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 2: Reduce Human Disease

Systemic manifestations and co‐morbidities of chronic lung disease

More emphasis must be placed on systemic manifestations and co‐morbidities of chronic lung disease such as depression, oral disease and heart disease.

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 :

Management of multiple comorbidities: Health care delivery is undergoing reform to improve

efficiency and reduce costs. At present subspecialists are generally adept at managing a narrow aspect

of an individual’s health but less commonly is a practitioner able to provide comprehensive

management of people with multiple comorbidities. Indeed, many clinical trials are performed in highly

selected cohorts yielding important results but frequently lacking the generalizability to be applied to

many of our patients. Thus, we would support efforts to optimize the design of clinical trials to be more

applicable to heterogeneous groups including elderly, people with chronic diseases, and patients

receiving multiple medications.

Name of idea submitter and other team members who worked on this idea : Research Advocacy Committee, American Thoracic Society

Voting

1 net vote
1 up votes
0 down votes
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Goal 2: Reduce Human Disease

Cystic Fibrosis

There should be a ramp up in research to address both treatments and management strategies for patient with CF.

Submitted by (@szlewishcr)

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

Voting

3 net votes
8 up votes
5 down votes
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Goal 2: Reduce Human Disease

Severe obesity prevention in pediatric and community settings

What novel lifestyle and behavioral modification therapies are needed to prevent or treat youth with severe obesity (>99th percentile for BMI) versus those who are overweight?

 

Can we harness ongoing registries such as POWER (Pediatric Obesity Weight Evaluation Registry) in pediatric primary care (PC) settings to implement novel trials that would link PC and community settings to prevent severe obesity in youth?

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 :

A huge impact on obesity prevention in high risk youth. In addition to physiologic and metabolic changes, severely obese youth are stigmatized and bullied more often than those who are overweight. Self-esteem issues are also common among severely obese youth. Reduction of obesity could improve long term cardiovascular risk factors as well as quality of life and future chronic diseases.

Feasibility and challenges of addressing this CQ or CC :

This CQ is feasible because there a smaller scale RCTs that are short term and have demonstrable efficacy that could be harnessed. Chronic obstructive sleep apnea is also common in severely obese subjects. Thus this initiative could be across HL divisions.

Severe obesity is prevalent in ~6% of US youth (~ 8% in African American and Hispanic youth). But there is limited research on the effects of lifestyle modification approaches on BMI and CV risk reduction in such youth. Of the limited number of tested lifestyle interventions, results (e.g., adiposity and metabolic) have been modest and not sustained long-term. Most severely obese youth may not qualify for bariatric surgery and questions arise on long-term effects of bariatric surgery in young subjects with severe co-morbidities who might qualify for surgery but may lack the emotional maturity, family support, and motivation.

 

Research to better elucidate the underlying physiological, psychological, and environmental factors associated with severe pediatric obesity are needed. Behavioral trials are needed that intervene on multiple areas of influence (e.g., pediatric care, family, and community) and evaluate traditional and non-traditional outcomes—adiposity, cardiometabolic risk factors including vasculature and function, and inflammatory markers and oxidative stress.

 

There could be challenges in changing behaviors but these could be mitigated with novel and intensive approaches.

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

Voting

46 net votes
87 up votes
41 down votes
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Goal 1: Promote Human Health

Obesity and Morbid obesity

Obesity is a pervasive disease. It contributes to serious diseases such as heart, all the way down to cancer. In the past five decades it has been confirmed that the sugar from rich carbohydrate (CHO) foods increases the production of insulin which in turn converts the excess caloric intake into fat. So far neither dieting with highly processed foods rich in CHO’s, nor radical surgery have made a dent in this most ...more »

Submitted by (@baz200)

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

Details on the impact of addressing this CQ or CC :

This is a fairly new idea of reducing glycemic indices of rich carbohydrate foods which may have an impact on our cultural diets and reduce obesity in children and adults.

Morbidly obese require an additional minimally invasive surgical approach which by GES will be able to curb appetite and produce weight loss.

Feasibility and challenges of addressing this CQ or CC :

The preliminary feasibility studies have been performed in production of lower glycemic index foods such as rice.

