Subscribe
Share
Share
Embed
This podcast series features Mass General Brigham researchers whose work is redefining what's possible and how we care for patients. Our goal is to spotlight transformative discoveries, the people leading these transformations, and how they can improve patient outcomes, highlighting how today's research is shaping the future of medicine, including training the next generation of clinicians and scientists.
This podcast series is not accredited for CME/CE at this time.
SEASON 1: Crossing Medical Frontiers: Research Innovations Transforming Care hosted by Dr. John Co
SEASON 2: Learn, Discern & Return: An MGB Physician's Journey hosted by Dr. Erik Alexander
Welcome to our Mass General Brigham podcast: Learn, Discern, and Return: An MGB Physician's Journey. I'm Erik Alexander, Vice President of Education, and today it's a real pleasure to have Doctor Patrick Ellinor, our Executive Director of the Mass General Brigham Heart and Vascular Institute. Welcome, Patrick.
Dr. Patrick Ellinor:Thanks, Erik. It's so great to be able to spend a bit of time with you this morning.
Dr. Erik Alexander:It's wonderful. I would love to start you know, we always start our podcast thinking back a little bit to when we were trainees. It takes us back at least thirty years, which seems to have gone by awful fast. But I actually remember you as my resident at the time when I was an intern. You've had the unique opportunity of training both in medicine, then cardiovascular medicine and electrophysiology, and in multiple different locations throughout the system here at Mass General Brigham.
Dr. Erik Alexander:Maybe you could just give that history a little bit and reflect on some of those unique moments, certainly through a hard but still fulfilling training period.
Dr. Patrick Ellinor:Well, thanks, Erik. And I'm glad that I didn't that your experience with me as a resident did not turn you off academic medicine. That's a good starting point.
Dr. Patrick Ellinor:It's it's hard to believe that it has been thirty years. So in July 1996 or it was actually I remembered it was June 20 1996. Right? When we started residency at the Brigham.
Dr. Patrick Ellinor:And I distinctly remember walking through the doors at 75 Francis Street. That was intimidating. I was a medical student.
Dr. Erik Alexander:It was busy, and there's a lot going on here. You know, when you reflect back at other than the stress and the anxiety that's natural to training and stepping into those roles, especially dealing with the severity at times of patient care and human health, but, you know, what were some of the other unique aspects maybe you can remember back from those days or the special attributes of who you were around?
Dr. Patrick Ellinor:Sure. I mean, I do remember, and I think all of us had this when you're an intern. You've whether - even if you've been successful in other areas and things, when you started an intern, you're kind of resetting where you are academically. And, you know, I think a lot of us, you know, would have impostor syndrome. You look around your classmates and what they've accomplished.
Dr. Erik Alexander:So true.
Dr. Patrick Ellinor:You know, that was so if any anybody's out there who's an intern now and they wonder how can they navigate a path, they can and they will.
Dr. Erik Alexander:Just step into it. Right?
Dr. Patrick Ellinor:Just jump right in.
Dr. Erik Alexander:Start moving forward is one day at a time. Everyone feels their insecurities and doesn't know what they don't know, but you just gotta start somewhere and whatnot.
Dr. Patrick Ellinor:But it was fun. I would say it was intense, but fun. You were working with a really smart, talented group of people. Internship is one of those unique opportunities, perhaps a bit like a military boot camp where you bond in the the time and and things that you spend there.
Dr. Patrick Ellinor:You learn a lot. You're working with great colleagues. You may be tired or overwhelmed at times, but in the end, it made you a much, much better doctor. And some of the people that I met at that time, you're still in touch with, and you've shared this journey now in academic medicine that has been thirty years.
Dr. Erik Alexander:You know, I hear those comments again from others like what you just mentioned. One is, that theme seems to come up, which is the uniqueness of who is around you when you train here at Mass General Brigham. And then here we are thirty years later and looking where the leadership has taken some of our colleagues.
Dr. Patrick Ellinor:Absolutely. And that's a lot of what you see, both in our cases. Two of us took different pathways, but are sitting back here in this room thirty odd years later, but, also many, many others throughout our system.
