Cardiology Spotlight: Far north local's heart for rural health

Cardiologist and JCU alumnus Dr Anthony Brazzale took an ‘all in’ approach to pursuing his career in medicine and it has certainly paid off. His journey into cardiology has taken him from Far North Queensland to major health services across the country and back again. As a Consultant Staff Specialist at Cairns and Hinterland Hospital and Health Service (CHHHS), he is part of one of the country’s leading cardiology units and is committed to helping address outback Queensland’s escalating heart disease epidemic.

The grandson of Italian immigrants, Dr Brazzale grew up on the family tobacco farm (now mango farm) in Mutchilba, a small community an hour and a half drive north-west of Cairns. His first exposure to cardiology came at a young age from an unexpected role in supporting his grandfather through treatment for heart disease.

“I was always very interested in biology and medicine, but the experience with my grandfather’s illness left an impression on me and was a driver for sure,” Dr Brazzale says.

“They don't know the cause of his heart failure, but his heart was functioning at 10% of what is considered normal. Because my parents were working long hours on the farm and I could speak a little Italian, I would go into town to appointments with him and translate what the doctor told him,” Dr Brazzale says.

Graduating at the top of his class from Mareeba State High School, Dr Brazzale decided to pursue his childhood dream and enroll in Medicine at James Cook University (JCU).

“I didn't have a backup option because there wasn’t anything else I was that passionate about. It was either medicine or going back to the family farm.

“Given my country upbringing and JCU’s focus on rural health, it was the perfect fit for me,” Dr Brazzale says.

After graduating with First Class Honours and completing his internship in Cairns, Dr Brazzale made the move to Brisbane and subsequently the Sunshine Coast to pursue cardiology training. Once he had developed a solid foundation in clinical cardiology he headed further south for a year of sub-specialty training in Interventional Cardiology at Western Health in Melbourne.

Keen to return to the Far North, Dr Brazzale moved back to Cairns in 2017, commencing at Cairns and Hinterland Hospital and Health Service (CHHHS) as a Consultant Staff Specialist in Interventional Cardiology. He also works in private practice offering a range of services in contemporary cardiac care.

Why I am passionate about cardiology 

Inspired by his own experiences and early exposure to the specialisation, Dr Brazzale’s passion for cardiology is immediately evident. He says it’s the type of specialisation that has enabled him to ‘write his own story’ as a physician. 

“I get excited to come to work every day. To me, it’s not just a job it’s what I do. I am privileged to be able to meet patients and their families, in clinic or during their hospital stay, and take the journey with them to improve their health. In doing so, I also have the opportunity to perform procedural work, in the form of interventional procedures. There is a lot of variety in the job, which I think is very important.”

“There is a balance between life and family. I have Thursday afternoons dedicated to family life, as also I run my own private practice which I work at one and a half days a week when I am not the Hospital. Every day I am continuing to learn and develop as a doctor, and I think that’ll never end,” Dr Brazzale says.

Cardiology in Far North Queensland 

The Cardiac Unit at Cairns and Hinterland Hospital and Health Service (CHHHS) has established a reputation as a national leader in clinical care and research. With two new cardiology cath labs, the unit’s output rivals its metropolitan counterparts.

“Based on the numbers of procedural work we perform, we are rivaling the output of cath labs in much larger metropolitan areas, such as those in Brisbane. We’re performing over 550 stent procedures per year,” Dr Brazzale says.

The growth of the unit is a necessary response to the high prevalence of cardiovascular disease in North Queensland. According to the Heart Foundation’s Australian Heart Maps, the Queensland Outback region has the second-highest age-standardised rates of hospital admission for heart disease in the country, behind only the Northern Territory Outback.

“We have such high rates here, particularly of preventable cardiac diseases like rheumatic heart disease,” Dr Brazzale says.

“We’re dealing with a younger cohort of people here and you see all sorts of medicine and cases. I feel the work here is very satisfying.”

“The Cardiac Unit here is young and dynamic, and there is a real focus on getting out into the community with initiatives like our outreach clinic. The way you treat people is by getting to know them in their community. You get them involved. That’s how you improve healthcare and that’s what we offer here,” Dr Brazzale says.

“We’ve a range of cardiology sub-specialties here in cairns (interventional, imaging, electrophysiology) so you can do most of your training in regional or semi-regional areas. Though I still recommend trainees do a stint in a metropolitan hospital. I think you need to experience what else is out there and then appreciate what you have here as well!”

Rural Opportunities

The Cardiology Unit at CHHHS is helping dispel the myth that metropolitan centres offer more opportunities for specialty training. In his role as a supervisor, Dr Brazzale has seen many junior doctors discover the quality training experience on offer in northern Queensland.

“We have advanced trainees that come from Brisbane, and they all want to come back here now as consultants. They tell us this is one of the best training centres in Australia. The opportunities you get here, you’ll get nowhere else.” 

A stand-out opportunity for trainees is the unit’s outreach clinics to the Cape – all the way from the Torres Strait down as far South as Innisfail. Now in its third year, the outreach program offers specialist cardiology services to communities that would otherwise have to travel long distances to access care.

“We intentionally send the same consultants to the same communities so that they can establish a relationship with the patient and the community. Continuity of care is really important, Dr Brazzale says.

“The feedback from trainees on the outreach program has been excellent. For doctors from the city, they want to come up here, particularly for their final years of specialty training where they’ve got the skills and want to use them where they’re needed,” Dr Brazzale says.

The pathway to specialty training in Cardiology

To apply for specialist training in cardiology, you must first complete Basic Physician Training. In Queensland, there is the Queensland Basic Physician Training (Adult Medicine) Network which is a stateside network designed to support Queensland trainees complete the first three years of basic training. Following completion of the course, including RACP written and clinical examinations, you are then eligible to apply for an Advanced Training position in Cardiology.

Following three years of core training, trainees will then complete a further one to two years of training in a sub-specialty. Sub-specialisations include advanced cardiac imaging, electrophysiology and pacing, interventional, structural, advanced heart failure and adult congenital cardiology.

Dr Brazzale says the sub-specialties enable physicians to discover a particular passion and improve their skills in a niche area.

“What separates cardiology from other specialties is that we have sub-specialties within our specialty. If you're the sort of doctor who doesn't want race into work in the middle of the night for an emergency heart attack, you can always choose a less acute sub-specialty .

Stand out through unique research opportunities

If you’re interested in pursuing a career in cardiology, Dr Brazzale says getting involved in research is a great way to make your application more competitive. The CHHHS Cardiac Unit is involved in many research studies and multi-centre clinical trials.

“Research can help you in the application process because it demonstrates initiative. You don’t have to do an independent study that gets published in the Lancet, you just need to get involved. It could be in the form of an audit or poster presentation at a national meeting,” Dr Brazzale says.

“Medical students have recently helped to submit an abstract for our national cardiology meeting on Patent Foramen Ovale (PFO) closure procedures performed in Cairns. For a hospital without cardiothoracic surgery we have a large case volume and assessing our outcomes is pivotal to improving healthcare delivery in North Queensland.” Dr Brazzale says.