New approach to heart failure helps patients regain quality of life

Winnie knew something wasn’t right. But she just didn’t understand what her body was trying to tell her. It was a variety of symptoms that gradually grew worse. First, there was the reflux. It was so bad that sometimes she would throw up after meals. Then her legs and feet began to swell. Her lungs became so congested at night that she had to prop herself up with six pillows or more so she could breathe. She was growing more tired and weaker all of the time.

“I just kept ignoring the symptoms and telling myself that I was sick or it was my heartburn,” says Winnie. Then her son noticed a pulsating mass on the side of her neck. That was the last straw, she recalls. It was time to see a doctor.

A visit to her doctor and an echocardiogram revealed that her ejection fraction (a measurement of how much blood the heart pumps out with each heartbeat) was severely reduced to just 10% to 15%(normal is over 50%). Winnie was referred to Douglas Stoller, MD., Nebraska Medicine advanced heart failure specialist and transplant cardiologist. Nebraska Medicine is the region’s leader in heart failure. The Nebraska Medicine Heart Failure Program is the largest and only Joint Commission-certified heart failure program in the state.

“Winnie was in advanced stages of heart failure,” says Dr. Stoller. “While more than half of heart failure cases are caused by coronary artery disease, in Winnie’s case, she had non-ischemic heart failure, meaning her heart failure was not caused by coronary heart disease but by other factors or conditions that may have predisposed her to heart disease.

“Winnie’s presentation was quite unique. The pulsating mass on the side of her neck was a condition called jugular venous distention (JVD). The jugular vein is like a water gauge for the body. The degree of distention is based on how much extra fluid you have in the body. While this condition is common in heart failure patients, in Winnie’s case, it was remarkably distended and obvious. She was in fluid overload.”

Dr. Stoller initially started Winnie on diuretics to reduce fluid build-up. But Winnie’s symptoms continued to persist. Then one morning, she woke up and couldn’t get out of bed. “I felt so fatigued,” she recalls. “My body just wouldn’t respond. I couldn’t talk or walk or get up to take a shower. I felt like I was drowning in fluid.”

Winnie was admitted to the heart failure inpatient service at the Nebraska Medical Center, where she was placed on intravenous therapy (IV) to remove the excess fluid. After five days, Winnie left the hospital 15 pounds lighter, as a result of fluid removal.

Winnie was started on several heart failure medications and was referred to the Nebraska Medicine Heart Failure Optimization Clinic, designed to enhance the care of patients with heart failure and help them live longer. Using a multi-disciplinary approach of heart failure providers, pharmacists, nutritionists and nurses, the new approach follows guideline-directed medical therapy developed by the American College of Cardiology, American Heart Association and Heart Failure Society of America. Members of this team provided Winnie with education on medications, nutrition, and exercise to help her manage her disease more independently.

“This approach is designed for patients who have been hospitalized with heart failure in the past year or have a new heart failure diagnosis,” says Dr. Stoller. “Oftentimes, patients are started on heart medications, but they are not followed closely and their medications are not adjusted. Our goal is to follow them closely, start them on proven, guideline-directed medications, and slowly increase their doses until they have been optimized. There is solid evidence that patients who are treated aggressively with these guideline-directed medications, experience improved mortality and fewer hospitalizations caused by heart failure.”

After just a couple visits, Winnie says she had already begun to feel better. “When I started, I could only exercise for about five minutes,” she says. “After three weeks, I was walking and jogging, lifting weights and bicycling for 45 minutes. I couldn’t believe how quickly I started feeling better.”

“Close follow up and medication optimization is an important aspect of heart failure management,” says Theresa Diederich, NP, heart failure nurse practitioner. “Heart failure is one of the top diagnoses that cause patients to be readmitted to the hospital. Our goal is to keep them out of the hospital and feeling better again. Winnie was very engaged and motivated. When she arrived, she could barely walk a half block. Now she is doing so much better and has much more energy.”

Within a couple of months, Winnie’s ejection fraction had risen to 30% to 35%. “As we continue to optimize Winnie’s medications, I expect her heart function to improve,” says Dr. Stoller. “If Winnie had not been started on aggressive medical therapy and followed closely by our heart failure team, I don’t think she would be doing as well as she is today.”

“I feel so good now,” says Winnie. “I had read a story about someone with heart failure, but I never dreamed that was what was happening to me. I thought that was for old people. I just thank God that I was in the right hands. The care here has been just amazing. I felt like I was among family. When I first started going to the clinic they told me, ‘we want to make you better as soon as possible,’ and that’s what they did.”

This story was provided to the foundation courtesy of Nebraska Medicine.