Dr. Carrie Wolfberg has been caring for patients in northwest Connecticut since 1992 when she first went into private practice as a cardiologist. That practice grew and evolved over the years. It became part of the Charlotte Hungerford Hospital network of services approximately 10 years ago. Following the hospital’s strategic partnership with Hartford Healthcare, it became the Hartford Healthcare Heart & Vascular Institute at Charlotte Hungerford Hospital. The practice has three locations (Torrington, Thomaston, and Winsted) and is now made up of five cardiologists, two APRNs, and one physician’s assistant. They are currently accepting new patients.
Dr. Wolfberg explains that she and her colleagues in the practice are non-invasive cardiologists. This means that they care for patients with diseases of the heart and vascular system but do not perform invasive procedures such as angioplasty or cardiac catheterization. They are able to perform imaging of blood vessels, such as ultrasound, in their offices. The practice focuses on taking care of patients as opposed to research or teaching medical students and residents. Dr. Wolfberg prefers it that way.
The most common cardiac diseases Dr. Wolfberg sees in her practice are coronary artery disease, heart failure, and atrial fibrillation. “Atrial fibrillation is a disease of the elderly, mostly. Since we have an aging population (in the U.S.) and we have a fairly elderly population in this area, we see a lot of patients with atrial fibrillation.” She adds that hypertension (high blood pressure) and hyperlipidemia (high cholesterol) are primarily treated by primary care providers (PCP). However, a PCP may consult with the cardiologists when they are caring for a patient who has particularly difficult to manage disease.
Affiliation Provides Seamless Care
Some patients will require an invasive procedure or surgery to manage their cardiac disease. Examples include placing an implantable cardioverter defibrillator (ICD) for certain arrhythmias (abnormal heart beat pattern); heart valve replacement; and cardiac ablation (destroying a very small area of heart tissue that is the source of abnormal rhythms). For patients who require one of these procedures, Dr. Wolfberg and her colleagues work “very well and in concert with the Hartford Healthcare structural cardiologists” to coordinate the care of these patients.
Although patients may need to travel to Hartford or Avon for the actual procedure, follow-up care can often be provided locally. “We work really well with those physicians. We know each other, and care is seamless,” she says. For instance, they have offered a monthly ICD clinic for years. Dr. Wolfberg points out too that some other cardiac subspecialists are now traveling to one of the northwest locations once or twice a month to provide initial consultations saving patients time and inconvenience.
Dr. Wolfberg is also very proud of their care of patients who present with symptoms of a heart attack to the emergency room at Charlotte Hungerford Hospital. Prompt diagnosis and treatment are vital. Patients are transported quickly by helicopter (or ground in bad weather) to Hartford Hospital to have angioplasty and stent placement, which opens up the blood vessels that provide oxygen to the heart muscle. Consequently, “the mortality rate is as good as if the patient showed up at Hartford Hospital.”
Recent Advances in Cardiac Care
“There are lots of new procedures being done all the time!” Dr. Wolfberg exclaims. One of them is transcatheter aortic valve replacement or TAVR for short. It is a nonsurgical approach to aortic valve replacement that uses a catheter threaded through an artery (a blood vessel) to access the heart and replace the faulty valve. Previously, valve replacement required open heart surgery. This procedure has been available for about 10 years. At first, it was used mainly for patients who were considered too high risk for traditional surgery. Because TAVR is much easier for patients to tolerate and requires less recovery time, it is now being used regularly in moderate surgical risk patients and being tested in low surgical risk patients.
Another advance is the availability of a new device called CardioMEMS™. This is an implantable pressure monitoring device that they’ve just recently started using for patients at Charlotte Hungerford Hospital. It is implanted in the pulmonary artery of a patient with heart failure by an interventional radiologist. It sends a pressure reading wirelessly to the cardiologist daily. The pressure in the patient’s heart indicates whether or not they are holding onto too much fluid even before they exhibit outward symptoms such as weight gain. This enables the cardiologist to promptly modify medication doses in response. At this time, CardioMEMS™ is used mainly in patients who have required frequent hospitalizations for their heart failure.
There have also been advances in the classes and formulations of medications to treat various cardiac diseases. One example is the class of medications called PCSK9 inhibitors. These may be used in patients whose cholesterol is not well controlled by statin medications or in patients who do not tolerate statins well. Dr. Wolfberg notes that these medicines are very effective at lowering lipids with very few side effects. The available drugs are injectable rather than in pill form. However, this isn’t as restrictive or inconvenient as one may think. For example, one of the medicines comes as a patch that contains a small needle. The patient applies the patch once a month to their arm and pushes a button which infuses the medicine over 9 minutes.
Road to Connecticut
Dr. Wolfberg grew up in upstate New York and knew she wanted to be a doctor since she was 12 years old. She went to college at the University of Florida in Gainesville. She opted to major in math, instead of chemistry or biology as many pre-med students do, because she always liked math. She then attended the University of Miami’s Miller School of Medicine. She found herself missing the Northeast, so when the opportunity presented itself, she chose externship rotations at a few large community hospitals up north. One of them was Hartford Hospital.
She found she really liked the people and the environment at Hartford Hospital so she listed it as her first choice in the matching process for an internal medicine residency. She must have been their first choice, too, because she matched! It wasn’t until the second year (out of three) of her residency that she decided to pursue cardiology as a subspecialty. Her three-year fellowship in cardiology was also at Hartford Hospital.
She explains, however, that because you had to apply for cardiology fellowships two years in advance, she ended up with a gap year between finishing her internal medicine residency and starting the cardiology fellowship. She spent that year working full time as a physician at a private walk-in center. She found it very valuable and is thankful to this day for the experience. It exposed her “to a wide array of different things,” so now, when her patients mention non-cardiac related problems, she feels better equipped to advise them.
Impact of COVID-19 Pandemic
During the past year, Dr. Wolfberg’s practice never closed. They continued to see patients in person, although at reduced volumes. They also had telemedicine appointments available out of necessity, but it is not her preferred method of seeing her patients. Cardiology does not lend itself to telemedicine, she explains. Obtaining patients’ blood pressure readings, weights, and EKGs (a tracing of the heart’s rhythm) are key components of caring for her patients, and none of those measures can be performed during a telemedicine encounter. She views telemedicine as an option mainly for homebound patients.
Outside of work, Dr. Wolfberg is an avid hiker and enjoys all the hiking trails that northwest Connecticut has to offer. She is also looking forward to resuming travel once it is safe to do so.
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.