Thank you for participating!

Thank you to all who contributed to the National Heart, Lung, and Blood Institute (NHLBI) Strategic Visioning Forum. Ultimately, over 1,000 ideas were submitted, with more than 42,000 votes. This remarkable response exceeded expectations and provided a wealth of ideas to draw upon as NHLBI moves forward. Please visit the NHLBI Strategic Visioning page to find out more about the NHLBI Strategic Visioning process.


Welcome to the National Heart, Lung, and Blood Institute (NHLBI) Strategic Visioning Forum. The Institute is gathering ideas for the most compelling scientific priorities in the four NHLBI Strategic Goals to address over the next decade.

Goal 4: Develop Workforce and Resources

Enhancing Medical Professional Education, Training and Research

Would using multi-disciplinary teams (nutritionists, exercise physiologists, social workers, nurses, etc.) be an effective approach to applying lifestyle medicine to improve patient care?

Submitted by (@nhlbiforumadministrator1)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Compelling Question (CQ)

Details on the impact of addressing this CQ or CC :

It would have a global impact on the health of the public, should patients CV and pulmonary health improve as a result of training and application of skills.

Feasibility and challenges of addressing this CQ or CC :

Previous NHLBI initiatives dovetail with the proposed and have demonstrated feasibility. NHLBI supported the Nutrition Academic Award program.

There is a movement to implement novel approaches to enhance training in and application of lifestyle medicine (e.g., smoking, nutrition and physical activity) for physicians (e.g., resident physicians and fellows) to improve patient care and cardiovascular and pulmonary health outcomes. The Affordable Care Act (ACA) recognizes the role of nutrition and physical activity and recommends that health professionals (e.g., practicing physicians, residents, fellows, physician assistants, nurse practitioners) counsel patients on lifestyle behavior changes. To capitalize on ACA, medical professionals must be trained and obtain the necessary practice skills to deliver needed services. Research to evaluate the approach must be an integral part of the process.

 

Collaborative resource needs in public-private partnerships have the potential to address this CQ. Research to evaluate this approach is equally needed.

Name of idea submitter and other team members who worked on this idea : NHLBI Staff

Voting

15 net votes
31 up votes
16 down votes
Active

Goal 2: Reduce Human Disease

Early COPD

What does early COPD actually look like. This is defined as severe COPD 30 years prior to its manifestation.

Submitted by (@davidmannino)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Critical Challenge (CC)

Details on the impact of addressing this CQ or CC :

Prevention programs in COPD either target smoking or those with established disease. Better understanding the factors that lead to the development of COPD (both in ever and never smokers) is critical to improved disease prevention.

Feasibility and challenges of addressing this CQ or CC :

We need to revisit long term studies in novel ways- and look at new cohorts. Better biomarkers need to be developed.

Name of idea submitter and other team members who worked on this idea : Dave Mannino

Voting

22 net votes
31 up votes
9 down votes
Active

Goal 2: Reduce Human Disease

Persistent Burden of HIV Infection on Lung Health in the U.S. and Globally

Despite the advent of HAART the lung and vascular compartment continue to bear the brunt of complications associated with HIV infection. Potential causes include the establishment of HIV latency in the lung, inability of current therapeutic agents to treat latent reservoirs, inadequate immune reconstitution in the lung, and persistent impairment of normal lung homeostasis after treatment (i.e. persistent alterations ...more »

Submitted by (@htwig0)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Compelling Question (CQ)

Details on the impact of addressing this CQ or CC :

Lung disease remains a major contributor to HIV morbidity in the HAART era. In fact, the lung continues to bear the burden of chronic HIV complications. The cause of this is likely multifactorial, including:

 

1. Persistence of HIV reservoirs. The lung is populated by long lived cells which makes them uniquely situated to serving as reservoirs. A better understanding of viral latency in the lung is needed.

 

2. Inadequate immune reconstitution. This can lead to persistent increased risk to chronic infections and poor tumor surveillance. It is well recognized that earlier initiation of antiretroviral therapy, rather than waiting till immune exhaustion, leads to better immune reconstitution. Thus to improve lung immune reconstitution will need better approaches to diagnosing HIV early. Furthermore, studies are needed to better define when adequate lung immune reconstitution has occurred.

