sMater - Heart Week - Dr Nick Aroney

Cardiovascular disease remains one of Australia’s leading causes of death — and general practice sits at the heart of prevention, early detection and timely escalation.

In this Heart Week episode of sMater, host Jillian Whiting and GP specialist Dr Maria Boulton are joined by Dr Nick Aroney, interventional and structural cardiologist at Mater, to unpack what frontline clinicians need to know right now.

Together they explore:

• How much heart disease is truly preventable
• When CT coronary calcium scoring can change management
• Navigating statins, soft plaque and patient resistance
• Recognising atypical presentations, particularly in women
• When symptoms should trigger urgent escalation
• The quiet progression of valvular heart disease — and why auscultation still matters
• How advances like TAVI, AF ablation and heart–brain teams are reshaping outcomes

This is a practical, evidence‑informed conversation designed to support everyday decision‑making in general practice — when to reassure, when to escalate, and how evolving cardiology care can change lives.

sMater is a podcast by clinicians, for clinicians, brought to you by Mater.

To learn more about Mater, visit https://www.mater.org.au/

Transcript

Jillian Whiting:
Hello and welcome to sMater — a podcast by clinicians, for clinicians, brought to you by Mater, an Australian leader in healthcare for more than a century. I’m your host, Jillian Whiting.

Dr Maria Boulton:
And I’m Dr Maria Boulton, GP specialist and former President of AMA Queensland.

Today, to mark Heart Week, we’re talking about one of the most important — and preventable — health challenges facing Australians today: cardiovascular disease. And importantly, what this means for clinicians on the front line — recognising risk, knowing when to escalate, and understanding the rapidly evolving treatment landscape.

Joining us is Dr Nick Aroney, a Queensland‑born, bred and educated interventional and structural cardiologist. Nick has particular expertise in aortic stenosis, acute coronary syndromes, structural heart disease, cardiac 3D modelling and risk factor modification.

We are Mater.
This is sMater.

Nick, Welcome

Jillian:
Nick, welcome to sMater.

Dr Nick Aroney:
Thank you for having me.

Jillian:
Let’s start with you. Can you tell us a little about your work and what you see every day as a cardiologist in Queensland?

Nick:
First and foremost, I’m a general cardiologist. I spend a lot of my time seeing patients in clinic and on the ward — people coming in with symptoms like chest pain and breathlessness — organising investigations and getting to the bottom of what’s going on.

Another big part of my work is seeing patients with cardiovascular risk factors and working on how we can lower their long‑term risk of heart disease.

My other role is as an interventional cardiologist, working in the cardiac catheterisation laboratory. That’s where I perform minimally invasive, keyhole procedures — putting in stents and replacing valves.

Referral Pathways

Dr Maria Boulton:
As a GP, it can sometimes be challenging to know which cardiologist to refer to. As a general cardiologist, do you see all comers?

Nick:
Yes, definitely. I see patients right across the spectrum — high blood pressure, high cholesterol, coronary artery disease and valvular heart disease.

My specialty interest is treating coronary artery disease — patients with chest pain, blocked arteries who may need stents or bypass surgery — and valvular heart disease, which often affects an older population presenting with breathlessness or a heart murmur.

Why Interventional Cardiology?

Jillian:
What drew you to interventional cardiology?

Nick:
I found it incredibly satisfying. You can take someone who arrives very unwell with a heart attack, identify a blocked artery, open it up, and see them dramatically better within minutes — often heading home the next day.

It’s the combination of imaging, procedural skill and tangible, immediate benefit for the patient.

Earlier Diagnosis — or Still Too Late?

Dr Maria Boulton:
Are patients presenting earlier these days, or still coming in late?

Nick:
There are really two groups. One group is very motivated and proactive about risk factors — cholesterol, blood pressure — and they want to do everything they can to improve longevity. That’s fantastic.

But we still see the classic patient who’s had chest pain for weeks, brushing it off as reflux or musculoskeletal pain, and they often present in quite a bad way. So we’re still seeing both populations.

Women and Heart Disease

Dr Maria Boulton:
What about women? Are they presenting when they should?

