Shortening The Distance to Healthier Lives

Janet Llapitan still remembers how it felt when every breath was a struggle. When her doctors told her she had only a year to live. She’d survived breast cancer, only to face a deadly new threat: heart disease.

Heart disease is the leading cause of death for women in the U.S. Yet many women aren’t getting care that’s designed for the way their bodies experience and respond to heart disease.

At UW Medicine, specialists in the Division of Cardiology are working to better understand the complex ways that heart disease uniquely affects women. Their vision is to create a new UW Medicine Center for Women’s Heart Health, where women across the region can access world-class cardiovascular care backed by the latest research.

Because, for women like Llapitan, getting the right care can mean the difference between life and death.

“YOU’RE IN FIGHT MODE”

In May 2019, Llapitan’s annual mammogram revealed a lump. Her doctors recommended a mastectomy and chemotherapy, but the surgery caused bruising and bleeding, which had to heal before she could begin chemothe­­­rapy.

Llapitan started chemotherapy that September, but something didn’t feel right. At first, she felt like she had a severe cold; soon, she was struggling just to walk a few blocks or climb stairs. By December, Llapitan was fighting to breathe.

Llapitan’s doctor referred her to UW Medicine, where she began seeing April Stempien-Otero, MD, FACC, associate professor of cardiology, cardiology research and medicine. At UW Medicine, patients with heart disease are treated by collaborative teams of specialists from many disciplines to ensure the best possible care; Llapitan’s care team included cardiologists with specializations in heart failure and transplant, cardio-oncology and implantation of support devices.

She spent the holidays in the intensive care unit, and from then on, she would be in and out of the hospital every few weeks — including the day in July 2020 that she’d hoped would be her wedding day. (Llapitan later married her husband, Greg, in a small, pandemic-friendly courthouse ceremony.)

The chemotherapy had caused cardiomyopathy, a disease of the heart muscle that makes it hard for the heart to pump blood to the body. It’s a complication that particularly affects women with underlying heart disease. In Llapitan’s case, a small amount of coronary artery disease, so mild that it hadn’t been diagnosed, may have increased her risk.

In August, Llapitan went back into the cardiac intensive care unit, where her doctors had some devastating news: She had a prognosis of just 12 months. Her only option was a heart transplant, but they were concerned that she was too sick for surgery.

“That was one of the hardest conversations,” says Llapitan. “You’re in fight mode, you survive breast cancer and think you’ll be OK, but it didn’t turn out to be that way.”

Despite the bleak prognosis, Stempien-Otero continued to advocate for Llapitan, presenting Llapitan’s case at the transplant committee’s meetings.

“Janet was determined to get better,” says Stempien-Otero. “I wanted her to know that we were going to work through it together.”

“That was one of the hardest conversations,” says Llapitan. “You’re in fight mode, you survive breast cancer and think you’ll be OK, but it didn’t turn out to be that way.”

UNDERSTANDING HEART DISEASE IN WOMEN

While heart disease is the leading cause of death for both women and men in the U.S., women are dying of heart disease at a faster rate. This is largely because, until now, heart research has focused on male anatomy and the conditions that affect men — meaning that treatments based on that data are less effective for women.

As we learn more about how heart disease impacts women, the need for more gender-specific research and targeted clinical care for women has become clear. And, in turn, improving our understanding of heart disease in women will help lead to better treatments for everyone.

A new Center for Women’s Heart Health would be transformative in significantly reducing heart disease. The center will build upon UW Medicine’s collaborative, team-based approach to patient care. Cardiologists would partner with researchers and clinicians to study how heart failure and coronary artery disease uniquely affect women — and to develop treatments designed for them.

The center would also help improve healthcare equity by bringing inclusive, high-quality care to more women, especially from underserved communities. Updated and expanded clinical spaces, enhanced telemedicine services and culturally responsive care will enable the center to better serve patients.

It’s an ambitious vision. And, says Stempien-Otero, making the Center for Women’s Heart Health a reality will require equally visionary support from the community.

“Donors can help us build a center that delivers the best care, including telemedicine to reach more patients in the WWAMI (Washington, Wyoming, Alaska, Montana and Idaho) region,” says Stempien-Otero. “We can bring in national experts and offer community education. And we can increase the amount of women-specific research, which will ultimately help both men and women.”

A NEW GIFT OF LIFE

Stempien-Otero’s persistence paid off. The transplant team rapidly assessed that Llapitan was indeed a candidate for transplant.

“I think that having people stand up and speak for those of us who may not be the standard cases is so important,” says Llapitan. “Dr. Stempien-Otero was my main advocate and my biggest voice.”

But transplant recipients must be cancer-free for at least a year. To get Llapitan to that point, her team used an implanted heart pump called a tandem heart, placed using an innovative technique developed by Jamie McCabe, MD, FACC, section chief of interventional cardiology. The procedure involves inserting lines into veins on both legs, crossing one line into the aorta internally, then connecting the lines to an external pump. It’s physically demanding and carries its own risks, but it was Llapitan’s best chance.

In early September 2020, still in the cardiac ICU, Llapitan officially celebrated a year of being cancer-free and was placed on the heart transplant list. Weeks later, she had transplant surgery, and after two weeks in the hospital, Llapitan went home.

Three months after transplant, Llapitan can climb stairs and walk several miles. She’s thrilled at her progress and hopes to be running again at the six-month mark.

“I am so amazed by their knowledge, wisdom, compassion and empathy,” says Llapitan of her care team. “They’re incredibly smart and they work together as a team. I wouldn’t have wanted to be any place other than UW Medicine.”

From breast cancer, to heart disease, to transplant and survivorship, Llapitan’s experience reflects the many ways that the UW Medicine Center for Women’s Heart Health would help provide women with a lifetime of heart health care.

“Having an advocate who understands what you’re going through and can help you make those hard decisions is just part of what we’re trying to achieve with the Women’s Heart Health Center,” says Stempien-Otero.

Today, Llapitan, who recently retired as a King County Superior Court clerk, is focused on recovering and spending time with her husband. She’s thankful for Stempien-Otero and others who advocated for her and gave her a new lease on life, and she’s thinking about how to pay that forward.

“Every day I’m grateful — it’s a new gift of life,” says Llapitan. “I think of the donor often. Someone died so you could have a new life, and it makes you think of how you’re going to honor it. You don’t want to waste that gift; it’s huge.”

Written by Stephanie Perry

“Every day I’m grateful — it’s a new gift of life,” says Llapitan. “I think of the donor often. Someone died so you could have a new life, and it makes you think of how you’re going to honor it. You don’t want to waste that gift; it’s huge.”

HELP TRANSFORM WOMEN’S HEART HEALTH

If you’d like to help patients like Janet Llapitan access life-changing heart health care at a new UW Medicine Center for Women’s Heart Health, make a gift to the Women’s Heart Health Initiatives Fund.

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