US Patent # 8,568,820 B2

Issued October 29, 2013

To turn off the appetite of a hungry canine has been shown in experimental lab by stimulation of the funds of the stomach by pacemaker leads. It requires more experiments to create the sophisticated pacer with many parameters which would be controllable by radio frequency waves from outside. The minimally invasive operation would be performed by laproscopy.

United States Patent # 6,564,101

Issued May 13, 2003

Name of idea submitter and other team members who worked on this idea : Prof. B.A. Zikria, MD, FACS (Emeritus)

Voting

-1 net votes
4 up votes
5 down votes
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Goal 3: Advance Translational Research

Rx for HFpEF

HLBI should make it a priority to develop therapeutic options for the treatment of heart failure with preserved ejection fraction.

Submitted by (@johnrobinson)

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

Details on the impact of addressing this CQ or CC :

Heart failure with reduced ejection fraction (HFrEF), formerly called systolic heart failure, is the classical form of heart failure that is characterized by defective ventricular contraction. The most common variant of heart failure is heart failure with preserved ejection fraction (HFpEF), formerly called diastolic heart failure, characterized by resistance to ventricular filling. The prevalence of HFpEF has been rising steadily over the past two decades at a rate of increase of 1% per year, while the prevalence of HFrEF which has remained stationary. The most common causes of HFpEF are ischemia, obesity, hypertension, diabetes and ageing. Since the population is increasingly obese, hypertensive, diabetic and ageing, the incidence of HFpEF will be the dominant heart failure phenotype over the next decade. The clinical management of HFpEF is complicated by lack of therapeutic options that provide survival benefit. Therapies of proven benefit in HFrEF have repeatedly been shown to add little if any benefit in HFpEF. The prognosis of HFpEF is about the same as HFrEF, with 5-year mortality ranging from 54% to 65%.

Feasibility and challenges of addressing this CQ or CC :

Recent developments in our understanding of the molecular mechanisms of myofilament regulation and assays can be used to develop lead compounds for treating HFpEF.

Name of idea submitter and other team members who worked on this idea : John Robinson

Voting

1 net vote
13 up votes
12 down votes
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Goal 3: Advance Translational Research

Integrating New Genomic Discoveries with Genome Editing Towards Personalized Medicine

The human genome is a veritable digital library of information that includes millions of regulatory elements and the expansive classes of long and short noncoding RNAs. These noncoding sequences represent a rich source of sequence variation (eg, SNPs), but the role such sequence variants play in the control of gene expression or noncoding RNA function is poorly understood. Many noncoding sequence variants will prove to ...more »

Submitted by (@j.m.miano)

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

Details on the impact of addressing this CQ or CC :

We have limited knowledge of the noncoding sequence aspect of the human genome. Defining the full monty of noncoding sequences and their function will provide a more advanced understanding of CV development, homeostasis, and disease. This will be facilitated best by a centralized repository of data modeled after the UCSC Genome Browser. Further, with all functional noncoding sequences in hand, it will be an easy exercise to place, in context, sequence variants that could impact noncoding sequence function. For example, it would be important to know whether a sequence variant in a specific TFBS confers protection or susceptibility to disease. CRISPR-Cas9 could easily model such noncoding sequence variants in cells (and animals) for further exploration of function and responsiveness to intervention. As the cost of WGS continues to fall, more and more genomes will be sequenced with the identification of rare alleles that could have large explanatory power for an individual's CVD and associated treatment responses. Integrating individual genomic data with electronic health data (obviously requiring careful planning and implentation) will, in turn, allow for hypothesis testing based on experimental data accumulating in the centralized database. Ultimately, personalized medicine will be achieved by intersecting patient genomic data with wet lab data that would, in turn, inform the best route of action using CRISPR-Cas9 in patient-derived pluripotent stem cells.

