Life and Times of Leading Cardiologists: Kim Eagle

Editor's Note:
The following interview was recorded on November 13, 2016, during the American Heart Association Scientific Sessions in New Orleans, Louisiana.

E. Magnus Ohman, MD: Hello. I am Magnus Ohman. I want to welcome you to another episode of Life and Times of Leading Cardiologists. We are very fortunate today to have my good friend and esteemed colleague in cardiology, Kim Eagle, from the University of Michigan where he is the director of the Cardiovascular Center, among other things. Kim, you have done many different things over the years in cardiovascular medicine. What stands out for me, which we will talk about in a bit, is your early work on two things: thoracic aortic aneurysms and perioperative guidelines. But I want to start off with where you grew up. Where did life begin for Kim Eagle?

Fly Fishing and a Mentor's Generosity

Kim A. Eagle, MD, MACC: I grew up in Bozeman, Montana. I decided to go into engineering in college and went to Oregon State. I did not like engineering, but I liked biology. I also thought a little bit about the ministry. I had a very shrewd advisor who said, "Ministry and biology: That is medicine. You should go to medical school." As far as I know, nobody in my family had ever done that.

Dr Ohman: Let us not leave Montana just yet. There are very few Montanians whom I know of who have done as well as you have in medicine. How did you make the step from Montana onwards?

Dr Eagle: I had a mentor, named Don Hopkins, who had graduated from Yale College. I was his fishing guide. He was really fond of Eastern education, and he encouraged me to go east. He was adamant that at some point in my life, I would go east. Interestingly, he asked my parents if he could help them pay for my college. This fellow decided that I was a good investment for him, and he funded my medical school as well. My dad was a math teacher with four kids—there was no way I could have gone to medical school otherwise. I went to Tufts for medical school, and then, of course, I went to Yale for residency. He was thrilled. He was shocked when I went to Harvard for fellowship, but that was okay. Because I had gone to Yale first, it was fine.

Dr Ohman: Basically, you could not talk to him during the football season?

Dr Eagle: We could not talk, yes.

Dr Ohman: You must have been really good at fly fishing.

Dr Eagle: I started fly fishing when I was 5 years old. My grandfather settled the west entrance of Yellowstone and was a fishing and hunting guide. He guided two presidents, Coolidge and Hoover. I started being a fishing guide when I was in junior high school and continued through college and medical school. I was this fellow's fly fishing guide, and he ended up becoming very important to my life.

Dr Ohman: That is amazing. We very rarely talk about the importance and the value of philanthropy. It is not something that comes up and is not natural to us in medicine. This is philanthropy at a tremendous level. Is your mentor still alive?

Dr Eagle: No, he passed a number of years ago. But you are right. My desire to raise funds for things that matter in our cardiovascular center was fueled by my own experience where one person made a huge difference in my life. I doubt I would have gone into medicine without his support. I certainly would not have gone east as I did. I will forever be thankful to him.

Dr Ohman: It is an amazing lesson.

From East to the Midwest

Dr Ohman: Oregon is west of Montana. Did I get that right?

Dr Eagle: I think you are right. You looked at the map. A couple of colleges were strong in engineering, but Oregon State was the closest to Montana that looked interesting to me, so I went there.

Dr Ohman: You have three siblings. Did any of them go into medicine?

Dr Eagle: No. My brother is a banker. He went to Yale College while I was there. My two sisters own kitchen design businesses in Montana. I am the one who left and stayed gone, so to speak. But I go back all the time.

Dr Ohman: The east must be very different from Montana. How did it feel to go from the mountains to the city?

Dr Eagle: The hustle and bustle and complexity of living were very foreign to me. We adapted, and it was fine. Obviously, the medicine is fantastic, and the striving for excellence is fantastic. I am forever thankful that I had the chance to be at Tufts, Yale, and then Boston again. When I was recruited to Ann Arbor, which is a college town not unlike the one in which I grew up in Bozeman, Montana, I felt like I was back in an environment that was more comfortable. Not that I did not love Boston—it was great. But I have been in Ann Arbor for 22 years, and I absolutely love the town.

Dr Ohman: It is a great college town.

Dr Eagle: I love the university, the medical school, and the health system.

Dr Ohman: Particularly when the football team is doing well.

Dr Eagle: Yes, that is good. I enjoy that.

Dr Ohman: When did you decide you were going into medicine and so on? What was your thinking at the time?

Dr Eagle: At Tufts, I decided to do internal medicine. When I was at Yale, I was just struck by how I was drawn to cardiovascular problems. When I would go to the library, that is what I would read about. When I got admissions, I would be completely smitten by the cardiology admissions. I was not interested in a gimmick; I was more interested in how we ask questions about things that come along at the bedside. I wanted a fellowship that would allow me to get training in cardiology and clinical research, and that is what Mass General let me do. I did a Kaiser fellowship at the Harvard School of Public Health and a cardiology fellowship at Mass General at the same time. That got me launched.