Dr. Erik Alexander:And it's somewhat kind of ironic, but also fulfilling at the same time that sometimes those different old connections can lead to new opportunities, new synergies, just kind of cross talk, the ability to reach out to your old friends and colleagues and say, "Hey, I have a question," or "I have an idea." And you never know kind of the fruitful academic next step where that kind of takes you.
Dr. Patrick Ellinor:Yeah. I mean, one of the other things that really jumps out from that time was the uniqueness that we had to be able to learn from some of the household names in medicine. People that, you know, you would read Harrison's or another textbook and they wrote the individual chapters.
Dr. Erik Alexander:So true.
Dr. Patrick Ellinor:And they were so concentrated at Mass General Brigham that it was a unique window into both patient care, academic, and academic medicine all rolled up into one.
Dr. Erik Alexander:Isn't that well said? And actually, to reflect in the last year or so, we've lost two of our chairman in the Department of Medicine, Gene Braunwald and now John Potts, who are both luminaries as well.
Dr. Patrick Ellinor:Absolutely. And, you know, when I was interviewing for medical residency, I distinctly remember meeting with Doctor Potts on the interview day. And, you know, it certainly left a lasting impression. And Doctor
Dr. Patrick Ellinor:Braunwald who I was in touch with many times as we brought together the institute, and he would call me regularly and give some advice on directions and was one of the greatest supporters of the institute.
Dr. Erik Alexander:I thought it was just invaluable connections, you know, when you look back and how time moves so fast.
Dr. Patrick Ellinor:Yeah. And it was honestly just a privilege to be able to be exposed to such giants in medicine.
Dr. Erik Alexander:Absolutely. And just our alumni association and the network that it provides is so intangibly a benefit for all of us who are internal and connected to it. So love to keep that network and community growing. But tell us a little bit, Patrick, as you move beyond training, kind of your academic and your career path. What did you do after fellowship?
Dr. Patrick Ellinor:Sure. Well, just as background, I spent a couple of years in medicine on the Brigham campus and then jumped all the way, you know, a five k run away over to the Mass General side of things.
Dr. Erik Alexander:Seems like it's really far away sometimes.
Dr. Patrick Ellinor:Yeah, it's really - it's not that far. But I went there for cardiology and then electrophysiology training. And then I was always interested in human genetics, and I had no idea when I started what I was going to spend my, you know, time on. And when I look back now, I would have given myself less than a 0% chance that I would still be in our system or doing what we're doing.
Dr. Patrick Ellinor:So, when you I think back to myself as an intern, you don't have to have it all mapped out. And that arose over many subsequent years.
Dr. Erik Alexander:And the academic mission kind of finds itself naturally taking left and right turns. There are new opportunities, there are new ideas, there are new collaborations. And so, certainly having kind of an idea of where you're headed is useful, but you're absolutely right. It seems like you want to be around the people who afford sometimes the open opportunities, and they can take you in whatever direction is most advantageous.
Dr. Patrick Ellinor:Yeah. Absolutely. I had - and even within cardiology, I had an inkling of what I wanted to do. So I had done some ion channel work during my doctoral studies, and that kind of naturally leads you, or at the time was leading you, in about three directions, either to psychiatry, to neurology, or cardiology.
Dr. Erik Alexander:They're all quite different, Patrick.
Dr. Patrick Ellinor:But I like the interventional aspects of cardiology and the physiology, so that drove me to initially cardiology and then on to electrophysiology. And when I started trying to explore what I was going to do for research, it really came - the spark was actually in the Fellows Room , which was in the basement of the Bullfinch Building, - an abandoned building or abandoned room there. That was a fellows room for many generations of fellows. And one of my co fellows had a large family with clearly autosomal dominant atrial fibrillation.
Dr. Patrick Ellinor:They were from a coal mining town in Pennsylvania, and one of the branches of the family happened to live in New England. They had sixteen children in the family.
Dr. Erik Alexander:Wow.
Dr. Patrick Ellinor:It's a busy upbringing, but was reflective of kind of the US at the time. About half of the family members had a-fib. And so with that one family, we started then collecting the members of the family, doing blood samples and EKGs and ECHOs on them. We went to their family reunion.