 

3. Persistent abnormalities in normal lung homeostasis. Despite the absence of detectable replicating HIV in the lung there appears to be persistent alterations in the lung inflammatory state. Abnormalities in the lung microbiome and virome could also remain. Lastly, risk factors that may have contributed to HIV infection and lung disease in the first place (i.e. smoking, IVDU) persist in patients on therapy. Contributions of these risk factors towards lung disease in the HIV-infected population are sorely needed.

Feasibility and challenges of addressing this CQ or CC :

Given the continued large burden of the HIV population in the U.S. and globally these studies are certainly feasible. One of the biggest challenges will be the identification of an appropriate control nonHIV-infected cohort that shares the same risk factors (i.e. smoking, IVDU) as the HIV-infected population. Historically this has been problematic given the known demographic differences in the HIV population (i.e. increased prevalence of smoking, greater male to female ratio, differences in other HIV risk factors). The second major challenge is the recognition that the new spectrum of lung complications in HIV-infection are chronic in nature and thus will require long term longitudinal studies to adequately assess the critical questions raised here. Finally, it must be recognized that the greatest burden of HIV infection lies outside our borders in third world countries. In addition to the high prevalence of HIV infection in these regions, the major infections complications, which have been largely controlled in the U.S. through early antiretroviral therapy, continue to play a major role in HIV morbidity and mortality. Thus one cannot forget that first and foremost untreated HIV infection leads to profound immunosuppression with an associated increased risk of usual and opportunistic infections.

Name of idea submitter and other team members who worked on this idea : Homer L. Twigg III on behalf of the INHALD Consortium

Voting

-14 net votes
8 up votes
22 down votes
Active

Goal 1: Promote Human Health

Lung Anatomy and Environmental Exposure

How does human lung anatomical structure (e.g., angles of branch points, luminal diameter, etc.) affect exposure to environmental factors?

Submitted by (@nhlbiforumadministrator1)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Compelling Question (CQ)

Name of idea submitter and other team members who worked on this idea : NHLBI Staff

Voting

-5 net votes
6 up votes
11 down votes
Active

Goal 2: Reduce Human Disease

Gene Therapies to Revitalize/Regenerate Cardiac Function

There is a need to examine the use of recombinant DNA to the heart for correction of genetic abnormalities or restoration of normal signaling pathways to prevent heart failure. However, gene therapy is a complex process and more studies are needed in which tissue targeting, route of delivery, regulation of target gene expression, therapeutic dose, and identification of robust biomarkers are further investigated.

Submitted by (@nhlbiforumadministrator1)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Critical Challenge (CC)

Details on the impact of addressing this CQ or CC :

Successful gene therapy could restore or improve the condition of heart failure patients, especially when medications have been unsuccessful.

Feasibility and challenges of addressing this CQ or CC :

There have already been human trials of gene therapy in heart failure patients with positive outcomes.

Improvements in cardiac revascularization and medical therapies have significantly reduced cardiovascular-related deaths; however, the number of patients developing heart failure (HF) has steadily increased. One explanation is that surgery and medical therapies are palliative, but do not address the molecular pathogenesis of HF.

Name of idea submitter and other team members who worked on this idea : NHLBI Staff

Voting

-18 net votes
8 up votes
26 down votes
Active

Goal 2: Reduce Human Disease

A Program of Research in the Prevention of Chronic Heart Failure

There is a need to improve identification and surveillance of persons at risk for heart failure and pathological ventricular remodeling prior to development of clinically overt heart failure.

Submitted by (@nhlbiforumadministrator)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Critical Challenge (CC)

Details on the impact of addressing this CQ or CC :

Substantially reduce the age-adjusted incidence and population burden of chronic heart failure.

Feasibility and challenges of addressing this CQ or CC :

The big data and omics revolutions have made it feasible to collect and analyze a variety of data in large numbers of persons within a relatively short time. A very large sample size provides excellent statistical power. Also, the public health and economic magnitude of the problem create the urgency needed to address the critical challenge expeditiously.

Chronic heart failure (HF) is easily the most common and growing cardiovascular cause of hospitalization and impaired functional status and quality of life in the U.S. and much of the world. This is the case despite improved pharmacologic and lifestyle treatment of HF, as well as improved control of blood pressure in the general population. While some HF in the very elderly may reflect the aging process, the epidemiology suggests that most incident cases could be prevented or postponed for years. Also, there are major ethnic and socioeconomic disparities in the incidence of HF.

