
Equally rewarding is identifying opportunities to make a genuine difference to someone’s long-term cardiovascular health. That might involve picking up previously undiagnosed high blood pressure or high cholesterol, or recognising an important family history. I can then explain the risks, help people understand what they need to do and put a plan in place to reduce their chances of developing heart disease in the future.
If I see a younger patient who has developed heart disease, for example, I’ll often encourage them to speak to their close relatives about getting screened. There may be an inherited risk, and identifying that early could make a significant difference to other members of the family.
Then, on the less frequent occasions when someone presents with something genuinely urgent, there’s the satisfaction of being able to investigate the problem quickly and arrange the treatment they need.
That’s one of the real advantages of private healthcare and, specifically, being based at Welbeck. I remember a patient who came to see me a couple of years ago with chest pain. He had initially gone to A&E but, after waiting around 12 hours without being seen, decided to leave and arrange an appointment with me instead.
We organised a CT scan that same day, which revealed a very tight narrowing in one of his coronary arteries. I arranged for him to be admitted to hospital, where he had a stent fitted that same day.
That was an incredibly satisfying outcome because we were able to identify a potentially serious problem, act quickly and get him the treatment he needed. Ultimately, it’s about making a difference to people’s lives, whether that’s reassuring someone who’s worried about their heart, reducing their future risk or treating a potentially life-threatening condition.’
‘The fact that the way we work at Welbeck, where all of our specialists and services are on the same floor in our Heart Health centre, really helps. It’s what I would consider a concierge service for patients. Our patients can have their tests all sorted out at the same level, which is just nicer for them. If I want something done urgently, I can walk over to a member of the team and explain that I want that test done immediately. Even if they don't have slots, they'll find a way to do it. We really do work together for the betterment of the patient.
The Welbeck model also allows us doctors to shape how we deliver the care, which is not how it works in other places. We can all do things which we know are good for us, and we're not ruled by the ‘corporates’. It’s quite revolutionary.
Not just in cardiology but in other specialities at Welbeck, we’re passionate about making sure that the best person sees the patient for their problems. We can monitor a patient and say, “Well, actually, you've got this condition; there are five world-famous cardiologists for that condition at Welbeck, and you’ll see one of those.” I can pick up the problem, do all the tests, tell a patient what they need, and then refer them to someone who's not just the best in the country, but one of the best in the world. The patient really gets the best deal.’
‘I saw Dr Wasan last year with symptoms of chest pain. He took my concerns seriously and explained the recommended tests clearly and thoroughly. Thankfully, all of the results were reassuring, but he did identify that my blood pressure was higher than it should be, and we discussed some lifestyle changes that might help. His advice felt practical and achievable. I particularly appreciated the way he approached the consultation as a conversation and a partnership. I felt listened to and involved in the decisions, rather than simply being told what to do, and that made it much easier for me to act on the advice. A year later, I’ve lost around 10kg, I’m exercising 4 to 5 times a week, drinking much less, and my home blood pressure readings have improved significantly. The hard work came from me, but Dr Wasan was definitely part of that journey. Thank you.’
– Patient of Dr Wasan
Dr Balvinder Wasan and Welbeck’s wider team of cardiology specialists diagnose and treat a wide range of symptoms and conditions in state-of-the-art facilities, with access to the latest tests and treatments. All care is tailored towards the individual, taking into account your symptoms, medical history, lifestyle, and personal needs.
To arrange an appointment, contact our dedicated Heart Health centre today. We offer same- and next-day appointments wherever possible, so you can access the care you need when you need it.
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