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

Why is the heart resistant to cancer?

Cancer of the heart is almost unheard of, whereas most other organs can develop cancer. Why is this?

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 :

If we could understand why cancer does not develop in the heart, this might help to develop strategies to protect other organs from doing so.

Feasibility and challenges of addressing this CQ or CC :

To my knowledge, no one has looked at this problem, because cardiologists and oncologists train in different fields. With molecular profiling, iPS technology, and animal models, this question can be addressed.

Name of idea submitter and other team members who worked on this idea : Henry Chang, M.D.

Voting

-1 net votes
11 up votes
12 down votes
Active

Goal 3: Advance Translational Research

What is the comparative effectiveness of short-term vs. chronic (e.g., 12 mo) pulmonary rehabilitation?

What is the comparative effectiveness of short-term vs. chronic (e.g. 12 mos) pulmonary rehabilitation on survival, patient-reported outcomes (symptom frequency, activities of daily living, quality of life, sleep quality, exacerbations), healthcare utilization, and costs from a societal and healthcare system perspective?

Submitted by (@jakris)

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

Details on the impact of addressing this CQ or CC :

Modest sized efficacy trials demonstrate substantial health benefits, that wane as Pulmonary rehabilitation is discontinued. We need to test the health and resource implications of "chronic" (e.g., 12 or 24 mos) pulmonary rehabilitation. Such information will benefit health systems seeking to implement care models for high-risk, costly, patients - patients with COPD are of increasing interest to health systems. Such a comparative effectiveness trial should also involve behavioral interventions to promote self-management and involve caregivers.

Name of idea submitter and other team members who worked on this idea : Jerry Krishnan

Voting

26 net votes
32 up votes
6 down votes
Active

Goal 2: Reduce Human Disease

Optimizing Utilization of Composite and Repeat Endpoints in RCT

The use of win-ratio and other new statistical methods to analyze endpoints in new and existing clinical trials.

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 could enable trials to be powered with smaller sample sizes. It can also be used to combine diverse information in a way to better guide clinical decisions.

Feasibility and challenges of addressing this CQ or CC :

The methodology exists and the need is growing as we try to sort out smaller treatment effects and our focus shifts from MI (which is fairly easy to define) to heart failure (which is more nebulous).

Traditional time-to-first endpoint analyses of clinical trials fail to capture the full impact of treatment in diseases with recurring endpoints (like heart failure hospitalization) or to capture the net benefit/risk of treatments with significant opposing effects (like the anti-thrombotic pro-bleeding effects of drugs like warfarin and dabigatran in atrial fibrillation or dual anti-platelet therapy after cardiovascular stenting), New statistical methods like the (win-ratio) when used together with patient- and clinician-based rankings of the importance of possible outcomes might provide a quantitative way to optimize the relevance of trials with multiple diverse endpoints to practical clinical decision making. I propose to encourage the use of these and other similar methodologies to analyze endpoints in new and existing trials. It would require a paradigm shift in how trialists look at endpoint data and in how regulators interpret trials.

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

Voting

-3 net votes
10 up votes
13 down votes
Active

Goal 3: Advance Translational Research

Increasing the adoption of low tidal volume ventilation in ARDS patients

How can we use implementation science to increase the adoption of low-tidal volume ventilation in patients with acute respiratory distress syndrome (ARDS)?

Submitted by (@lar000)

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

Details on the impact of addressing this CQ or CC :

Low tidal volume ventilation has been shown to significantly reduce mortality in ARDS patients (from 40% to 31% in the ARMA trial published in NEJM in 2000), but it is inconsistently adopted (frequently with rates <50% in both community and academic settings). Improving adherence has the potential to significantly improve mortality in patients with ARDS.

Feasibility and challenges of addressing this CQ or CC :

Given the rapid growth and interest in the field of implementation science over the past several years, addressing this question is now feasible.

Voting

-10 net votes
2 up votes
12 down votes
Active

Goal 2: Reduce Human Disease

International epidemiological studies with huge contrast

Well-conducted international epidemiological studies with huge contrast of disease outcome and risk factor exposure will provide clues to disease prevention that cannot be obtained by studies solely within the US.