Dr. Patrick Ellinor:And I brought some of my co fellows with me at the time, and they were great in helping out.
Dr. Erik Alexander:And isn't it great just to reflect on what now may seem so obvious in retrospect, Patrick, but like, you take the clinical idea and the idea that this can't just be coincidence and how are we going to put this together genomically or in some sort of hereditary lineage and then you figure out the science to solve that question, you know? And I think we do that all the time here at Mass General Brigham is this idea of the the clinic to the bench and back to the bedside and everything in between.
Dr. Patrick Ellinor:Yeah, and that's been a fun part for me, is that I still see folks, patients with or for arrhythmia issues. Now, of that turns out to be a-fib. That's true of any electrophysiologist these days, not just myself. But, you know, my interest in the genetics of a-fib really came not only from that family, but also in the early days of ablations. Those procedures, when they first started, were taking anywhere from eight to twelve hours to do the early ablation.
Dr. Patrick Ellinor:So as a fellow, you weren't doing much, and you had a lot of time to think. And one of the things that I noticed was that we were largely doing a-fib ablations on young, healthy patients at the time with very frequent episodes of a-fib. And a lot of those young, healthy folks had a brother or sister or mother or father with a-fib. And so even if you - because the families with 16 brothers and sisters are an anomaly.
Dr. Patrick Ellinor:But outside of that, what we saw was that there was a lot of clustering of a-fib in families that made us think that it was and made me think that it was a genetic condition. So we then set it -
Dr. Erik Alexander:You took it forward.
Dr. Patrick Ellinor:Yeah, we took it
Dr. Patrick Ellinor:forward. You also have lived through this era, too, we both have lived through, of kind of the process of seeing the understanding of the human genome become a truly translational tool to impact and understand human health.
Dr. Patrick Ellinor:Absolutely. And when we started, that first blueprint wasn't out yet quite yet.
Dr. Erik Alexander:I remember that. So in nature and science simultaneously were just over the millennium. Right? The new millennium.
Dr. Patrick Ellinor:That's right. About 2003. And we - so the first big project in addition to collecting the families was just to collect blood samples and take a history and gather information on a cohort of folks with early onset a-fib, and that was before we had that first map of the Human Genome Project, and that later became the basis as we collected hundreds of those patients. And I would say our patients were incredibly willing, because if you were 30 or 40 years old and you had a-fib, you were really pissed off, you know, or annoyed, and you were in search of an answer. And if someone approached and said, "I'm a nurse or a doctor studying what you - the disease that you have," and it's often your first major medical condition.
Dr. Erik Alexander:Mhmm.
Dr. Patrick Ellinor:For most of these patients, they were incredibly enthusiastic.
Dr. Erik Alexander:Yeah. I want help. I want the collective good here, contribute to something.
Dr. Patrick Ellinor:And I want to learn more.
Dr. Erik Alexander:Yeah. And the partnership we have with our patients and the research base is so important, and we value that so much to really make the discoveries that we make.
Dr. Patrick Ellinor:Yeah.
Dr. Erik Alexander:You know, let's just take it a little bit more towards the simple end for those listeners, Patrick, and just talk atrial fibrillation in general. Common arrhythmia. Maybe just give that one or two minutes. What is an arrhythmia? And when we talk about atrial fibrillation, what's going on?
Dr. Erik Alexander:Sure.
Dr. Patrick Ellinor:Happy to, Erik. So, atrial fibrillation, or arrhythmias in general, or just any irregularity of the heartbeat. And that can come in many shapes and forms. The - of - and it could be a simple skipped beat of the heart.
Dr. Patrick Ellinor:That's not a big deal. A skipped beat from the upper or the lower chamber. Those happen in all of us. Some very rarely, meaning a few times a day, and others hundreds of times a day.
Dr. Patrick Ellinor:And that's all just within the normal range.
Dr. Erik Alexander:Yeah.