Name of idea submitter and other team members who worked on this idea : NHLBI Staff

Voting

14 net votes
28 up votes
14 down votes
Active

Goal 2: Reduce Human Disease

Pick Me, Pick Me! The Challenges of Being at the Mercy of a Few

One significant challenge if you're a patient or a patient advocate is "who is going to find a life-saving treatment or cure for my disease. Who is going to Pick me and my disease?". The answer is complex but lies within the research community's priorities and interests. Think for a moment like a patient. You are at the mercy of the research community at large, government agencies and companies willing to make your ...more »

Submitted by (@teresabarnes)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Critical Challenge (CC)

Details on the impact of addressing this CQ or CC :

So how do we address the issues with the "Pick Me Approach"? Perhaps there are some clues.. The current approach that a few major things need to happen in order for patients to get treatments is: 1. The NIH has to identify a disease as a priority and provide intramural or extramural research funding for it 2. researchers need to be interested in the disease and seek/receive funding for their research and 2. The research that is done results in a device, tool or treatment that one or more companies is willing to invest in in the private sector to bring to market. NIH and FDA (as government agencies run by public dollars) have perhaps an obligation to identify gaps and needs/opportunities and fill them or enable them to be filled. Not to just stand by as guidance for researchers and companies doing the work they are interested in, but as facilitators of progress. Perhaps all stakeholders including NIH, researchers, clinical practitioners, patients/patient advocates and industry can come together to identify and address the areas of need and plot the path forward. By addressing the gaps and opportunities as the for-profit sector does when planning for engagement in a market, many more areas of research will benefit in the years to come. And ultimately patients will benefit.

Feasibility and challenges of addressing this CQ or CC :

The Office of Rare Diseases at FDA has made an impact with a similar strategy. Rather than acting as a traditional guidance agency, this office analyzes, reviews and identifies gaps and opportunities and develops strategies for them. It puts out RFPs for the areas identified as priority (and multiple stakeholders are provided opportunities for input) and fills the areas with potential solutions.

 

The NIH could consider reviewing its portfolio and evaluating its successes and failures over the last few decades. It could publish a record of the outcomes of all studies it has funded perhaps stratified by organ, system or disease areas. It could identify areas of overlap or duplication and find ways to help multiple disease areas benefit from the research in each.

Name of idea submitter and other team members who worked on this idea : Teresa Barnes and Dolly Kervitsky

Voting

-3 net votes
1 up votes
4 down votes
Active

Goal 4: Develop Workforce and Resources

How to decrease the amount/level of mistreatment by medical staff toward Sickle Cell Patients

How can we better train the medical staff to realize that we are individuals and not see us as a disease as opposed to an individual when treating us in the Emergency Room. To listen to the patients advice and comments. Helps them realize most adult patients have been taking narcotics the majority of their lives and that's why they require higher doses (without the judgment).

Submitted by (@kenalovesgoddrew)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Compelling Question (CQ)

Name of idea submitter and other team members who worked on this idea : Kena Drew

Voting

3 net votes
3 up votes
0 down votes
Active

Goal 2: Reduce Human Disease

Can Tai Chi Chuan Improve Osteoporosis?

Tai chi chuan, a slow-moving ancient form of martial art, is one of the fastest growing exercises today. People of all ages are learning it for a wide variety of reasons. The main reason seniors are learning tai chi is for the health-building effects. Osteoporosis is a common problem suffered by many seniors. I challenge NHLBI to research if and how osteoporosis is actually improved by a consistent and long-term ...more »

Submitted by (@mcs756s)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Critical Challenge (CC)

Details on the impact of addressing this CQ or CC :

Helps to add scientific findings to a long-held belief that tai chi can improve health. It is being studied in other areas of medicine but the more we understand tai chi limitations and possibilities, the less "woo woo" it will sound to nay-sayers and dis-believers.

Feasibility and challenges of addressing this CQ or CC :

There are still organizations that refuse to allow tai chi instruction in their institution due to a mis-understanding of what it is and how it is being used by people. Some feel it is a religion. This is wrong. It is not.

Name of idea submitter and other team members who worked on this idea : Healthcoach Cathy Shafer

Voting

-20 net votes
6 up votes
26 down votes
Active

Goal 2: Reduce Human Disease

Lung Transplantation

Although the majority of lung recipients experience significant health improvement, they also frequently face serious symptom distress, impaired physical functioning and poor quality of life due to post-transplant morbidity, such as chronic rejection, infection and multiple side-effects of immunosuppression. a) Conduct clinical trials of interventions designed to maximize clinicians' support of patients' self-management ...more »

Submitted by (@nhlbiforumadministrator)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Compelling Question (CQ)

Feasibility and challenges of addressing this CQ or CC :

a) Conduct clinical trials of interventions designed to maximize clinicians' support of patients' self-management behaviors so that patients and clinicians working together can achieve optimal control of disease, reduce symptom distress and complications, and promote quality of life.

