Dr. Richard Soucier, who prefers to be called “Rick,” grew up in Manchester, Connecticut, the fourth in a family of five children. His interest in medicine was sparked by his two older brothers, who were both physicians. He set his sights on attending Bates College in Maine at age 10 when one of those brothers allowed him to sleep on his dorm room floor during a Parent’s Weekend visit.
He went on to attend Dartmouth Medical School in New Hampshire, followed by a three-year residency in internal medicine and a three-year fellowship in cardiology, both with the University of Connecticut. The residency was a combined program that included providing care to patients at John Dempsey, Hartford, and Saint Francis hospitals. Clinical time during his cardiology fellowship was split between John Dempsey and Saint Francis.
Upon completing his medical training in 1997, Dr. Soucier wanted to stay in the area to be near family. He had spent considerable time during his residency and fellowship at Saint Francis Hospital and valued the sense of community he felt there. Dr. Soucier recalls, “During orientation for my job, one of the things they taught us was to make sure you say ‘Hi’ to people in the hallway. I just love that.” Dr. Soucier worked as a cardiologist at Saint Francis for nearly 20 years before taking a position with another institution. He recently returned to Trinity Health Of New England in a new role.
Inspired By Tragedy
Two key events influenced the direction of Dr. Soucier’s career. The first occurred just before he headed off to college, when his mother was diagnosed with stage IV pancreatic cancer. She died six months later, in February of his freshman year. “That kind of clinched it. After that I said, ‘I’ve got to do something to help people.’ So originally, I was going to become an oncologist,” he reports. However, once in medical school, he was fascinated by the physiology of the heart and by the end of his first year of residency, he knew he wanted to pursue cardiology as a specialty.
Then, toward the end of his cardiology fellowship, he cared for a young woman who developed severe heart failure shortly after delivering her baby (peripartum cardiomyopathy). This young woman was placed on a transplant list for a new heart but died about six months later, before receiving one.
“That brought me back to the helplessness I felt when my Mom died from pancreatic cancer because heart failure is the cancer of cardiology,” says Dr. Soucier. He knew then that he wanted to focus his career in cardiology on caring for patients with heart failure. In 2011, the American Board of Internal Medicine recognized Advanced Heart Failure and Transplant Cardiology as a subspecialty within the practice of cardiology. Dr. Soucier became board certified in 2012.
Caring for Patients with Heart Failure
In the early years working as a cardiologist at Saint Francis, Dr. Soucier cared for patients with an array of cardiac diseases but he continued to gravitate toward those with heart failure. Heart failure occurs when the heart is unable to adequately pump enough blood and oxygen to support the body’s needs. There are many reasons this can occur, including damage to the heart from an infection or a heart attack. The disease is usually categorized according to severity of symptoms into four classes (I-IV or A-D) from least to most severe. If the disease is not well controlled, patients may eventually require a heart transplant or die from the disease.
The risk of dying from heart failure increases with each class, which is why “even in patients who are relatively asymptomatic, it is a significant disease that needs aggressive management,” Dr. Soucier explains.
According to the American Heart Association, approximately 6.5 million adults in the U.S. currently live with heart failure. It is a life-long disease. The therapy is intensive, requiring significant diet modifications, many medications and, sometimes, procedures. The goals of these therapies are to improve a patient’s quality of life and slow progression of the disease. This requires significant and ongoing education and support of the patient and family. Because of this, Dr. Soucier says, “You get really close to patients and their families. I really love it.”
Early in his career, he identified an inequity. “The opportunities for patients in hospitals that don’t have a transplant program are a lot different than for patients who are in hospitals with transplant programs. I didn’t like that.”
Dr. Soucier, along with others, worked to improve this by helping to grow his hospital’s heart failure program, which became The Hoffman Heart and Vascular Institute. This program stands apart. Whereas many programs focus the majority of resources on the sickest yet small number of patients, the Hoffman Institute’s focus is on the larger number of patients with early heart failure, to prevent symptom progression.