Nick:
Women often don’t experience the classic symptoms we’re taught — central chest pain radiating down the arm. Symptoms can be much more atypical, which means heart disease can be missed.

There’s also still a misconception that cancer is the leading cause of death in women, when it’s actually heart disease. Many women are busy caring for others and don’t prioritise their own preventive care.

The Role of General Practice

Narration:
Cardiovascular disease remains the leading cause of mortality in Australia, accounting for around one in four deaths — or a death every 12 minutes. More than 4.5 million Australians are currently living with cardiovascular disease, with the majority managed in primary care.

Dr Maria Boulton:
When we suspect coronary artery disease, what investigations should ideally be done before referral?

Nick:
Up‑to‑date bloods — lipids including LDL, HbA1c, smoking history and blood pressure readings — are essential.

I’m also a strong advocate for CT coronary calcium scoring, which allows personalised and individualised risk assessment beyond traditional calculators.

It helps identify people who might otherwise be labelled “low risk” but actually have early disease — and also reassures some patients who appear high risk but have zero calcium.

Statins and Soft Plaque

Dr Maria Boulton:
Are patients still resistant to statins?

Nick:
Less so once you can show them objective evidence. Patients with high calcium scores have risks equivalent to someone who’s already had a heart attack. When you explain that and show them the imaging, the conversation becomes much easier.

Soft plaque is more nuanced, but again, an informed discussion goes a long way.

Prevention

Jillian:
How much heart disease can realistically be prevented?

Nick:
A lot — probably 60–70% of meaningful cardiovascular disease — if we identify risk early and treat it aggressively. Prevention is the best treatment we have.

When to Escalate

Dr Maria Boulton:
When should GPs pick up the phone for an urgent review?

Nick:
Symptoms are key. Chest pain at rest, heart failure symptoms or uncontrolled atrial fibrillation should prompt urgent escalation.

A high calcium score alone isn’t an emergency — it’s stable disease that can be managed medically while awaiting review.

Valvular Heart Disease

Dr Maria Boulton:
When should murmurs or echo findings prompt referral?

Nick:
Any moderate disease with symptoms, or any severe valvular disease, should be referred.

Valve disease is insidious. Patients normalise symptoms and attribute them to ageing. If the stethoscope doesn’t go on the chest, the disease gets missed.

TAVI and Modern Valve Care

Jillian:
Treatment has transformed over recent decades.

Nick:
Absolutely. Severe aortic stenosis used to require open‑heart surgery or conservative management, with very poor outcomes.

Now we can treat many patients with TAVI — a 20–30‑minute keyhole procedure under light sedation, with patients often feeling better the next day. It’s dramatically changed survival and quality of life.

Imaging, AF and Technology

Nick:
Advances in imaging and 3D mapping have transformed atrial fibrillation care. New ablation technologies are safer and more effective, and we’re expanding these services at Mater.

Adult Congenital Heart Disease

Dr Maria Boulton:
Does Mater manage adults with congenital heart disease?

Nick:
Yes. We have a dedicated Adult Congenital Heart Disease Unit at Mater, working closely with the Queensland Children’s Hospital. These patients do best in specialised services.

Heart–Brain Collaboration

Jillian:
What work are you most excited about?

Nick:
Our heart–brain service, investigating young stroke patients for cardiac causes such as PFOs and offering minimally invasive closure when appropriate. It’s a highly collaborative model with excellent outcomes.

One Practical GP Focus

Dr Maria Boulton:
What’s one thing GP practices could focus on to make the biggest difference?

Nick:
Two things:
• Better risk assessment in younger patients
• Heart health checks — including auscultation — in patients over 70

So many cases of advanced valve disease are picked up late simply because no one listened to the chest.

Closing

Jillian:
Nick, thank you for joining us on sMater and for such a practical Heart Week discussion.

Nick:
My pleasure. Thanks, Jillian. Thanks, Maria.

Jillian:
This episode was recorded on Meanjin, the land on which it was recorded.
Thank you for listening. See you next time on sMater.