 

b) Evaluate the impact of integrating palliative care and transplant care for symptom management, goal setting and advanced care planning along the entire lung transplant illness trajectory (pre, post and end of life).

Name of idea submitter and other team members who worked on this idea : ATS Member

Voting

1 net vote
1 up votes
0 down votes
Active

Goal 1: Promote Human Health

Early Life Elements

What are the early life elements that contribute to the development of chronic lung disease? Strategies need to be developed for treatment/prevention of these elements.

Submitted by (@jdc000)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Compelling Question (CQ)

Details on the impact of addressing this CQ or CC :

Neonatal and early life events can be essential elements for risk of development of chronic lung disease developing after age 40. Prevention of late life chronic lung disease may require that action takes place during the neonatal and childhood periods.

Feasibility and challenges of addressing this CQ or CC :

Early life and late life events can be readily studied; however, integrating cause and effect relationships between the two is challenging due to the multiple decades of time separating these events.

Name of idea submitter and other team members who worked on this idea : James Crapo

Voting

5 net votes
16 up votes
11 down votes
Active

Goal 1: Promote Human Health

Understanding Plasma Triglyceride Metabolism

Understanding basic mechanisms for intravascular triglyceride metabolism

Submitted by (@sgyoung)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Compelling Question (CQ)

Details on the impact of addressing this CQ or CC :

Over the past two years, it has become extremely clear that impaired processing of triglyceride-rich lipoproteins has an enormous impact on the frequency of coronary heart disease. For example, large genetic studies have shown that loss-of-function mutations in the gene for apolipoprotein CIII protect from atherosclerotic heart disease. Equally important is the observation that mutations in the gene for apolipoprotein AV are nearly as important as the LDL receptor as a cause of coronary heart disease.

 

The fact that plasma triglyceride metabolism is so important for atherosclerotic heart disease has caught the field by surprise. For many years, there was considerable doubt about the importance of plasma triglycerides for atherosclerotic heart disease. These doubts have vanished.

 

Now, in terms of basic research, the triglyceride metabolism field needs to play "catch up" ball. At this time, we have little understanding of intravascular lipolysis. We don't really know the molecular basis for the effects of apo-CIII, apo-CII, and apo-AV on intravascular lipolysis. The effects of these proteins on the LPL–GPIHBP1 complex are unknown. We don't understand how the lipid products of lipolysis move across capillary endothelial cells. We don't even understand why heparin releases LPL from GPIHBP1, and that observation is more than 60 years old! We don't understand the factors that explain differences in the efficiency of plasma triglyceride metabolism.

Feasibility and challenges of addressing this CQ or CC :

I believe that the field is now poised to understand intravascular lipolysis at the molecular level, and to investigate why some individuals have inefficient lipolysis and higher plasma triglyceride levels. Within the past few years, the "cast" of molecules that affect (or regulate) plasma triglyceride metabolism have come into focus. The field is poised for progress.

 

In part because of long-held doubts about the importance of plasma triglyceride metabolism, reagents for key proteins in intravascular metabolism are not in hand simply not in hand (recombinant proteins, specific antibodies). Developing and distributing these reagents is quite feasible, but it has not yet been accomplished.

 

Similarly, imaging tools are now available to understand the movement of the fatty acid products of lipolysis to myocytes and adipocytes, but there have been few attempts to use those tools.

 

We need to understand intravascular metabolism. At this time, no one understands the basics. No one knows how app-CII, app-CIII, and app-AV work. We need to understand how ANGPTL4 and ANGPTL3 regulate lipolysis. We need to understand the biochemistry of the LPL–GPIHBP1 complex. These tasks are feasible but will require hard work from many interested investigators.

 

In the end, once intravascular lipolysis is better understood, it is highly likely that there will be many new strategies for lowering plasma triglyceride levels and reducing the frequency of coronary heart disease.

Name of idea submitter and other team members who worked on this idea : Stephen G. Young

Voting

0 net votes
7 up votes
7 down votes
Active