Feasibility and challenges of addressing this CQ or CC :

Developing an interactive and continually updated "Cardiovascular Browser" is certainly feasible. The approach should be much like that taken by the pioneers of the Human Genome Project; that is, all participating labs should make data freely available. The data would include, among other things, expression analysis of noncoding sequences and their relationship to protein-coding genes, regulatory aspects of all coding and noncoding genes in cells of the cardiovascular system and presence of regulatory SNPs, functional annotation of noncoding sequences and sequence variants therein using CRISPR-Cas9 genome editing, and systems biology data that would integrate the accumulating data. Challenges include organizational aspects of a centralized database, appropriate selection of cell types (primary or immortal) and experimental conditions (human cells or animal model?) to capture as much information relating to CVD progression as possible (eg, noncoding sequence expression and function in [a] ECs at disturbed flow regions, [b] SMCs following exposure to oxidized LDL and [c] cardiac myocytes treated with chemotherpy or pressure overload). A challenge with CRISPR-Cas9 continues to be that of inadvertant off target effects (especially in cells). Patient privacy and safeguards against discrimination (eg, insurability) will be key. A board of CV scientists (term limited) and lay persons would thus be needed to develop, implement, and continually revise data management and directions.

Name of idea submitter and other team members who worked on this idea : Joseph Miano

Voting

6 net votes
16 up votes
10 down votes
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Goal 2: Reduce Human Disease

Clinical Trials in Pediatric Sleep Disorders

Effect of anti-inflammatory medications (including nasal steroids and leukotriene antagonists) in children with obstructive sleep apnea syndrome, stratified for severity of OSAS as well as presence of atopy.

Submitted by (@nhlbiforumadministrator)

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

Details on the impact of addressing this CQ or CC :

Small studies suggest a therapeutic effect of anti-inflammatory medication in childhood OSAS. This may be especially useful in children with residual OSAS following adenotonsillectomy (as CPAP adherence tends to be low) or children who are poor candidates for surgery. Current studies have been limited to children with extremely mild OSAS, have not determined whether atopy plays a role in the response to therapy, and have been limited to very short-term trials.

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
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Goal 1: Promote Human Health

Lung Resilience

What is the dynamic range of homeostasis (limits of resilience) for lung biology? What makes a lung resilient across the life span and to environmental insults?

Submitted by (@nhlbiforumadministrator)

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

-1 net votes
7 up votes
8 down votes
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Goal 2: Reduce Human Disease

Optimal hemoglobin threshold for transfusion in children with ARDS?

Do different hemoglobin transfusion thresholds alter outcomes in children with ARDS? What is the optimal *minimum* transfusion threshold for children with ARDS? What patient-centered outcomes can be affected by transfusion strategies: ventilator free days, time to organ function recovery, duration of intensive care stay, survival?

Submitted by (@greg.martin)

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 : Society of Critical Care Medicine Executive Committee/Council

Voting

8 net votes
9 up votes
1 down votes
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Goal 2: Reduce Human Disease

Cardiovascular dysfunction in geriatric trauma patients

There is too little research funding addressing cardiovascular dysfunction in geriatric trauma patients. There have been little interest in funding this work. Yet, the geriatric population is growing. Geriatric trauma patients are predominantly women. Historically, the trauma societies provide guidance for diagnosis and treatment of severe trauma. However, "trauma guidance" historically was the same for children, ...more »

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 :

Document and understand the role of cardiac dysfunction in contributing to morbidity and mortality of geriatric trauma patients.

 

Reduce mortality rates in geriatric trauma patients.

Feasibility and challenges of addressing this CQ or CC :

Little research has been conducted to understand the role of cardiac dysfunction in elderly trauma patients. These patients may be intubated and treated with pain meds, so the normal symptoms of cardiac ischemia are silenced. Because 12 lead ECGs or cardiac enzymes are not routinely collected in these patients after admission, the question is what types of cardiac dysfunction occur and can they be prevented?

 

While evidence is scant, we conducted a structured chart review of WMD Shock Trauma patients' medical records in fiscal year 1999 data. Mean age was 76 and mean ISS of 24. In reviewing charts we found 71% of patients had one or more risk factors for ischemic heart disease (beyond age) and 30% had a history of ischemic heart disease. On admission 29% had ECG changes consistent with acute cardiac ischemia, but ischemic changes were noted equally between patients with and without a history of IHD. Cardiac enzymes were ordered for 45% of patients and 19% were positive. We found that patients with acute cardiac ischemia on admission (ECG or enzymes) had more adverse in-hospital cardiac events than those without ischemia on admission. Patients experiencing adverse events were significantly more likely to die.

 

We believe these findings suggest a substantial role of cardiac dysfunction in this population, but we were unable to generate interest in the topic.

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

Voting

-31 net votes
1 up votes
32 down votes
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