Dr. Patrick Ellinor:For most people. And then there are other arrhythmias, and a-fib is the most common of all of the irregularities of the heartbeat. And the atria is the upper chamber of the heart, the ventricles, the lower chamber of the heart. And with a normal heartbeat, it would typically, when we're sitting here at rest, it'd be around 60 beats a minute. So the top would beat and then the bottom would beat.
Dr. Patrick Ellinor:And each 'lub dub lub dub' of the heartbeat would be nice and smooth and steady.
Dr. Erik Alexander:Yep.
Dr. Patrick Ellinor:When patient goes into atrial fibrillation, the upper chamber of the heart essentially goes into electrical chaos. So for a visual image, imagine taking a handful of stones and throwing them into a pond and then watching the waves collide into each other.
Dr. Erik Alexander:That's a great image.
Dr. Patrick Ellinor:So any any single point will have many, many waves coming and hitting at once. And the top of the heart will actually start beating in the range of four to 600 times a minute.
Dr. Erik Alexander:Yeah. And the bottom doesn't know what to do.
Dr. Patrick Ellinor:Exactly. And the bottom may then beat either very quickly or very slowly. You know, if you're younger, it tends to beat very, very rapidly. And the lower chamber of the heart, those ventricles, are what determine your pulse. And so that's what a patient would feel.
Dr. Patrick Ellinor:If you're older, it may slow down. But with that very rapid movement of the heart, initially, your heart can keep up and the upper chamber can keep up. But over time, it can't keep up with running 400 or 600 beats a minute. So it essentially starts to stand still.
Dr. Erik Alexander:Okay.
Dr. Patrick Ellinor:And then when it stands still, blood clots can form in patients.
Dr. Erik Alexander:That's the association here with stroke that everyone thinks about.
Dr. Patrick Ellinor:Exactly. And particularly as you get older, that association with stroke goes up. What causes a-fib? There's not one specific trigger, but there are things that increase your risk or so called risk factors.
Dr. Erik Alexander:Yeah. What are those?
Dr. Patrick Ellinor:The common ones, being a man, getting older.
Dr. Erik Alexander:I got both of those, Patrick, right there.
Dr. Patrick Ellinor:So do we. Yes. We're in good company. High blood pressure, diabetes, obesity, other heart disease, and then genetics as, you know, we've uncovered.
Dr. Patrick Ellinor:Yeah. All of those add up. There's not one - it's not like flipping a light switch where you either have it or you don't.
Dr. Erik Alexander:Are there any lifestyle risk factors that some patients can also lean into trying just to reduce that risk at all?
Dr. Patrick Ellinor:Absolutely. Controlling - so the the single biggest driver currently is obesity. And until recent medications, we haven't had great treatments for long term management of obesity.
Dr. Erik Alexander:Boy, that's changed, hasn't it?
Dr. Patrick Ellinor:Absolutely. And with GLP-1s and similar medications, I think that will be in our primary arsenal to treat a-fib. Because it's very clear if you lose weight and you sustain that weight loss, you will reduce the burden of atrial fibrillation.
Dr. Erik Alexander:That's great. And is that linear all the way down to just a normal weight?
Dr. Patrick Ellinor:We think so, but that is a little harder to quantify. We tend to put obesity in different buckets.
Dr. Erik Alexander:I bet I have some listeners out there who are going to ask about, what about some stimulants like alcohol use or caffeine use, things like that?
Dr. Patrick Ellinor:Yeah. All of those can increase the risk of atrial fibrillation. It tends to be very localized. So if you know, the holiday heart is when someone goes binge drinking over either a holiday or a weekend, and then they have a-fib the next day.
Dr. Patrick Ellinor:So, you know, our basic advice is if that's a trigger for you, stop it. Now, that's pretty logical, not always easy to do, but it's a good starting point. You know, if you've had six cups of coffee and you get a-fib the next day, don't have six.
Dr. Erik Alexander:Maybe one or two.
Dr. Patrick Ellinor:Exactly.
Dr. Patrick Ellinor:But it's not always perfectly predictable.
