Transcription:

Bill Klaproth (Host): The heart is a muscle that pumps oxygen rich blood to all parts of the body. When you have heart failure, the heart can't pump as well as it should, or the heart muscle can't relax and fill the pumping chamber with blood. Blood and fluid may then back up into the lungs. This causes congestive heart failure.

The specialists at NHRMC Physician Group Cape Fear Heart Associates have developed a comprehensive and multidisciplinary program around heart failure and more specifically around a specific course of treatment to help a patient suffering from this disease. It's called the left ventricular assist device or LVAD. So, let's learn more about the LVAD with Bridgette Williams, a Nurse Practitioner and Rebecca Westendorff, a Physician Assistant, both with NHRMC Physician Group Cape Fear Heart Associates.

This is the Healthy Conversations podcast from New Hanover Regional Medical Center. I'm Bill Klaproth. Bridgette and Rebecca, thank you so much for your time. It is great to talk with you. Bridgette, let's start with you. Can you explain to us what exactly is an LVAD and how does it work?

Bridgette Williams, FNP-BC, MSN, RN (Guest): An LVAD is a left ventricular assist device and essentially what it does, it's a device that replaces the pumping action of your heart, and it gets implanted in the left ventricle and it's there to essentially take over the pumping action of your heart muscles.

Host: Okay. And then Rebecca, what are the conditions under which an LVAD might be needed?

Rebecca Westendorff, PA-C (Guest): An LVAD would be needed in a patient with advanced systolic congestive heart failure. That's when the bottom chamber of the heart does not pump very effectively. So, you had the advanced class IV congestive heart failure. You have very limiting symptoms. You have dyspnea or shortness of breath at rest. You can't lay back and sleep because your lungs fill up with fluid. You have swelling, great fatigue. And an LVAD is good in patients that have advanced systolic congestive heart failure and they are failing guideline directed medical therapy. And sometimes those patients have a special pacemaker that has already been put in to help the heart muscle get stronger.

Host: Okay. Really good. So, Bridgette, can you share just a little bit more detail about heart failure? What do we specifically need to know about that?

Bridgette: So, heart failure is a chronic condition when your heart is not pumping the blood or the oxygen to meet the demands of the body. So, either your heart muscle is too weak and it can't get the circulation going, or your heart muscle is too thick and it causes fluid to back up. And essentially this is what causes congestive heart failure.

Host: Right. And Bridgette, can you tell us about the types of patients who would most benefit from the use of an LVAD?

Bridgette: So, patients who are not able to manage their symptoms anymore because they're failing medical therapy, they're not able to advance with their medicine to help their pump. Patients who have caregivers, because patients who get LVAD do need a caregiver to help them be around when there are certain things going on with their pumps. So, and they've got to have a basic understanding of what their need are. They've got to be able to take medication, but when they are failing all those, that's when we'll send those patients out for consideration of an LVAD.

Host: And then Rebecca, can you tell us why Cape Fear Heart Associates launched an LVAD program? When did it begin and how it has grown? And also, can you explain the work that you do with do DUMC and UNC?

Rebecca: So, Cape Fear Heart Associates started a Shared Care Program with Duke University in approximately 2012. Duke is the largest LVAD implanting center in the country and its hardship for patients with LVADs to travel two, three hours every three months to see their heart failure cardiologists, have their LVAD checked. When we first started the Shared Care Program, we saw LVAD patients every three months, just for routine care. That was with myself and one of the other cardiologists. And we did not see a lot of patients at that time. Just usually saw three or four patients every three months. And then that advanced into a larger LVAD patient population with Cape Fear Heart Associates since we had a heart failure specialist join our practice named, John Rommel and Bridgette who was a heart failure specialist and Dr. Rommel work together.

I'm still involved in the Shared Care Program. And so, currently we see LVAD patients that are relatively stable. We usually see about four patients once a month and Bridgette and I usually alternate seeing those patients always with Dr. Rommel. If there is a problem with the LVAD, there's a complication, or if the patient has another medical condition that needs to be admitted to the hospital, that patient still has to go to their implanting center. Most of our patients had their LVADs put in at Duke or at Chapel Hill. We have a couple patients also Moses Cone in Greensboro, but we also see patients that have problems.

If they are worried about a drainage from where their LVAD, the cord exits their abdomen, or they have some worsening heart failure symptoms, Cape Fear Heart can see the patient in the office, usually figure out what's wrong with a patient without sending them back to Duke or UNC. So, it's a good program for the patient and we still work closely with Duke and UNC, but it gives the patient a different alternative from having to travel, especially when they think there is a problem.

Host: That's great. And let me ask you both the same question, Rebecca, let me stay with you. So, how has the program been doing?

Rebecca: The program's been doing great. Bridgette can probably talk about this more. We refer patients to Duke or UNC for LVADs, the heart transplants. There's not a lot of people giving up their hearts. And so people that need a transplant, often cannot get one. And so an LVAD can be implanted for patients with advanced systolic congestive heart failure that have an indication to get a new heart, but they're not able to do so.

Host: And Bridgette, can you expound on that and share your thoughts on how the LVAD program is doing?

Bridgette: The LVAD program is growing by leaps and bounds. It started really small in 2012, and now it's gone from an every three months to an every month. And then also additional visits as needed. We work closely with Duke University Medical Center and UNC Chapel Hill seeing their patients who live locally. We generally rotate on a three monthly basis, but if they're having acute issues that can be managed locally without them having to drive up two or three hours to the implanting center, we see them for those acute visits as well.

Host: And then Rebecca, what are the symptoms we need to look out for that would suggest someone might have congestive heart failure.

Rebecca: Yeah. So, frequent symptoms, when patients have acute congestive heart failure, if you're diagnosed with congestive heart failure, you always carry that diagnosis. And so you can have chronic congestive heart failure. But acute congestive heart failure, some of the frequent symptoms are shortness of breath that's not normal for you, waking up in the middle of the night with shortness of breath. If you usually sleep on one pillow, but you go back to sleep or get in bed and you get on that one pillow, but you feel short of breath. You wake up gasping for air. You have to prop yourself up on more pillows. If you have swelling, it's of both legs, ankle area. Sometimes people have a cough and they think they have a little cold or sometimes it's not due to a cold, but it's due to acute congestive heart failure.

Host: Well, it's important to understand what we're looking for and then Bridgette, last question. And thank you both so much for your time. Is there anything else you would like the listener to know about LVADs, the program or congestive heart failure?

Bridgette: Absolutely. I think being aware of their symptoms, you know, if they've been seeing a doctor and they're having recurrent symptoms, they not getting better, they are short of breath, they have leg swelling, they sort of have a cough that's not going away; never be afraid to ask for a second opinion. An LVAD is something if the right person needs it, that gives them back both their quality and their quantity of life. They are able to do a lot of the things that they stopped doing due to their symptoms. And now they're able to stay at home in Wilmington or Southeast North Carolina and get care locally.

Host: Well, thank you both for talking to us today about the LVAD program. This has really been informative and interesting, and I know for some people, this may very well save their life. So, Rebecca and Bridgette, thank you both very much for your time.

Bridgette: Thank you.

Rebecca: Thank you.

Host: That's Bridgette Williams and Rebecca Westendorff. And to learn more about heart failure or the LVAD program visit nhrmcphysiciangroup.org. That's nhrmcphysiciangroup.org. And if you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you.

This is the Healthy Conversations podcast from New Hanover Regional Medical Center. I'm Bill Klaproth. Thanks for listening.