Dr Ohman: It is fascinating to hear that your father was a mathematician, and you do epidemiology. The two fields are not that far apart. That is actually an amazing piece. Were there mentors along the way at Oregon State or at Tufts who helped you along?

Mentors and Matrimony

Dr Eagle: I have had so many mentors, Magnus. Too many to count. At Tufts, the chief of medicine was Sheldon Wolff, and the associate chief was Jerry Kassirer. These two men took a real personal interest in my career and helped me a lot. In fact, it was Jerry Kassirer's relationship to Sam Thier, a chief of medicine at Yale, that connected me to Yale. I wanted to train under Sam Thier. He was a bigger-than-life figure who was just magical in thinking about medical problem-solving. At Mass General, Roman DeSanctis was phenomenal; George Thibault influenced my thinking about outcomes research; and Val Fuster really taught me to think globally and to think about the whole world as a place of research. Larry Cohen at Yale was probably the cardiologist I most wanted to be like. He was this amazingly cerebral, kind, and professional cardiologist who made every patient feel like they were his only one. He was just so good with them at the bedside. All of these people were mentors—and many, many more.

Dr Ohman: Jeremy Kassirer went on to become editor at the New England Journal of Medicine, of course.

Dr Eagle: I did Images in Clinical Medicine with him. I was the first editor for Images in Clinical Medicine back with my medical school mentor.

Dr Ohman: Along the way, a family came along.

Dr Eagle: Yes. I married my wife, Darlene, who was working at Mass General. We had a son in Boston named Taylor. He went to U of M and worked there. He works for a health-related nonprofit now.

Outcomes Research in Coronary Disease

Dr Ohman: That is great. When did you get interested in outcomes research? When did this area of thoracic aneurysm pop up for you as a big piece? You made sense of it for all of us, which is so important for prognosis.

Dr Eagle: It is pretty interesting. My interests in acute coronary disease, perioperative risk, aortic dissection, and how we use guidelines to influence care all developed in my fellowship. I was studying how to do clinical research, and I was facing patients with nasty dissections [and questions arose]. When do we do perioperative stress testing? How do we manage patients with coronary care in the intensive care unit and then move them along? How do we give evidence-based care? All of these areas of interest started when I was a fellow. I have had them throughout my whole career.

Dr Ohman: Did you struggle at times to get funding for some of these projects?

Dr Eagle: Sure. As you remember, outcomes research 25 years ago was not funded by the National Institutes of Health (NIH). It was not funded by the American Heart Association. I learned to find money elsewhere from donors, local foundations, whatever. I have never followed the NIH track at all. I have always tried to find funding in other areas, and we have been successful.

University of Michigan Bound

Dr Ohman: Very successful. You were a Bostonite, a long way from Montana, and you decided to go to Ann Arbor, Michigan. What pulled you to the Midwest?

Dr Eagle: There were a couple of things. First, I had worked with Val Fuster for two years and got the energy from him to build a team-based practice and research effort. That really changed my thinking about maybe trying to do more and to put things together. At Mass General, I was associate chief of cardiology. University of Michigan had gone through some transitions and needed to recruit a number of clinical people, including a clinical chief of cardiology. They wanted me to start an outcomes research lab using a hospital as its laboratory. They wanted the University of Michigan to do a statewide effort to try to improve cardiovascular care.

Dr Ohman: There is a connection with the School of Public Health.

Dr Eagle: There was a bit of friction between cardiology and cardiac surgery at the time, which happens occasionally. The hospital created something called The Heart Care Program. They asked me to lead it with a cardiac surgeon. It was a very interesting opportunity. My lovely wife said that she would go to Michigan. My son came along, and we have been there for 22 years.

Dr Ohman: Great. When you got there, you obviously also dealt with acute myocardial infarction (MI) care in the state of Michigan. It is hard to imagine, but this is long before there were any formal registries. You used the statewide database.

Dr Eagle: The American College of Cardiology (ACC) had updated their guidelines. When I went to Michigan, we did a chart review of 300 consecutive MIs in our hospital to see whether we were really giving evidence-based medicine. It was shocking. The house officer was thinking that the intern did it, the intern was thinking that the medical student did it, and so on. We were not giving evidence-based care. We created a guideline-based toolkit to use from admission in the emergency department to discharge. Based on the ACC's guidelines, we created something called the GAP program, Guidelines Applied in Practice.^[1] We got funding from ACC to do a statewide effort in 33 hospitals.^[2] It worked.

