Clinical Briefing: Comprehensive Care at Every Stage of Heart Failure
March/April 2008
The Heart Failure
and Transplantation Program at the Hospital of the
University of Pennsylvania (HUP) has developed a multidisciplinary algorithm for
heart failure management that reflects the chronic, progressive nature of the disease.
“In
designing a heart failure management program,
it's vitally important to
embrace continuity of care, ideally beginning well
before the first symptoms
appear, to ensure consistent, appropriate treatment
throughout the natural
course of the disease.”
– Mariell Jessup, MD
Medical Director,
Heart Failure and Transplantation
Program |
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Case Study
Mr. W, a 58-year-old male with a two-year history of non-ischemic
cardiomyopathy, was referred to the Penn Heart Failure
and Transplant Program. At presentation, his medications
included carvedilol 25 mg BID, lasix 40 mg BID, enalapril
20 mg BID, and spironolactone 25 mg QD. Despite good compliance
with this regimen, Mr. W was increasingly symptomatic,
requiring an increase in his daily diuretic dose.
After
consultation at Penn, Mr. W was electively scheduled for
right heart catheterization, which revealed a markedly
abnormal cardiac performance, with a cardiac index of only
1.4L/min/m2 and an elevated pulmonary capillary wedge pressure
(35mmHg) with normal systemic vascular resistance. Milrinone
was initiated following admission to the inpatient heart
failure unit, with improvement in cardiac index.
An inpatient
heart transplant evaluation was begun with the transplant
team, including the nurse coordinator for transplant assessment and education,
a social worker to address potential psycho-social concerns pre- and post-transplant,
and a financial counselor to verify insurance and prescription coverage. A battery
of lab tests was performed to more accurately determine
Mr. W’s risk at the time of
transplant and to aid in individualization of his post-transplant immunosuppression.
Mr.
W felt much better on inotropic support, although he developed
significant ventricular dysrhythmias. At the weekly multidisciplinary
transplant meeting, the cardiac surgeons decided to evaluate
Mr. W for a ventricular
assist device (VAD) as a bridge
to transplant. Subsequently, he underwent successful implantation
of the HeartMate® II.
His recovery was uneventful. To ensure that he would be
in optimal condition for his transplant, he was followed
closely by the nutritionists and physical therapists on
the transplant team.
After successfully completing 6 weekly
outpatient appointments with the VAD coordinators and HUP
transplant cardiologists, Mr. W underwent heart
transplant surgery. He has done remarkably well post-transplant. He
eagerly talks about his experience and serves as an inspiration
to those who are waiting on the list. He now comes in on
a routine basis for his cardiac biopsies and is scheduled
to start cardiac rehabilitation soon.
Our Team of Faculty
The Heart Failure and Transplantation Program at Penn is comprised
of a multidisciplinary team of specialists and clinicians whose experience spans
the breadth and depth of heart failure care. The team includes some of the
nation's finest cardiologists, cardiovascular surgeons, nurses, transplant and
VAD coordinators, as well as social workers and specialists in cardiac imaging,
arrhythmia management, cardiac anesthesia, infectious disease, immunology and
rehabilitation medicine. Together, this team is dedicated to the management of
patients with complex heart failure.
Hospital of the University of
Pennsylvania
Cardiovascular Surgery
Michael A. Acker, MD
Chief, Cardiovascular Surgery;
William Maul Measey Professor
of Surgery
Rohinton J. Morris, MD
Surgical Director, Heart Failure &
Transplantation Program;
Clinical
Associate Professor of Surgery
Alberto Pochettino, MD
Associate Professor of Surgery
Wilson Szeto, MD
Assistant Professor of Surgery
Y. Joseph Woo, MD
Assistant Professor of Surgery
Heart Failure/Transplant
Mariell L. Jessup, MD
Medical Director, Heart Failure
& Transplantation Program
Professor of Medicine
Susan C. Brozena, MD
Associate Professor of Medicine
Thomas P. Cappola, MD,
ScM
Assistant Professor of Medicine
Daniel L. Dries, MD
Assistant Professor of Medicine
Lee R. Goldberg, MD, MPH
Associate Professor of Medicine
Kenneth B. Margulies,
MD
Associate Professor of Medicine
Joyce W. Wald, DO
Assistant Professor of Medicine
Paul Forfia, MD
Assistant Professor of Medicine
Penn Presbyterian Medical Center
Ross
R. Zimmer, MD
Director, Heart Failure Program;
Clinical Assistant Professor of Medicine
Brian M. Drachman, MD
Clinical Assistant Professor of Medicine
Transplant Nurse Practitioners
Susan Chambers, RN, MSN, CRNP
David Drajpuch, RN, MSN, CRNP
Nicole Hornsby, RN, MSN, CRNP
Wilhelmina Maslanek RN, MSN, CRNP
Patrice Schneider, RN, BSN
Patricia Stutman, RN, MSN, CRNP
Bridget Vincent, RN, MSN, CRNP
Mary Williams, RN, MSN, CRNP
Social Work
Deborah Gordon, MSS, CSW
Financial Coordinator
Cammy McCaskill
Clinical Manager
Donna Chojnowski, MSN, CRNP
Access
Patient appointments are available at:
Penn Heart and Vascular at the
Hospital of the University of
Pennsylvania
6 Penn Tower
3400 Spruce Street
Philadelphia, PA
Penn
Heart and Vascular at
Penn Presbyterian Medical Center
Philadelphia Heart Institute, 4th Floor
38th and Market Streets
Philadelphia, PA
To refer a patient and/or consult
with a doctor, call 800-789-PENN (7366) or
you can also refer
a patient online.
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