Submitted by (@akirasekikawa)

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

Details on the impact of addressing this CQ or CC :

The Seven Countries study in the 1960’s noted a 5-fold difference in CHD between the US and Japan; the low CHD in Japan was largely attributed to very low levels of total cholesterol. Since studies of migrant Japanese to the US in the 1970’s show marked increase in CHD, exposure to more Westernized lifestyle in Japan would cause total cholesterol to rise and CHD to increase. Surprisingly, age-adjusted CHD mortality declined by >50% both in the US and Japan for the past 5 decades. The decline in CHD mortality in the US is attributed to changes in risk factors (decline in total cholesterol, BP, smoking) and improved treatment, whereas Japanese experienced continuous and marked rise in total cholesterol by 50 mg/dl during the past 5 decades. This is despite higher levels of BP and smoking, especially in men, similar levels of lipids and diabetes.

 

COPD is the fourth leading cause of death in the US, of which singular important risk factor is smoking. Rates of cigarette smoking in men in Japan have been 20-30% higher than in men in the US for the past 5 decades. Yet, it is known that COPD mortality in men in Japan is internationally very low: less than a half of the US. First step is to compare the prevalence of COPD with standardized methods between the US and Japan and if COPD prevalence in Japan is much lower than in the US, elucidating some factors responsible for the low COPD rates in Japan might lead to novel preventive ways for this important disease.

Feasibility and challenges of addressing this CQ or CC :

Though both the US and Japan have well-established cohort studies, key methods are not generally standardized which makes the comparison difficult. Moreover, standardization of methods is limited by its cost.

Name of idea submitter and other team members who worked on this idea : Akira Sekikawa

Voting

1 net vote
2 up votes
1 down votes
Active

Goal 2: Reduce Human Disease

Mechanics of aortic dissection

The mechanical events in the wall leading to aortic dissection are not well described because merely stating that cellular or biopolymer connections have weakened does not predict the path of the rupture through the media or the risk of rupture. Elucidate the mechanical role of substructures such as collagen fibers, elastin sheets, smooth muscle cells and interstitial fluid in the progression of dissection. Study in animal ...more »

Submitted by (@haslach)

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

Details on the impact of addressing this CQ or CC :

While in recent years the lives of patients with aortic dissection have increasingly been saved, an understanding of the mechanisms involved might suggest new techniques to increase the percentage who survive aortic dissection.

Feasibility and challenges of addressing this CQ or CC :

Knowing the mechanisms involved in dissection is more important than attempting to determine and measure some critical rupture stress because of the large differences between specimen aortas within a given species.

Name of idea submitter and other team members who worked on this idea : Henry W. Haslach, Jr.

Voting

7 net votes
17 up votes
10 down votes
Active

Goal 2: Reduce Human Disease

Heart transplant surveillance

It is essential to develop clinically viable, non-invasive, less expensive technologies for the surveillance of allograft rejection in heart transplant patients. Critical challenges that exist in the near term or long term surveillance after transplant is the unavailability of molecular and cellular level markers that can be non-invasively imaged and quantified detect rejection and thus improve patient survival. Development ...more »

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 :

Development of methods for near term or long term surveillance after transplant can help detect the rejection and thus improve patient survival

Feasibility and challenges of addressing this CQ or CC :

The fast growth in the imaging technologies and molecular and cellular imaging technologies are gaining foot in cardiovascular sciences and should be feasible within a decade

The current surveillance to detect transplant rejection requires repeated testing with endo myocardial biopsy and catheter angiography. Both technologies are highly invasive and very expensive. Post-transplant surveillance is focused on the cellular rejection in the near term after transplant and cardiac allograft vasculopathy in the long term.

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

Voting

1 net vote
14 up votes
13 down votes
Active

Goal 2: Reduce Human Disease

Improve Repair of injured lung

Why can’t we improve outcomes following acute lung injury. A half century of ICU interventions have resulted in only incremental improvements in survival and morbidity following acute lung injury. While we have pursued innumerable strategies for decreasing ventilator associated exacerbation of lung injury, we have failed to identify treatable common or selective pathways from the initial injury that can be targeted post ...more »

Submitted by (@dcenter)

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

Voting

5 net votes
8 up votes
3 down votes
Active

Goal 2: Reduce Human Disease

Cardiac Defibrillator Therapy Management in the Elderly

Older patients have been largely under represented in the landmark clinical trials that have established the beneficial effects of ICD therapy on survival. With older age, comorbidities increase leading to a higher incidence of non-cardiac mortality. This is supported by very well documented decrease in the incidence of appropriate defibrillator shocks. Based on the above, it is important to know whether defibrillator ...more »

Submitted by (@sabas0)

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

Details on the impact of addressing this CQ or CC :

Given the increase in the proportion of older patients in the US, addressing these important questions regarding the value of defibrillator therapy in this stratum of the population is critical to:

1) Avoid unnecessary surgeries with its complications (short term and long term)

2) Reduce the cost of health care, primarily in a Medicare population

Feasibility and challenges of addressing this CQ or CC :

A large multi-center non-inferiority trial of CRT-P vs. CRT-D ( and at alater stage of ICD vs. No ICD) in the elderly is needed to answer these questions. These trials are feasible but require comittment and resources.

