Heart failure is a condition in which the heart is unable to pump enough blood to the body. This can lead to significant health problems. But according to Stacey Gardiner, MD, cardiologist and Medical College of Wisconsin faculty member, many people underestimate the available options.

“When people hear the term ‘heart failure,’ they think it’s sort of an endgame for them,” Dr. Gardiner said. “However, with the right treatment, many patients can go from impaired heart function to improved or even normal heart function. Our goal is to get people doing the things they enjoy again and better able to participate in physical activities.”

The most common symptom of heart failure is shortness of breath.

“People may experience difficulty lying flat or sudden waking at night due to breathing difficulty,” Dr. Gardiner said. “Other symptoms include fluid buildup in the lungs, swelling of the legs and fatigue with exertion.”

Common Heart Failure Symptoms

  • Swelling
  • Fatigue
  • Shortness of breath from simple activities
  • Trouble breathing at rest
  • Chest pain
  • Coughing

Early diagnosis and treatment of heart failure gives people the best chance of prolonging their life.

Dr. Gardiner is one of a large team of specialists who see patients in the Froedtert & MCW Comprehensive Heart Failure and Transplant Program.

“Because heart failure exists along a spectrum, it really does require a team-based approach to care,” she said. “Our program includes physicians and clinicians who address every aspect of heart failure. We all work together as a team — and that is the key to reducing hospitalizations for people with heart failure, lessening mortality and improving their quality of life.”

Medication Management for Heart Failure

Medication therapy is the cornerstone of care for people with heart failure, but getting patients on the right combination of medications takes time and careful management.

“There are four classes of heart failure medication that make up what we call Guideline-Directed Medical therapy, or GDMT,” said Jonathan White, PharmD, clinical pharmacist in the Heart Failure Clinic. “These drugs make the heart pump more efficiently. And when your heart is pumping better, you tend to feel better and you’re able to do the things you want to do.”

GDMT also helps prevent events that send people with heart failure to the hospital. The key is to identify the patient’s maximum tolerated dose for each medication. To do this, clinical pharmacists stay in close contact with patients between their regular cardiology appointments.

“Regular follow-up between physician appointments is where patients see the most value from working with a clinical pharmacist,” White said. “We can make a small change in medications to get a patient closer to their target dose and then follow up in a week or two to make sure it is working appropriately.

“I worked with one patient who lived far away, and he was having a hard time coming in for visits. He was on two medications and not having the quality of life he desired. Through virtual visits, we were able to adjust his GDMT, and now he is doing really well.” 

Innovation Treatment Options for Advanced Heart Care

Nunzio Gaglianello, MD, advanced heart failure and transplant cardiologist and MCW faculty member, works with patients who require a higher level of care. One newer option is a miniature implant (smaller than a dime) that monitors pressure within the heart.

“We have found that pressures start going up about a week before the patient develops symptoms,” Dr. Gaglianello said. “When we get that early warning, we can then be aggressive about increasing the patient’s medications and, hopefully, keep them from being admitted to the hospital.”

Another type of implant uses electrical stimulation to dampen the abnormal fight-or-flight response that can damage heart function long term.

“The initial data shows that this device can improve quality of life and functional capacity for patients with significant heart failure,” Dr. Gaglianello said.

For patients with the most advanced heart failure, the Froedtert & MCW health network offers one of the nation’s premier heart transplant programs.

Heart Failure Treatment Options with Second Opinion

While transplant and other advanced therapies are centered at Froedtert Hospital, the academic medical center of the health network, most ongoing care can be managed at health center locations throughout the network. In addition, people diagnosed with heart failure elsewhere can explore new treatment options via the Second Opinion Program.

“What I love about my job is that I have the chance to work with patients for years and really get to know them,” Dr. Gaglianello said. “Then when it comes time to consider the next level of care, there is a relationship of trust. It is fulfilling for me as a physician — and it’s really good for the patient.”

Our heart failure team offers the full spectrum of options, from early-stage to advanced heart failure. For an appointment, call 414-777-7700. For more information, visit froedtert.com/heart-failure.