Faculty Spotlight: Shweta Motiwala, MD

Helping Patients Live Better and Longer

“There’s a big gap between what we know we should do for patients with heart failure, and what actually happens,” said Shweta Motiwala, MD, MPH. “Anything we can do to bridge that implementation gap is really useful.”

Heart failure affects millions of Americans, and develops when the heart is unable to pump enough blood to meet the body’s needs. It can lead to symptoms such as shortness of breath, fatigue, and fluid buildup. Many conditions can contribute to heart failure, including high blood pressure, heart attack, diabetes, and coronary artery disease. Although there is not yet a cure, proper treatment can slow progression of the disease and improve longevity and quality of life.

Dr. Motiwala joined the UCSF Cardiology faculty in 2023 as director of the Heart Failure Disease Management Program within the UCSF Advanced Heart Failure Comprehensive Care Center. She is working to help more patients access life-saving therapies as early as possible. “Recently there have been transformational innovations in advanced therapies for heart failure, including in heart transplantation,” she said. “But since the majority of heart failure patients will never get a transplant, for me the most exciting thing is figuring out how to reach more patients and take better care of them earlier in their disease process, hopefully preventing most of them from reaching the point of needing a transplant.” 

As director of the Heart Failure Disease Management Program, she oversees the care of patients who need to be seen for medication titration, advanced diagnostics, referrals for interventional or structural procedures, introduction to clinical trials, and ongoing hemodynamic monitoring. Dr. Motiwala and her colleagues also provide ongoing surveillance for the need for more advanced heart failure therapies, such as mechanical heart pumps called left ventricular assist devices (LVADs) as well as heart transplant. She also is the site principal investigator for a number of clinical trials focused on novel devices and heart failure management therapies. She sees heart failure patients in both the clinic and hospital.

Caring for Patients Throughout their Journey

Born in India, Dr. Motiwala came to the U.S. with her family when she was two, and grew up in Bergen County, N.J. The daughter of two physicians, she gravitated towards science and medicine at a young age. She earned a bachelor’s degree in history and science at Harvard, with a focus on the history of medicine, then earned her medical degree from New York University School of Medicine.

In Boston, Dr. Motiwala completed her internal medicine residency at Massachusetts General Hospital, then spent an additional year there as a clinical research fellow, focusing on heart failure studies under the direction of James Januzzi, MD. She worked on a number of projects focused on the use of biomarkers to better understand response to therapy and predict outcomes in chronic heart failure. “In addition to being an important mentor and sponsor, Dr. Januzzi also introduced me to the world of clinical trial development and participation and played a crucial role in getting me involved in national committees of the American College of Cardiology,” she said. “His guidance has influenced many of my career decisions.”

She then completed her cardiology fellowship at Beth Israel Deaconess Medical Center, and a fellowship in advanced heart disease at the Brigham and Women’s Hospital. She also earned a master in public health degree focused on clinical effectiveness from the Harvard T.H. Chan School of Public Health.

“Heart failure includes a lot of what I enjoy about interacting with patients and continuity of care,” said Dr. Motiwala. “These are patients who have a chronic disease that requires ongoing management. I get to see them through the entire course of their disease, through the ups and downs. I get to care for them in the clinic, and for those who become critically ill, I also get to care for them if they require ICU care or advanced heart failure therapies. Caring for patients across that entire spectrum of disease is really appealing to me.”

Earning Trust through Effective Communication

One of the most important things she learned during her training was the importance of establishing relationships with her patients that are rooted in trust. “I had the privilege of being trained by many master clinicians, and I observed how these physicians interacted with their patients,” said Dr. Motiwala. “In heart failure, there isn’t a one-size-fits-all approach. It’s important to take the time to get to know your patients. Show interest in their lives, ask them what their day-to-day life is like, and make a note of that. Ask them about whatever is important to them. It’s important that these interactions aren’t just transactional, but that you get to know them on a personal level.”

Part of that process of earning patients’ trust is listening deeply to what they share. “It’s important to understand what they do and don’t want to do, and to consider that when making a plan with them about which medications to start, how often to get lab work, and what tests to prioritize,” said Dr. Motiwala. “For example, there is good data showing that for heart failure patients, the faster they can get on the highest doses of all the medications they should be on, the better. But that doesn’t work for everybody. Understanding what that particular person can do, then tailoring your approach, goes a long way to building a trusting relationship.

Effective communication is key. “There’s a way to communicate that is honest and appropriately concerned, but not overwhelming for patients,” said Dr. Motiwala. “By demonstrating that I truly care, providing them with all the necessary information and answering their questions using terminology that is clear and understandable, it helps us take that next step together.”

