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The Second Neurologist President of the AHA: His Vision, Goals, and Work in the Time of COVID-19

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Mitchell Elkind, MD, MS, FAAN, the president-elect of the American Heart Association (AHA), discusses his career, his vision for AHA, and how COVID-19 will change the field of neurology.

Mitchell Elkind, MD, MS, FAAN, was always fascinated by the mind and brain, and now he's connecting both to matters of the heart. As the president-elect of the American Heart Association (AHA), Dr. Elkind, professor of neurology and epidemiology at Columbia University Vagelos College of Physicians, is the second neurologist to head the organization. The first was former AAN president Ralph L. Sacco, MD, MS, FAHA, FAAN, chairman of neurology at University of Miami Miller School of Medicine

But Dr. Elkind wasn't always focused on biology and physiology. Before going to Harvard Medical School, he earned his undergraduate degree in philosophy at Harvard and his master's degree in the history and philosophy of science at Cambridge University in England. Neurology Today spoke to Dr. Elkind about his plans for the AHA, his thoughts on medical and residency challenges in the time of COVID-19, and why he's grateful for his Peloton bike.

What got you interested in neurology?

When I was in medical school, I saw the brain as the next frontier of medicine and science, and that's largely been borne out. When I started training, there was maybe one medication for multiple sclerosis; now there are many. I was a resident when IV tPA was approved for stroke and now it's a reality, part of regular treatment for strokes, and that's exciting to see.

Did you have anyone who particularly mentored you or who was an inspiration?

I was fortunate to have several great mentors. As a resident, C. Miller Fisher, one of the giants of vascular neurology, was still conducting weekly conferences, and I learned much of the approach to neurological patients, and especially stroke medicine, from him. Other mentors, including Walter Koroshetz, then at Massachusetts General Hospital and J. P. Mohr at Columbia also paved my path. Perhaps the greatest influence on my career, though, has been Dr. Ralph Sacco, now chair at the University of Miami, with whom I continue to collaborate and learn, not just about stroke, but about leadership and commitment. He was also the first neurologist president of the AHA.

What did you think being a doctor would be like versus the reality?

In training, during the rotations, you spend a lot of time with patients. They always say you learn neurology “stroke by stroke,” and it's true. Every patient is different, and neurology is not just about the brain, but the personality and experience of the individual.

You start as a doctor with a lot of intense focus on the patients. But as you choose a specialty and transition from learning to teaching, that shifts, and then you throw research into the mix. So now I'm still seeing patients, but I'm also doing administration, writing grants, teaching...I didn't think about those aspects initially.

Do you miss working with patients?

I miss some parts of it. Personally, I spend the bulk of my time doing research, so in some ways I'm not primarily a clinician. But if you woke me up in the middle of the night and asked “What do you do?” I'd say “I'm a doctor.'” I never wanted to do just one thing, so it's very gratifying to be involved in multiple areas. If I were just seeing patients or I were only in the lab, I think I'd feel like I was missing out. I like to remain open-minded to different experiences - although some people will think that being involved in the American Heart Association is a bit of a left turn for someone in neurology.

What is a neurologist doing heading up a heart association?

I think people don't understand that the AHA is different from the AAN or even the American College of Cardiology. Those are essentially professional organizations, and they are focused on the lives and well-being of those practitioners. The AHA is more of a public health organization focused on prevention and treatment of cardiovascular disease, and that includes strokes. It's got a wide range of activities, and it even began to include brain health a few years ago.

What are your goals for AHA?

Part of what I hope to do during my tenure is not only to incorporate stroke and other vascular disease of the brain into the message of the AHA, but also brain health and brain science. We just announced our impact goals for 2030, and the mission is to extend the healthy lifespan, free of disability, by two years in the US. There are a lot of neurological diseases that we don't think of as vascular disease, but we have learned that blood vessel disease contributes to dementia and cognitive decline as well. Inflammation of the blood vessels, for example, can lead to blood supply issues to the brain, potentially leading to Alzheimer's and other degenerative diseases.

The AHA has tremendous resources and provides some of the highest levels of grant funding outside of the NIH. I hope members of the neurology community start looking more to AHA for funding.

What kind of work would you like to see expedited?

The treatment of inflammation is an important developing area. It started with cardiology and moved into stroke and it's playing a bigger role in neurology as well. There's a lot of promise there, and we need to continue developing better biomarkers of different diseases as well, both imaging biomarkers and blood biomarkers.

What are some of the biggest challenges?

Many have to do with long-term illnesses, like Alzheimer's, where the pathology begins 20 years before people have symptoms. It's hard to know when it's early enough for us to intervene and make a difference. When a disease goes on for so long, when is it right to start treating someone at a young age to prevent something that might happen in old age. We have to think deeply about how we conduct those clinical trials.

How do you think COVID-19 will change the landscape for neurology?

Although it's thought of as mainly a respiratory illness, there are implications for cardiology and neurology as well. There is evidence that the virus can enter cells through the ACE2 receptors in heart cells, and these may also be found in neurons. There was some evidence of brain involvement with the original SARS virus, which was also a coronavirus, since it was found in the brainstem in some patients after they died.

People with pre-existing conditions, such as heart disease and stroke, also have a higher mortality from COVID-19.

All of which is to say that we may find there are neurological aspects that people may not be aware of yet. This is a disease that started at the end of December. Now it's March and more than 400 papers have been published about it already. It's amazing how much work has been done.

How do you think it will impact residents?

Trainees are working incredibly hard. It's a challenging situation. They are having to shift from a primarily educational mode to a service mode. We're even bringing people back from retirement. It's an all-hands-on-deck approach. I think resident education might suffer in the short term, and the neurological community will need to consider how best to make up for this. There will be a lot to unpack once we get to the other side. In the meantime, our residents and fellows are doing heroic work, and I am in awe of this generation.


“When a disease goes on for so long, when is it right to start treating someone at a young age to prevent something that might happen in old age. We have to think deeply about how we conduct those clinical trials.”—DR. MITCHELL ELKIND

What's the role of telehealth? What does the field need to do to ramp that up?

We've been doing telestroke for a long time, and it's filtered out to other areas of medicine. Now our practice has shifted largely to doing outpatient visits by telehealth and we're even doing visits within the hospital that way to minimize contact with COVID-19 patients and preserve personal protective equipment. As a nation, we're fortunate in the sense that telehealth technology started 20 years ago, so it wasn't too hard to fall back on that. We've got to ramp up the internet infrastructure, though, as telehealth may be increasingly used in the future.

So you write grants, you see patients, you do research, you're the head of AHA now. What do you do in your free time?

I like to cook, and I like to eat. I really like to make pizza, that's my favorite thing. But I'm also trying to stay fit, so I'm glad I recently got the Peloton bike.