If you create evidence at the point of service and do it reliably, care improves. We followed that with a similar effort in heart failure, and then we created a statewide registry in angioplasty working with Blue Cross^[3] because there was a lot of practice variation around coronary angioplasty.

Dr Ohman: It is fair to say that many people have looked at the program in Michigan and said that that is really how you make it happen. You have done it in a unique way. It is actually a shame, from my vantage point, that this has not been replicated in many other states. Some states have tried to do it. What do you think you were able to do that others could not?

Dr Eagle: I think of a couple of things. First of all, in the Midwest culture, there is a general willingness to collaborate and learn from one another, certainly in Michigan. Blue Cross Blue Shield in Michigan was very progressive in thinking that if they worked with physicians and hospitals throughout the state on quality initiatives, ultimately the patients would win. And maybe they would lower cost, which they have been able to do. Part of the fuel was due to the employers. Our kickoff meeting was at the General Motors headquarters. When the head of the General Motors asks you, a cardiologist, to come together and work around heart attack care, you listen. It was a unique moment, but it has worked.

Dr Ohman: After these efforts on quality improvement, you spread out a little bit towards younger individuals. Tell us a little bit about this.

Teaching Kids Cardiovascular Health

Dr Eagle: This is very interesting. My son was going to middle school, and he would come home and say, "We do not have recess anymore. Today we got three-meat pizza and tater-tots for lunch." I was just shocked that a very wealthy community was serving such bad food and not providing activity to children in the schools. Another person and I developed something called Project Healthy Schools, which is a middle school intervention that provides 10 lessons focusing on nutrition and movement. We change the cafeteria and the vending machines. We celebrate health in the school by working with the principal and the teachers. We have shown that by implementing a health curriculum in middle schools, you can improve children's health.^[4,5] They eat better, they move more, their cholesterol goes down, and their exercise tests suggest that they are more fit. This program has grown and is in 78 middle schools right now in Michigan, which is very exciting.

Dr Ohman: Does this excite the young individuals about science and medicine, or is it focused on diet?

Dr Eagle: First of all, kids like healthy food. If you go to a food desert like Detroit and give kids healthy food, they like it. The idea that they are only going to want bad food is a myth. They also like to move, but they need a place where they can move safely. Many of them like to work in a garden. Kids embrace health if you create a moment for them to embrace it.

But your question gets to the next step, which is high school. We created a program called the Science of Health, which is essentially a science curriculum focused on understanding why movement and better nutrition lead to healthier lives and better performance, things like that. This program is in two high schools now, and we are hoping it will grow. What is fun about that program, Magnus, is that high school students in those communities are going back into the middle schools and teaching some of the lessons in Project Healthy Schools.

Dr Ohman: That is amazing. Are you still doing fly fishing?

Dr Eagle: I am. I love to fly fish.

Dr Ohman: Are you still teaching it?

Dr Eagle: I do. I have auctioned myself for the symphony orchestra and a couple of other charities where I will take a couple and teach them how to tie a fly and how to cast. We take them to a river in the back of my house, and we fly fish for smallmouth bass. Then they come to dinner for fish with nice wine pairings. I still do this, and I love it.

A Change of Pace

Dr Ohman: It is amazing that you had a philanthropic beginning, and you have actually continued giving back throughout your life. If only Mr Hopkins could see what you have done. All of the various aspects you have tackled are truly remarkable.

Dr Eagle: He would be very excited. We are doing another project, which is one of the most exciting. A few years ago, one of our electrophysiology fellows came into my office and said that he had put a pacemaker in a woman 2 weeks prior, but she had since passed not related to the pacemaker. Her husband had her cremated, brought back the pacemaker, and asked whether we could give it to somebody in the world who needed a pacemaker. That moment created My Heart, Your Heart, which is an effort to recycle pacemakers for use in low-income countries.^[6] Over the last 5 years, we have received over 20,000 pacemakers in the mail. We are working with a nonprofit to make those devices sterile, reanalyzed, and available to people in the third world who otherwise would not have access.

Dr Ohman: Wow. That is another great story. What is next for Kim Eagle? What is on the horizon?

Dr Eagle: I am really enjoying working in aortic disease. The International Registry of Acute Aortic Dissections has 47 centers now. We have been doing this for 20 years. There are a million deaths a year in the world from the lack of a pacemaker. The next step for the My Heart, Your Heart program is a randomized trial of used vs new pacemakers. Once that is done, I hope to create distribution centers in Europe and the United States to reach this need in South America and Africa particularly. And there are 950 middle schools in Michigan, Magnus. We are only in 78. There is still plenty to do.

Dr Ohman: You have more great work to do. I want to thank you, Kim. It has been a great discussion.

Dr Eagle: I enjoyed it. Thank you for having me.

Dr Ohman: I want to thank you, the audience, for participating with us here today. Thank you.