New Clinic Means Better Care for
Mary Ann Papp, DO
Medical College of Wisconsin Cardiologist;
Director, Heart Failure Clinic
According to Mary Ann Papp, DO, breakthrough care for heart failure will come not from new drugs, but from doing a better job of delivering current therapies to the 5 million people who need them. Froedtert & Medical College's brand-new Heart Failure Clinic, she says, is an innovative way to connect patients with effective treatments.
Q. What is heart failure?
First of all, heart failure is not a heart attack. Heart failure is a condition that develops when the heart's muscle becomes weakened after a variety of injuries, one of which might be a heartattack. Others may be simply high blood pressure, age and toxins such as alcohol or drugs. The weakened muscle then fails to meet the demands of the body.
Q. What is the current treatment approach? How does it compare to the previous philosophy?
Our therapy for heart failure, for years, was "this heart is weak, we need to make it go faster and harder" — whipping it like a race horse. Every attempt to do that resulted in earlier death. For ten years, every drug that stimulated the heart not only failed to improve heart failure, but increased the death rate. It was a rational approach — the heart is weak, make it go stronger —but it turned out to be completely wrong.
Instead of trying to whip the failing heart into a higher state of function, we recognized that just as you would take the saddle off the horse, rub it down, and let it walk around the track — that isthe way to get people to age 75.
Q. How widespread is heart failure?
It's very common in people over 65 and it affects 5 million seniors. In fact, heart failure is the mostcommon diagnosis for admission to adult hospitals.
There were only 80,000 new cases of heart failure in 1980 and now we have 690,000. The projected number for 2020 is that there will be close to 2 million people presenting with heartfailure every year.
The very success of our therapies for heart disease has caused a greater number of people to live longer to experience these chronic manifestations. Right now, we're in an epidemic mode.
Q. What should we do to manage the epidemic?
The greatest advances in heart failure treatment will not be in the creation of newer drugs, they will be in the effective delivery of the regimens we have now. Complicated drug regimens requiring frequent adjustment of dosages are confusing to patient family and healthcare providers, but they can be very effective. We need to have pharmacists taking part in the "day to day" not just the "bottle to bottle" management of medications.
The hospital is no longer the most convenient nor the most effective site of care for chronic illness like this. Hospitalization itself does not stop heart failure, you need six to eight weeks of expert care advancing doses of medications and adjusting them to your needs.
At Froedtert & Medical College, we're exploring new methods for delivering outpatient heart failure care. It's been done with cancer and surgi-centers and I think heart failure management will move in that direction as well. It's not only less costly, but more effective.
Q. How is Froedtert & Medical College treating heart failure on an outpatient basis?
Our new Heart Failure Clinic has been up and running since October 2003. The center has all the resources that would normally be available in the hospital, but in an out-of-hospital setting.
We have a dedicated floor for administering medications under observation. Patients can sit in a relaxed environment — basically in lounge chairs — and be treated with medications testing and diagnostic tools, similar to what's available in an inpatient setting but in an outpatient area.
Patients get more support. They get contact up to three times a week with a healthcare provider, whereas with a hospital stay they see their provider for three days out of the month.