Dr. Erik Alexander:Maybe for those who are a little bit more clinically savvy, you know, the last thirty years, not just here at genomics, which we'll get into, but the field has certainly really advanced as to how we diagnose, how we treat, how we think about an approach. Maybe you could just share that very quick, but three decade long kind of growth in the field a little bit.
Dr. Patrick Ellinor:Yeah, think there have been three major developments on the clinical front for atrial fibrillation. The first, as you mentioned, Erik, is diagnosis. If you're carrying a watch, or in many cases, a phone, they can now record an EKG. You know, whether it's an Apple Watch or Google Fit or a Fitbit or others.
Dr. Patrick Ellinor:I don't have any loyalty to any particular one of the companies, but all of them are now building in the ability to detect a-fib. First, they'll do it by just detecting an irregularity of the pulse, but then they can go one step further and have you record an EKG that you can then bring to your doctor or send in to us to review.
Dr. Erik Alexander:Yeah. The technology is just leaps and bounds. Right?
Dr. Patrick Ellinor:Exactly. So that's been one huge improvement. Many people are walking around with the ability to detect a-fib, and that's great, because if you're 75 years old or 80 years old and you're at risk, you have other risk factors that may increase your chance of a stroke. One of the real tragedies that we see with a-fib is someone would have gone into a-fib, not have been aware of it, had a blood clot form, and a stroke happens.
Dr. Patrick Ellinor:Well, now if we detect it, you're 80 years old and you we detect a-fib on a watch, we can get you started on a blood thinner and try to prevent that horrible outcome of a stroke.
Dr. Erik Alexander:What are the other two major advances you were gonna talk about?
Dr. Patrick Ellinor:The one is with respect to the blood thinners. You know, when I started, and you and I spent a lot of time prescribing warfarin or Coumadin, which is a blood thinner that required - was very difficult to manage.
Dr. Erik Alexander:Yeah. Kind of a shotgun, you know? We put everyone on it, but some people were easily controlled. Others would go up and down with their INR.
Dr. Patrick Ellinor:Exactly. And if you go too high, you're at risk for bleeding complications in the brain or the bowels, and it can be deadly. If it's too low, you're not protected against a stroke. So, the newer medicines that we have have been really transformational, whether it's Eliquis, Xarelto, or others. You take these medicines, and within hours start protecting you from a stroke.
Dr. Erik Alexander:Yeah.
Dr. Patrick Ellinor:And as long as you're taking them, they're incredibly effective.
Dr. Erik Alexander:Yeah, that's great.
Dr. Patrick Ellinor:Yeah. And then the third major area has been the revolution of ablations.
Dr. Patrick Ellinor:As I mentioned earlier on, when I started, these were anywhere from eight to ten or twelve hour procedures. We are now routinely doing four or five ablations for a-fib per day.
Dr. Erik Alexander:And what's the goal there? To go in and kind of scar that area and not let that arrhythmia take hold?
Dr. Patrick Ellinor:Yeah. So we've learned a lot over the time on where a-fib comes from, and it not only comes from the left upper chamber of the heart of the atria, but it comes from a very specific place called the pulmonary veins. So the pulmonary veins bring oxygenated blood back from the lungs into the left upper chamber of the heart. And right where the vein meets the heart muscle tissue, there are little areas in people with a-fib of electrical instability. So they're just sitting there firing off these electrical signals, which then put the heart into that chaotic activity
Dr. Patrick Ellinor:of that four to 600 beats a minute, or those stones in the pond. But we know where the focus is, and so we don't go and cauterize that specific spot because if we did that, that could lead to complications or because the patients have any - or each of us - have anywhere from - we typically have four pulmonary veins. So what we do is we put a big circle around the pulmonary veins and electrically disconnect them from the rest of the heart.
Dr. Patrick Ellinor:And so those signals can continue firing, but they're not going to go anywhere. You're essentially walling them off.
Dr. Erik Alexander:Does the regular then heart rhythm kind of take over?
Dr. Patrick Ellinor:Yep. Then you are left in a regular heart rhythm, and they're particularly effective. Though it also highlights one of the major challenges we have in a-fib. So with respect to ablations, though, I would not take them lightly. They are invasive. They involve your heart. We go through larger blood vessels. We do them quite safely and effectively. In Mass General Brigham, we will do over 500 AF ablations this month.
