With five hours left to vote last month, John Fetterman’s Pennsylvania Senate campaign released a confusing primary day statement: He would undergo surgery before polls closed to install a pacemaker with a defibrillator following his recent stroke.
That sentence, which campaign advisers say was approved by the hospital, raised more questions than it answered. Though pacemakers are sometimes used to treat patients with A-fib — an irregular heartbeat caused by the upper chambers of the heart — devices that include defibrillators typically are not.
“You would never use a defibrillator to treat atrial fibrillation,” said Christian Thomas Ruff, a Harvard Medical School associate professor and director of general cardiology at Brigham and Women’s Hospital in Boston. “The defibrillator is used to treat dangerous heart rhythms from the bottom ventricles.”
It would take 17 days for Fetterman’s campaign to explain the inconsistency. A letter from his cardiologist, released Friday, said that the defibrillator had been installed to treat a previously undisclosed cardiomyopathy, first diagnosed in 2017, that decreased the amount of blood his heart could pump.
The fact that Fetterman, 52, and his campaign won the nomination without fully disclosing the extent of his physical maladies has raised concerns among Democrats that there may be more bad news to come, potentially endangering the party’s hopes for retaining Senate control this fall. The politician, whose advisers have pitched him as an “authentic, straight-talking, no-B.S. populist” — sporting a shaved pate, graying goatee and Carhartt sweatshirts — now faces the challenge of explaining the confusion to voters.
Fetterman, currently Pennsylvania’s lieutenant governor, responded Friday with a more expansive written statement, making clear that he “almost died” from the stroke, was still not fully recovered and had seen the error of not taking prescribed medication to treat his heart condition starting in 2017.
“I didn’t do what the doctor told me,” he wrote. “But I won’t make that mistake again.”
His campaign advisers say they have been working to be as transparent as possible. According to one adviser, Fetterman’s campaign only found out about the surgery on the morning of the primary, and doctors never mentioned the separate heart condition at the time. Doctors described the defibrillator as “like an insurance policy,” the adviser said.
Spokespeople for Lancaster General Hospital did not respond Saturday to a request for comment.
“We have no doctors on our campaign team,” said Rebecca Kirszner Katz, a senior adviser for the Fetterman campaign. “We have been learning about these conditions and explaining them in real time.”
The concerns have been magnified by the progress of his stroke recovery after his wife, Gisele, described his situation on election night as “a little hiccup” and predicted her husband would be “back on his feet in no time.” The campaign adviser said the stroke was serious, and that Fetterman had escaped serious effects largely because of his wife’s early intervention and his proximity to the Lancaster hospital, where he received prompt treatment.
His physical well-being has improved since the stroke.
“He is walking a few miles daily,” Katz said.
He has, however, still not appeared in public, and his appearances on video released by the campaign have shown him speaking only a few sentences at a time. His ability to have conversations rapidly has not fully recovered, though he is improving and doctors still predict a full recovery.
Two Democratic political consultants — who like others for this story spoke on the condition of anonymity to describe private conversations and a sensitive issue — worried that the campaign’s handling of Fetterman’s health would undermine his image as a straight talker.
“When you are the godfather of transparency and social media, and you go dark, people notice,” said one strategist who has long supported Fetterman. “It’s not as if admitting some health issue would immediately cause people to seek a replacement.”
Another Democratic consultant who did not work for any candidate in the Senate primary said that the campaign’s disclosure of information has been at best “opaque” and at worst “misleading,” which “makes your imagination run a little wild.” Fetterman will face Republican candidate Mehmet Oz, a retired cardiothoracic surgeon and television personality.
“There were so many red flags,” in the days after Fetterman’s stroke, the consultant said, adding later, “If Oz and the Republicans wanted to sort of get to the [health] issue in a roundabout way, they would do it through the trust issue.”
Republicans have already jumped on the theme. “Wow, @JohnFetterman starts off his campaign for Senate lying about his health,” Chris Hartline, the communications director for the National Republican Senatorial Committee, tweeted on Friday.