Name of idea submitter and other team members who worked on this idea : Samir Saba

Voting

4 net votes
16 up votes
12 down votes
Active

Goal 3: Advance Translational Research

Detection of inflammatory monocytes as a biomarker of CVD

Coronary artery disease (CAD), of which atherosclerosis is a major contributor, costs the United States $108.9 billion each year. While a number of conventional risk factors such as smoking, diabetes and hypertension have been associated with CAD, their predictive performance is poor in the prevention of acute coronary syndrome (ACS). Despite the prevalence of ACS in our society, there are currently no molecular biomarkers ...more »

Submitted by (@scottsimon)

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

Details on the impact of addressing this CQ or CC :

Need more opportunities to put forth innovative diagnostic and therapeutic solutions than currently vetted through the CTSC process.

We have developed the Artery-on-a-chip (A-chip), currently in a research tool format, which accurately measures the extent of inflammatory monocyte activation in a whole blood sample by shearing it along a molecular sensor and enumerating monocyte capture.

Name of idea submitter and other team members who worked on this idea : Scott I Simon, Greg Foster, Ehrin Armstrong

Voting

-6 net votes
8 up votes
14 down votes
Active

Goal 2: Reduce Human Disease

Recognition of bicuspid aortic valve's complexity, life threatening potential, and familial implications.

There is a persistent perception that bicuspid aortic valve (BAV), the most common congenital heart defect (estimated to occur in up to 6 million Americans), is a benign condition that may not require treatment until later in life, if at all. The implications for other blood relatives, although referenced in medical literature, may not be acknowledged. This notion, coupled with the inability to identify those most at ...more »

Submitted by (@bavtad)

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

Details on the impact of addressing this CQ or CC :

On the contrary, the presence of BAV should serve as a warning for potentially very serious issues for the individual and their blood relatives, including those with apparently normal trileaflet aortic valves. Childhood heart murmurs, deemed innocent and forgotten, may in fact be the first hint of a malformed aortic valve. Some born with BAV will undergo not just one but multiple surgeries, and some will lose their lives. Others in the family, considered trileaflet, may develop aortic aneurysm and experience dissection.

Despite an estimated incidence of up to 2% of the population and prevalence in males, there is no well-defined screening for this condition, leaving undiagnosed individuals vulnerable to endocarditis, valvular disease, and aortic dissection or rupture. Aortic coarctation may also be present and remain undetected for varying periods of time. Brain aneurysms have been found in some BAV families.

 

Those diagnosed with BAV may not be offered, or fail to seek, follow up care. Enjoying generally good health, they may fail to secure health insurance, believing they are not at risk, and find themselves with very limited options when abruptly confronted with the need for surgery.

Feasibility and challenges of addressing this CQ or CC :

This condition is not rare and will be commonly encountered in the community. Enough is currently known to alert medical professionals as well as the public of potential complications in individuals and blood relatives. The challenge is to overcome the perception, however well meant, that there is no need for concern, especially at younger ages.

Name of idea submitter and other team members who worked on this idea : Arlys Velebir, Bicuspid Aortic Foundation

Voting

1 net vote
12 up votes
11 down votes
Active

Goal 2: Reduce Human Disease

To build on the information obtained from population based and epidemiological studies

What is the basis for relative resistance or vulnerabilities to obesity or related adverse health effects observed in various segments of population?

Submitted by (@mturner)

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

Details on the impact of addressing this CQ or CC :

Population based and epidemiological studies have identified segments of population that are resistant or susceptible to obesity and cardiovascular risks. Continued research is needed to identify additional such populations and their differences. Moreover, the next phase of research could be to understand the basis for this relative resistance or vulnerabilities, and exploit the information to improve obesity and cardiovascular disease risk at a community level.

Feasibility and challenges of addressing this CQ or CC :

Moving forward, strategies are needed that don’t yield only incremental benefits, but instead emphasize ‘high risk, high impact’ research to some extent. Given the enormous public health crisis obesity represents we urge continued support of basic, clinical, population, and translational obesity research.

Name of idea submitter and other team members who worked on this idea : The Obesity Society

Voting

7 net votes
13 up votes
6 down votes
Active