Dr. Erik Alexander:Wow. That's a lot.
Dr. Patrick Ellinor:It's a lot.
Dr. Erik Alexander:Yeah. I thought were gonna say this year.
Dr. Patrick Ellinor:No. No. This month. It used to be in a year, but now it's on a per monthly basis. We're the largest of the academic medical centers doing these ablations, and we've spread the technology out to our community sites as well, both in Salem and in Cooley Dickinson up in Dover.
Dr. Erik Alexander:And then if you can effectively ablate that a-fib, you might not need the blood thinner?
Dr. Patrick Ellinor:That's not the short term goal. I'd say if you're young and healthy, that would be a goal. But if you're older and you're at risk for a stroke, we would be reluctant to take you off a blood thinner until you've had a long track record of proving to us that you remain in a-fib.
Dr. Erik Alexander:Got it.
Dr. Patrick Ellinor:Or have a careful monitoring strategy monitoring strategy.
Dr. Erik Alexander:So you're taking away that fast heart rate to some degree.
Dr. Patrick Ellinor:Exactly. We're trying to treat the symptoms, but I would not - we want to be very, very cautious. If you've had a signal that you've had a-fib and you're at risk for a stroke, stroke is devastating and we can't take it back.
Dr. Erik Alexander:Yeah. It really stresses the importance of talk to your doctor as there really is individualized risk. You know, let's just do one word - I know time is moving fast, but I would love to use your
Dr. Erik Alexander:knowledge of genomics in atrial fibrillation. I'm sure there's listeners out there who may say, "Geez, does that mean I should think about getting my genome checked? Am I at risk for atrial fibrillation?" Or how do we translate now what we know genomically into the care of patients with arrhythmia or a-fib?
Dr. Patrick Ellinor:Sure. Well, a few things have emerged. Going back to when we were first collecting blood samples in our clinics and from some of our floors, we've now brought entire populations around the country and around the world together to try to understand the genetics and genomics of a-fib. So we started very modestly.
Dr. Patrick Ellinor:My first study had about 400 patients from Mass General Brigham in an early genomic study. The latest study, which we've just posted and will be on the publication, you know, within the next six or so months, had four hundred thousand patients with a-fib and a few million people without a-fib. And what we've done in those studies has been to take patients with a-fib and those without a-fib, compare them across the entire genome and say, what's different?
Dr. Patrick Ellinor:And what that has given us is a genetic fingerprint of the disease. And we now have hundreds of individual regions of the genome that increase your susceptibility to the disease.
Dr. Erik Alexander:And this complexity that all of us have different DNA base pair changes, which are just variants, so to speak, but some of them are more pathologic and some of them are just natural evolution, I think, if I understand my simplistic genomics.
Dr. Patrick Ellinor:Well, they certainly can put you in aggregate. We can add all of those up and make them into a score, and that score can convey a probability or a likelihood or susceptibility to a-fib or any other common disease. The same type of approach has been done for everything from a-fib, high blood pressure, obesity, or any other common human disease. So just in the last decade, we've seen an explosion in our understanding of the genetic basis of disease.
Dr. Patrick Ellinor:Yeah. What it now does is really open up opportunities in two areas. One is to say, can we use that information to refine patient care? Who might be susceptible to the disease, who we should monitor more carefully.
Dr. Erik Alexander:Individualized care.
Dr. Patrick Ellinor:Exactly. And then the second is that opens up new therapeutic targets. And we're really in the early days of saying, "Can we take the genetic information for a disease and use that to drive new therapeutic targets?"
Dr. Erik Alexander:Yes, that's a great point. You know, Mass General Brigham has really taken some amazing steps in the last few years, now opening up several institutes, one of which you are the executive director, the MGB Heart and Vascular Institute. Can you just give us some information? What is the Heart and Vascular Institute? How is that from where we were five or ten years ago?
Dr. Erik Alexander:It's not a service line. Maybe you can talk about the differences and comparisons there, just so everyone understands the evolution of where we're going.