This focus is evident in several ways. Care is provided by an interdisciplinary team (doctors, nurses, advanced practice providers, dieticians) specifically trained in managing heart failure. Emphasis is put on applying guideline-directed therapy – having patients on the right combination of medicines at the optimal doses – both in the hospital and when the patient is discharged home. Patients are provided with ongoing education and support.
The care team makes all attempts to prevent a patient from needing hospitalization, including offering those with worsening symptoms a “same-day access program” where they may be treated with more aggressive therapy, such as an intravenous medicine, as an outpatient – without having to visit an emergency room.
When patients do require hospitalization, there is a dedicated floor for their care, staffed by those knowledgeable in the care of heart failure. Saint Francis Hospital does not perform transplant surgeries but the program maintains a close affiliation with Yale New Haven Hospital. Patients who do require a heart transplant have the actual surgery performed at Yale New Haven Hospital. However, except for the two weeks immediately around the surgery, care is provided by The Hoffman Heart and Vascular Institute.
Advances and Challenges in Heart Failure Care
In the last 20 years, the options for medicines that treat symptoms of heart failure have greatly expanded. National evidence-based treatment guidelines have been developed to assist clinicians in providing a proven consistent approach to treatment. There have also been improvements in the design and utility of devices used to monitor symptoms and assist the pumping of the heart. These devices are getting smaller and easier to implant. The pairing of technology with these devices to communicate their findings to the care team has also helped to streamline care. Lastly, the incorporation of palliative care as a component of heart failure management has been very important to meeting patient and family needs.
In Dr. Soucier’s opinion, the greatest challenge today is getting therapies that have been shown to improve the outcome of heart failure and other cardiac diseases to all the patients who can benefit from them. He cites national data that indicate poor compliance with guideline-directed therapy. The guidelines suggest that a certain category of heart failure patients should be taking a combination of three medicines. The data indicate that only one out of 100 – or just 1 percent of these patients – are actually prescribed the right three medications at the correct doses. The work is in identifying barriers to optimal care and overcoming them.
The current pandemic has, of course, also presented challenges but Dr. Soucier notes that it has revolutionized care in certain ways that, in the long run, will make it better for both the patient and the care provider. Telemedicine visits are more convenient for patients and overcome multiple barriers associated with a traditional office visit, such as a need for transportation or childcare. These virtual visits have actually given Dr. Soucier more access to patients and insight into their living situations. Combining video chats with the use of advanced home monitoring equipment – and the ability for patients to send data and answer symptom questionnaires electronically – has enabled him to better identify which patients truly require an in-person visit.
A Return to Saint Francis and Trinity Health Of New England
Dr. Soucier returned to Saint Francis as the Cardiovascular Service Line Lead Physician in August 2020. In his new role, he is responsible for organizing and overseeing all of the cardiovascular services in the Trinity Health Of New England network, which includes Saint Francis, Saint Mary’s, and Johnson Memorial hospitals in Connecticut, as well as Mercy Medical Center in Massachusetts.
His time is split between providing direct care to patients and his administrative duties. He has enjoyed returning to patients that he cared for at the start of his career. His goal is to expand access to award-winning care for people with heart failure and other cardiac diseases across the region by expanding the model used at The Hoffman Heart and Vascular Institute and across the Trinity Health Of New England network.
And that’s not his only goal. When it comes to optimizing medication use for people with heart failure, Dr. Soucier says, “My job is to try to figure out programs to help move that needle from 1 percent to way above 1 percent.”
Photography by Stan Godlewski
Margaret M. Burke, Pharm.D., BCPPS, is a freelance medical writer with more than 25 years of clinical pharmacy experience, including board certification as a pediatric pharmacotherapy specialist. She lives in Manchester.
Stan Godlewski is an editorial, corporate and healthcare photographer based in Connecticut and working primarily between Boston and New York City.