Heart Disease: A Physician’s Perspective

NANCY SWEITZER, MD, PhD, is an internationally recognized cardiologist, physician-scientist and clinical researcher specializing in heart failure and transplant cardiology. Currently serving as associate director of the Institute for Clinical and Translational Science and vice chair of clinical research in the department of medicine at Washington University in St. Louis, she has previously led major academic programs as chief of cardiology and director of the Sarver Heart Center at the University of Arizona. A fellow of the American Heart Association, American College of Cardiology and Heart Failure Society of America, Dr. Sweitzer’s research centers on understanding and advancing therapies for heart failure with preserved ejection fraction (HFpEF).

BSTQ: What initially drew you to the specialty of heart disease?

Dr. Sweitzer: I’ve been in the field for a long time. What first drew me to cardiology, and then to heart failure, was the ability to treat people and make them feel better. I’ve now been involved in trials for 25 years; watching new therapies improve both the quality and duration of life has been incredibly gratifying. I always say I have the best job in the world. We care for people in shock, people who are dying, people who are critically ill, and we have tools that can save lives. But we also build long-term relationships with patients over years, even decades, helping them to feel better, stabilize their disease and achieve their goals.

BSTQ: How can we improve cardiovascular care for women?

Dr. Sweitzer: I would love to see more women in trials. Companies sometimes say, “We provide childcare,” but women in their 70s with heart failure don’t need childcare, they need husband care. Many are caregivers not just for children, but for spouses and family. That burden makes trial participation difficult, especially with heart failure. We need innovative ways to lower those burdens while still learning what we need to know. It’s also important to talk about awareness. When women are diagnosed with heart disease, they’re often shocked to learn it’s the number one killer of women. That’s because women don’t talk about it. Women with breast cancer share their diagnosis, but women with heart failure keep it quiet. Part of that is the stigma that heart disease is the result of bad habits. However, age is the biggest risk factor, and none of us can avoid aging. I hope we can relieve some of the shame and encourage women to talk about heart disease, thereby raising awareness and increasing research participation.

BSTQ: How does socioeconomic status influence trial design and outcomes?

Dr. Sweitzer: Socioeconomic status affects everything. If you have food or housing insecurity, the last thing you can do is participate in voluntary research. Yet cardiovascular risk disproportionately affects people with socioeconomic disadvantages, and we need more resources devoted to that problem. I practice in St. Louis, Mo., a city with a troubled history around race and inequity. We’ve done well enrolling minority and some disadvantaged patients in trials, but the truly disadvantaged, those facing multiple insecurities, can’t participate. They simply don’t have the capacity.

BSTQ: How is digital health influencing cardiovascular care?

Dr. Sweitzer: Digital health is very exciting. People are collecting more health data than ever, though right now it tends to be healthy people. It will be interesting when patients with chronic diseases start generating that data, which we can then interrogate and learn from. I recently uploaded an app that can estimate my risk of systolic dysfunction with an Apple Watch ECG. With AI, wearables and apps, we’ll have enormous opportunities for earlier and easier diagnosis. But again, it comes back to socioeconomic disparities. These tools tend to reach higher socioeconomic groups. The challenge is making sure digital strategies reach the populations who need them most. That’s a big societal issue we still need to solve.

BSTQ: What advice would you give to those entering the cardiology field?

Dr. Sweitzer: At this stage, my greatest satisfaction comes from helping young cardiologists and physicians build careers in clinical research. Those of us in clinical practice see unmet needs most clearly. We’re well-positioned to ask the right questions, then develop the skills and tools to design studies, gather data and move the field forward. For me, I’ve always kept both parts of my career alive: patient care and research  I love medicine and I love my patients, but I’m never happier than when I’m diving into new data and seeing what clues they hold. That’s the excitement I try to pass on to young people: Stay curious, ask great questions and keep both the science and the patient at the center of it all.