Dr. Patrick Ellinor:Sure, happy to. Well, a service line is really just a clinical care delivery model. It just isolates the clinical care. It may be for heart or cancer or any could be for anything. I think the institute - the idea behind the institute's a bit different.
Dr. Patrick Ellinor:It's not just the clinical care, but in academic medicine, everything that we do is so deeply intertwined, and we want to make sure that we're touching upon all aspects of our academic mission. So, yes, it does bring together the clinical care for heart and vascular care. So bringing the divisions of cardiology, cardiac surgery, and vascular surgery under a common umbrella, because you often in cardiology have much more in common with cardiac surgery than you might have in some of the other disciplines in medicine.
Dr. Erik Alexander:And you create some efficiencies, or you share ideas, or you figure out those partnerships perhaps.
Dr. Patrick Ellinor:Absolutely. And even beyond that, even the clinical care delivery model
Dr. Erik Alexander:Changes and evolves towards the positive. Absolutely.
Dr. Patrick Ellinor:Yeah. And the but it's important that we also have other missions in academia, and particularly our research mission, our educational mission, which we've grown up with.
Dr. Erik Alexander:Yeah.
Dr. Patrick Ellinor:And then also our care in the community. And so the institute involves all of those, that four part mission of who and what we are at Mass General Brigham.
Dr. Erik Alexander:And I'm going to kind of lead you here, but directing an institute, are you able to break down some of those barriers? It can be very siloed to do research because you do have to have a reductionist mindset, but maybe the institute's allowing you to find those partners or those other patients willing to participate, or a different idea that's a collaborative one. I would think that that would be such a positive perhaps to the institute model.
Dr. Patrick Ellinor:I think we - I would say it's new.
Dr. Erik Alexander:Right?
Dr. Patrick Ellinor:We're under two years into the the existence of an institute, and we've made a lot of progress in the last two years. So we now, across Mass General Brigham, have a single chief of cardiac surgery and vascular surgery and cardiology. Yeah. We were just delighted to welcome back Doctor Christine Albert about just over four months ago as our inaugural chief of cardiology for Mass General Brigham, and she's working with Dr. from cardiac surgery and vascular surgery, respectively, to really reshape who and what we are. You know, when you think back just two years ago, we had different chiefs for each of these major areas on our campuses, and those have have come together. We've done that also in the sections within cardiology. So we have unified leadership in each of our major domains, whether it's general cardiology, echocardiography
Dr. Erik Alexander:Heart failure.
Dr. Patrick Ellinor:Heart failure, cath, EP. Each of these major areas have single leaders. And these are big jobs. They're tough jobs.
Dr. Patrick Ellinor:And, you know, you've gone from one institution that you know very, very well to now not only, you know, one AMC with two campuses, but you also have all of our community sites as well. And in the Heart and Vascular Institute, that's an important part of who and what we are, is the part of the the whole community division that extends well beyond these walls.
Dr. Erik Alexander:Yeah. And just from my own personal experience, you know, it is complex to open up double the size of your section or your division, but boy, the positives to just increasingly communicate, mingle and share ideas with more colleagues and honestly, approach the same disease in a slightly different way sometimes just from two institutions three miles apart. I think that really makes, you know, it makes me a better doctor, I think, and there's a real value add to what we're doing as well.
Dr. Patrick Ellinor:Absolutely. Maybe just some, you know - I would reflect back and - you know, when I was - before I took this job, I was the acting chief of cardiology at MGH. And I knew MGH very, very well, having effectively grown up there in the system. But I kind of view the institute as, like, one plus one equals five.
Dr. Patrick Ellinor:By that, I mean -
Dr. Erik Alexander:Love that.
Dr. Patrick Ellinor:It's not just adding the Brigham and MGH together. We are- we have a footprint throughout our entire system. And when we started, we didn't even have a good map as to how big we were. So we - there are about 60 locations throughout New England where we provide clinical care
Dr. Erik Alexander:Wow.
Dr. Patrick Ellinor:In the Heart and Vascular Institute. We have seven community hospitals. We have about 75 cardiologists and a similar number of advanced APPs in our community sites.