New Tools for Prevention

As a general cardiology fellow at Beth Israel Deaconess Medical Center, she worked closely with Robb Kociol, MD, who directed the Advanced Heart Failure Program. “The program was in its early stages then, having just recently launched an LVAD program, and Dr. Kociol was truly the force behind its growth in the years that followed,” said Dr. Motiwala. “Not only was he an incredible clinical role model and mentor, but I also had a close-up view of his advocacy to expand and push the program forward. After my advanced heart failure fellowship training at Brigham and Women’s Hospital, he recruited me back to Beth Israel Deaconess Medical Center for my first faculty position.”

Dr. Motiwala helped lead efforts to keep heart failure patients as healthy as possible and avoid preventable hospitalizations. For example, patients whose hearts have difficulty squeezing – a condition called heart failure with reduced ejection fraction – can benefit from taking several heart medications together. Because of possible side effects, it can take time and careful adjustments to get patients on the recommended doses of this guideline-directed medical therapy. At Beth Israel Deaconess Medical Center, Dr. Motiwala supervised a pharmacist-driven initiative to fine-tune each patient’s medication protocol, with pharmacists providing telephone guidance as needed to patients who were just starting these medications. “We were able to accomplish a lot more than what we could have done just by seeing these patients with frequent [cardiology] clinic visits,” she said.

She also led implementation of the CardioMEMS program, which is an implantable pulmonary artery pressure sensor for patients who are at risk of heart failure complications. Rather than waiting until patients become symptomatic, the sensor can detect elevated pressure in the pulmonary artery and send a warning message to the patient’s cardiology team. “Remote monitoring devices like these allows us to monitor data and adjust a patient’s medications or arrange for closer follow-up, potentially averting a hospitalization and preventing decompensation that contributes to a cycle of worsening heart failure and decline in functional status,” said Dr. Motiwala. “We haven’t yet figured out how to fix or eliminate heart failure entirely, but these sorts of tools will be very important in helping us better manage patients and support them in living better, longer lives.”

Dr. Motiwala helped implement a clinical trial that led to approval of another implantable pulmonary artery sensor, and has since helped lead trials of other heart failure monitoring devices. “Over the last several years there has been so much growth in the available technology, including moving from implantable devices like CardioMEMS to less invasive, more wearable devices,” she said. “This is where the field is going.”

Dr. Motiwala has also helped create national guidelines as a member of several national committees and working groups of the American College of Cardiology. For example, she co-wrote the 2017 ACC Expert Consensus Decision Pathway for Optimization of Heart Failure Treatment, as well as 2021 and 2024 updates to that document. She was also a member of the Heart Failure Therapies App Work Group, creating an app called TreatHF that provides physicians with decision support for management of chronic heart failure. “I enjoy helping shape the direction of national-level guidelines, and hope to continue doing this sort of work,” she said.

Right Place, Right Time

Dr. Motiwala loved her work at Beth Israel Deaconess Medical Center, but was intrigued by the opportunity to help lead similar work at UCSF’s burgeoning Advanced Heart Failure Comprehensive Care Center, led by Liviu Klein, MD, MS. “When I spoke with Dr. Klein and got a sense of his vision for the program, as well as the tremendous growth that had already begun on the transplant side, I was really excited about helping grow the heart failure infrastructure and chronic disease management programs here,” she said. “I thought it would be an impactful time for me to join, and I could bring my ideas and experiences to complement what had already started on the LVAD and transplant side.”

“Dr. Motiwala’s clinical interests lie in increasing access to care for all heart failure patients,” said Dr. Klein. “Her expertise in remote monitoring is an asset to the UCSF Advanced Heart Failure Comprehensive Care Center, and will ensure that our Heart Failure Disease Management program expands care to patients across Northern California.”

She is enthusiastic about her experience at UCSF so far. “My colleagues are fantastic,” said Dr. Motiwala. “Our group is very forward-thinking, and that has a lot to do with the tone and leadership style that Dr. Klein has established. Everyone is willing to push the boundaries in a responsible way, and work together to move the entire program forward.”

In addition to caring for patients, Dr. Motiwala enjoys teaching. “I love working with trainees,” she said. “Working with house staff and general cardiology fellows has always been a highlight for me, and in particular, we work very closely with the advanced heart failure fellows. Having conversations with fellows makes me take a step back and make sure I explain why I am making certain decisions or recommendations. That, combined with listening to trainees’ input, often changes the way we approach a patient’s care. I really value working collaboratively and contributing to their education.”

In the future, Dr. Motiwala hopes to move the needle on ensuring that every patient who is eligible for heart failure therapies to access them. “Helping to get eligible patients on these medications or providing access to other indicated therapies would do so much to improve not only individual lives, but also to reduce the overall burden of heart failure and the toll that it takes on society,” she said. “That could help more people live better and longer.”

Outside of the clinic and hospital, Dr. Motiwala enjoys running, playing tennis, and going to the beach. She is married to oncologist Nikhil Wagle, MD, who currently works at Genentech. Together they have two young children.

 

-  Elizabeth Chur