“While John Fetterman has earned Pennsylvanians trust, Mehmet Oz is a fraud who will do, say, and sell anything to help himself,” responded David Bergstein, the communications director of the Democratic Senatorial Campaign Committee.
Pennsylvania is the marquee open Senate contest of the midterm election cycle, providing Democrats their clearest opportunity to pick up a seat after the pending retirement of Sen. Patrick J. Toomey (R-Pa.). His health challenges aside, Fetterman’s campaign has had a strong start, winning every one of Pennsylvania’s 67 counties in the recent four-way Democratic primary, with Rep. Conor Lamb (D-Pa.) coming in a distant second. In 33 counties, his vote share was 70 percent or higher, according to the campaign.
A former mayor of the small town of Braddock, Pa., Fetterman has made a name for himself as a politician who can attract support beyond his party’s brand, with blunt appeals to legalize recreational marijuana, revitalize manufacturing communities and eliminating the Senate filibuster to get more done.
Those close to Fetterman say one of the issues in his campaign has been his discomfort with speaking about his own health issues, or attending to them properly, something that the candidate admitted in Friday’s statement.
“Like so many others, and so many men in particular, I avoided going to the doctor, even though I knew I didn’t feel well,” he said.
It was a message some Democrats hope would appeal to the crossover voters that Fetterman is hoping to reach in November.
“Would I have liked to see more information come out from the campaign faster? Yes. But in the end, you know, I don’t think it’s indicative of the type of campaign [Fetterman] is running,” said Democratic consultant Mike Mikus, who voted for Lamb in the primary. He said Fetterman looks “relatable” for admitting on Friday that he neglected to take his medicine and disregarded his doctor.
“He is recovering well and following doctor’s orders. I’m looking forward to being on the campaign trail with him soon,” Sen. Robert P. Casey Jr. (D-Pa.) said in a statement, after having a Zoom call with Fetterman on Friday. “I’m not sure I’ve seen a candidate in recent history who is better prepared to serve the people of Pennsylvania.”
Ramesh Chandra of Alliance Cardiology said in a statement Friday that he had seen Fetterman in 2017 after he experienced swelling in his feet. “I diagnosed him with atrial fibrillation, an irregular heart rhythm, along with decreased heart pump,” he wrote in the letter.
Fetterman — who stands 6 feet 8 inches tall — previously announced that starting in 2017 he changed his diet and began exercising more regularly, resulting in significant weight loss. A June 2018 article by the Pittsburgh Tribune-Review reported that he had lost 148 pounds in a year, coming down from a top weight of about 418 pounds.
“I was fat,” Fetterman said at the time. “It is embarrassing to talk about.”
Several cardiologists said the description of a “decreased heart pump” matches the diagnosis of cardiomyopathy, which Chandra said was the reason doctors in Lancaster decided to implant to pacemaker with a defibrillator. Cardiomyopathy is a disease of the heart muscle that makes it hard for the organ to deliver blood to the body, resulting sometimes in swollen feet.
“There are two broad reasons that we implant defibrillators,” said Matthew Tomey, an assistant professor of medicine and cardiology at the Icahn School of Medicine at Mt. Sinai. “One is for somebody who has already suffered a cardiac arrest. The other reason is primary prevention for individuals who have never had a cardiac arrest but have risk factors.”
Tomey said recent pharmaceutical innovations have made cardiomyopathy a much more manageable condition than it was 10 or 20 years ago. Treatments are generally determined by a series of tests, including a measure of the ejection fraction of blood that is pumped from the heart’s left ventricle and the CHA2DS2-VASc score, which takes into account age, diabetes, hypertension, vascular disease and other factors.
Fetterman’s campaign has not released this data.
“The prognosis I can give for John’s heart is this: if he takes his medications, eats healthy, and exercises, he will be fine,” Chandra wrote in the statement. “[H]e should be able to campaign and serve in the U.S. Senate without a problem.”
Annie Linskey contributed to this report.