John Fetterman, the 53-year-old Pennsylvania lieutenant governor and candidate for the US Senate, is one of the lucky ones. He beat the odds.
In 2017, he was diagnosed with atrial fibrillation (AF), an irregular heart rhythm, and although his cardiologist put him on a medication and exercise program, Fetterman couldn’t keep up.
Even for someone with atrial fibrillation, he was taking a big risk. The mortality rate from untreated atrial fibrillation five years after diagnosis is 51%, and Fetterman’s height and weight put him in higher risk categories.
He was about 400 pounds (Fetterman has since lost weight) and 6 feet 8 inches tall. Older people have larger atria and are more prone to atrial fibrillation. Diabetes, overactive thyroid, tobacco and alcohol use, high blood pressure and older age are some other risk factors for this disease.
Fetterman suffered a stroke on May 13, 2022, one of the most serious consequences of atrial fibrillation. “Like so many others, and especially so many men, I avoided going to the doctor even though I knew I wasn’t feeling well. As a result, I almost died,” Fetterman said in a statement.
The severity of the stroke and his recovery became major issues in the Senate race between Fetterman, a Democrat, and his Republican opponent, Mehmet Oz, M.D. The outcome of the November 8 election will determine whether Democrats or Republicans have a majority in the US Senate.
In addition to atrial fibrillation, Fetterman suffers from cardiomyopathy, according to a statement released June 3 by Ramesh Chandra, MD, a Pittsburgh-based cardiologist. In the statement, Chandra, a cardiologist, says she diagnosed Fetterman with atrial fibrillation and “along with a decrease in heart pump” in 2017, but only saw it the day before the statement was released. Chandra says in the statement that during that June visit, she told Fetterman that she had cardiomyopathy and that the doctors who treated him after his stroke put him in a “pacemaker-defibrillator.”
Although not specifically mentioned, Chandra was likely referring to an implantable cardioverter-defibrillator, a device implanted in the abdomen that restores the heart’s lower chambers (the ventricles) to a regular rhythm when it detects that they are beating irregularly. Implantable cardioverter-defibrillators often also act as cardiac pacemakers. Pacemakers, which are also implantable devices, send electrical impulses to the heart to keep it regular.
Fetterman’s campaign then released another letter about Fetterman’s health from another doctor, Dr. Clifford Chen, a family physician in Duquesne, Pennsylvania, outside Pittsburgh. Chen says in the letter, which is dated Oct. 15, that he saw Fetterman for a follow-up visit the day before after Fetterman had established him as his primary physician at Ma.
Chen described Fetterman as recovering well from the stroke, and an examination of his lungs was clear and his heartbeat was regular. Fetterman continues to show symptoms of an “auditory processing disorder,” Che wrote. He says the disorder means the “absence” of spoken words, which may appear as hearing impairment, “but are not actually processed properly.” Chen said Fetterman walks four or five miles a day and takes “appropriate medication to optimize his heart condition.
Fetterman, Chen concluded, “is doing well and shows a strong commitment to maintaining good health and fitness practices.
Fetterman will discuss Oz tonight at 8 p.m. Easter time. To help with auditory processing, Fetterman uses a captioning device that converts spoken words into written words on the screen. Fetterman’s health focus grew in the days leading up to the debate. Polls show Fetterman’s lead over Oz shrinking, in part because voters are worried about Fetterman’s health.
Managed Healthcare Executive® spoke with Mayo Clinic specialist Peter Noseworthy, M.D. untreated atrial fibrillation and why it is important to stick to prescribed treatment. Noseworthy commented on atrial fibrillation in general and was not involved in Fetterman’s care. Noseworthy is a cardiac electrophysiologist and cardiologist in the Division of Cardiovascular Medicine at the Mayo Clinic in Rochester, Minnesota.
A typical treatment for atrial fibrillation involves medications to slow the heart rate and maintain a normal rhythm. It is also important to minimize the risk of stroke with blood thinners. Adherence to blood thinners like Coumadin (warfarin) “is extremely poor,” Noseworthy said.
“Patients with atrial fibrillation often find that they take medication indefinitely each day, and it can often be multiple medications in combination. Joining also means being aware that there may be triggers for atrial fibrillation and making lifestyle changes as a result,” he said.
Although cost is sometimes a factor in patient adherence, Noseworthy said atrial fibrillation is so common that insurance coverage may be sufficient. “In general, treatment for atrial fibrillation is covered by (commercial) insurance and Medicare as a medically necessary treatment. But as with all health care in the United States, treatment can get expensive, and depending on how patients’ insurance plans are structured, there can be significant out-of-pocket costs, especially when patients are hospitalized or are subject to procedures.
Many patients are opting for more expensive treatments, including direct oral anticoagulants (DOACs), Noseworthy said. DOACs include Eliquis (apixaban), Pradaxa (dabigatran), and Xarelto (rivaroxaban). Patients with atrial fibrillation are also prescribed medications that treat the underlying arrhythmia, including amiodarone, flecainide, and propafenone.
Some patients with atrial fibrillation are also treated with catheter ablation, Noseworthy explained. Catheter ablation removes or destroys a small area of heart tissue that has been identified as the source of the arrhythmia. The tissue is destroyed with an instrument that is inserted into the heart with a catheter.
For some patients, the burden of atrial fibrillation treatment and lifestyle changes may not be as drastic as feared, Noseworthy said. Some people “do very well with atrial fibrillation and may not have any symptoms,” Noseworthy said. “Some patients are relatively debilitated by their atrial fibrillation and require more aggressive treatment.”
Untreated atrial fibrillation can lead to heart failure or stroke. “Usually we get the symptoms under control. The goal is to get her back to a normal life,” Noseworthy said.
Fetterman says he has moved on and is following the doctor’s orders. In the June 3 statement, Chandra said that “the prognosis I can give for John’s heart is this: if he takes his medication, eats healthy, and exercises, he will be fine.”
Chandra added that if Fetterman does what he’s told, “he should be able to run for office and serve in the US Senate with no problems.”