Dr. Erik Alexander:It's a huge footprint.
Dr. Patrick Ellinor:Massive footprint. And about half of the clinical care delivery that we do happens outside halls of our academic medical centers.
Dr. Erik Alexander:And it's an outstanding set of care that we can receive, especially when we're so integrated and can share the same expertise here in the main hospitals equally in our affiliated, more community focused hospitals.
Dr. Patrick Ellinor:Yeah. And I think when I reflect back, you know, there are things that we do very, very well. You know, we are some of the leaders at Mass General Brigham in the heart and vascular research and education. And in clinical care, we have incredible depth of talent in bench. But I think, if we're honest with ourselves, we're also a difficult system to navigate.
Dr. Patrick Ellinor:Yeah. Just try to get an appointment with us.
Dr. Erik Alexander:Yeah. Just try to drive into the hospitals.
Dr. Patrick Ellinor:Try to get an appointment with us. Try and find us on the web. Right.
Dr. Erik Alexander:Who does what, and where do I get my blood drawn, and how does this all work?
Dr. Patrick Ellinor:Right. And it's - I think when everyone is - a lot of the job that we're trying to tackle in the institute is to make this more seamless for our patients. Yeah. And that's something that's critically important.
Dr. Patrick Ellinor:I know we as physicians are - we're all busy. Yeah. Everyone's got plenty of work, and that's a luxury. And it's a bit of a - it's a blessing. It's a double edged sword, obviously, when you're really busy.
Dr. Patrick Ellinor:It's to work more effectively to make it easier for our patients to navigate this journey.
Dr. Erik Alexander:And I love how you're bringing it back to the patient as we close, Patrick. You see patients regularly, I know. And do you take those ideas from the clinic and bring them kind of high level up to how you think about the institute and vice versa back into your clinic?
Dr. Patrick Ellinor:Yeah, absolutely. I still do. My clinic is not as frequent as I would like it these days. It's been a busy couple of years, the last two years. Absolutely.
Dr. Patrick Ellinor:But I've always had and maintained a clinic in electrophysiology.
Dr. Erik Alexander:Yeah. What is it about patient care that doesn't let you let go of that special moment?
Dr. Patrick Ellinor:It's the longitudinal relationship with many of the patients I've followed for, in this case, twenty plus years in my particular domain. It grounds you with all the rest of the work that we do.
Dr. Patrick Ellinor:It's just so human. Right? I get to hear from patients.
Dr. Patrick Ellinor:It's shorter term because you can be helpful, and you can take care of things that aren't three and five years in development, but you can make an impact on, say, their a-fib today.
Dr. Erik Alexander:And on so many levels, just to kind of come full circle here, that's why we became doctors and why everyone goes in to be a clinician at the end of the day, and then obviously many of us get drawn to the academic mission on top of that, but patient care is so part and parcel of what we do.
Dr. Patrick Ellinor:Absolutely. And I would say I'm incredibly grateful for the opportunities that I've had across Mass General Brigham. Every system, every place is complex and has its own challenges. But I think one of the unique things about our system is the opportunities that it affords so many trainees. The depth of talent in the education, the research, the clinical space give you a lot that you can build.
Dr. Patrick Ellinor:Yeah. And I would say to that future trainee, all of the problems are not solved. There are plenty of opportunities that are out there. And if you have an idea, you know, mine was to collect some blood samples on patients with a-fib and study something crazy like genetics that didn't exist at the time.
Dr. Patrick Ellinor:But that type of story has played out time and time again with so many of my colleagues, and that's a very, very unique thing that we can bring to academic medicine and to medicine across the world.
Dr. Erik Alexander:I couldn't think of a better way to end the podcast, which is talking so much about why it's all about the patient, yet also the excitement of what we do to advance the science of clinical medicine and to also just think about the wonder of training to become a doctor and how we can do that best. So well said, Doctor Ellinor. Really appreciate you taking the time. I want to thank all of our listeners also for joining us today on the MGB podcast, and look forward to inviting you back for our next one.