By Kate Jacobson | September 12, 2019
For many years, Mary A. Whooley wondered why there was a connection between depression and heart disease
Whooley, MD, FACP, FAHA, FACC—a trained primary care doctor and Director of Cardiac Rehabilitation at the San Francisco VA—saw patients come in and out of her clinic with a recurring pattern. Those who suffered mental health issues, specifically depression, were prone to cardiac ailments as well. She was intrigued.
“Thirty years ago, there were lots of theories as to why depression and cardiac conditions were linked—elevated cortisol, inflammation, high adrenaline levels, sticky platelets—but no one understood exactly what was going on,” she said. “I wanted to figure out what was happening with these patients that could lead to heart disease.”
That was the beginning of the Heart and Soul Study, which Dr. Whooley conducted at the San Francisco VA. She examined more than 1,000 patients with known coronary heart disease and followed them over a period of 10 years. What she discovered was surprisingly simple: patients who struggled with their mental health were not exercising or taking their medications as prescribed, and these behaviors led to worse cardiovascular disease.
To be certain of this link, though, Whooley knew she had to eliminate all the other possibilities—even if the answer at the end was simple.
“I tell my trainees that I specialize in pointing out the obvious,” she laughed.
Whooley’s expansive study was the first of its kind, and it created a large dataset for other researchers to address more links between behavioral and cardiac health.
Thanks to Whooley’s work, she was awarded the Michael L. Pollock Established Investigator Award. It is given to an individual who has made significant advances in the field of cardiac rehabilitation through their research and scholarly contributions, and has earned national prominence in their field through contemporary research and education.
“It’s a great honor for me personally to receive this award,” she said. “I feel like this is an opportunity for me to improve participation in cardiac rehabilitation, too.”
Whooley always knew she wanted to be a doctor. From the time she was 12-years-old, she was fascinated not only by the science of medicine, but by the impact it could have on helping others. While going through medical school, she gravitated toward primary care because she liked taking care of the whole patient.
After completing her residency and fellowship at the University of California, San Francisco, she joined the VA. Once she started working with veterans, she felt as if she had found her place.
“Patient care is always challenging, and veterans have many more mental health challenges than your average patient,” she said. “But it’s incredibly rewarding. They’re a joy to work with, and they really do need our help.”
After completing her study, Whooley became extremely interested in cardiac care—specifically cardiac rehabilitation. She joined AACVPR in 2013 after she received a grant to start a home-based cardiac rehabilitation program at the VA. As she attended meetings, she met many people who inspired her and helped her throughout her research.
Just like she was drawn to primary care for its multifaceted approach to medicine, she appreciated how AACVPR members came from a variety of disciplines to help one another. She’s also grateful for all the information she’s been able to contribute and take away regarding home-based care.
For veterans specifically, home based cardiac rehab is an ideal option. She said a third of Veterans live in rural areas, and most of the veterans that she sees at her VA hospital live several hours away. Coming in three times a week for rehab is not an option for them.
“The largest barrier is not being able to manage the logistics of going to a traditional program, whether it’s social support, financial conflicts, transportation—whatever the case may be,” Whooley said. “When we examined what percentage of eligible patients were actually participating in rehab, we were really surprised to find it was less than 20%. But when we offered them home-based care, we were able to quadruple participation.”
She said watching veterans who have struggled with their heart health start and stick to their rehab regimen makes her feel proud of all the work she and her colleagues have done. It also pushes her to continue her work in helping more people get the care they need.
“This kind of work is challenging. With scientific inquiry, there are many more rejections than there are acceptances, so perseverance is really critical to success,” Whooley said. “But just working with patients one-on-one and seeing how much better they feel when they’re able to force themselves to exercise is really exciting. It’s very rewarding.”