Goal 2: Reduce Human Disease

Developing Standards of Care for adult muscular dystrophy (FSHD, DM) patients affected by hypercarbic respiratory insufficiency

There is an unmet need for the NHLBI to foster basic, preclinical and clinical research on the pulmonary consequences of respiratory insufficiency, and specifically with hypercarbic (high CO2) respiratory insufficiency, in facioscapulohumeral muscular dystrophy (FSHD) and other adult muscular dystrophies. The adult muscular dystrophies have received insufficient attention, both from research and clinical practice perspectives. ...more »

Submitted by (@daniel.perez)

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

Feasibility and challenges of addressing this CQ or CC :

As with cardiomyopathy and arrhythmia, currently little data is available as to how to best measure/monitor, and when and how to intervene in, the respiratory complications of the adult muscular dystrophies (FSHD, DM, LGMD) using respiratory therapy, non-invasive ventilation (bi-Pap, Trilogy) or ventilation. The absence of home-based sleep studies and technologies to easily assess hypercapnia are identified as a significant gap in knowledge. Additionally, since the cardiac and pulmonary hypercarbic respiratory insufficiency complications are inextricably linked, studies of the interrelationship between cardiac and pulmonary consequences of the muscular dystrophies (congestive heart failure, pulmonary hypertension) are needed, and interdisciplinary teams of researchers may be best equipped to conduct them.

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

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-11 net votes
4 up votes
15 down votes
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Goal 2: Reduce Human Disease

Improving devices for cardiac arrest

Can improved catheters, pumps and oxygenators for extracorporeal cardiopulmonary resuscitation be developed that will make feasible widespread implementation for refractory in-hospital and out-of-hospital cardiac arrest?

Submitted by (@rebecca.lehotzky)

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 : AHA Staff & Volunteers

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-2 net votes
2 up votes
4 down votes
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Goal 2: Reduce Human Disease

Developing techniques to monitor neurologic injury after cardiac arrest

Can techniques to monitor brain injury and recovery in post-cardiac arrest patients be developed to optimize post-cardiac arrest care and enable reliable neuroprognostication?

Submitted by (@rebecca.lehotzky)

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 : AHA Staff & Volunteers

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

Does epinephrine improve outcomes in OHCA

Epinephrine is the primary drug that is used in resuscitation but observational studies and a few small RCT suggest that it improves short term but not long term outcomes. Factors such as timing, dose, quality fo CPR and post-resuscitation care all confound the issue. Large RCTs conducted at multiple centers are desperately needed to address this question.

Submitted by (@dayam0)

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 short terms outcomes are improved but not long term outcomes, we are only adding costs and not improving population health

Feasibility and challenges of addressing this CQ or CC :

Will require a large prehospital clinical trials network and ideally also a current national registry of OHCA to address secular changes in other confounding variables

Name of idea submitter and other team members who worked on this idea : Mohamud Daya

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

Potential therapies for cardiac arrest due to non-shockable rhythms

Which, if any, pharmacologic and non-pharmacologic therapies are useful and effective in cardiac arrest due to non-shockable rhythms?

Submitted by (@rebecca.lehotzky)

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 : AHA Staff & Volunteers

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

Cellular & molecular effects of diabetes on the heart

Diabetes increases cardiovascular disease risk factors. Evidence suggests that diabetes alters contractile and electrical function of the heart, but little is known about the cellular and molecular basis for these changes.

Submitted by (@catherine.proenza)

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

Details on the impact of addressing this CQ or CC :

Develop more effective treatments for cardiovascular disease in patients with diabetes and metabolic syndrome.

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21 net votes
36 up votes
15 down votes
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Goal 2: Reduce Human Disease

Optimizing therapeutic hypothermia

What is the optimal dose and duration of post-cardiac arrest hypothermic targeted temperature management?

Submitted by (@rebecca.lehotzky)

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 : AHA Staff & Volunteers

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

Paradigm shift in cardiac arrest rhythm and resuscitation

What resuscitation strategies targeted toward pulseless electrical activity (PEA)/asystole would be successful in preventing cardiac arrest (CA)? Furthermore, what are animal models of PEA/asystole, what is responsible of this major shift in the underlying rhythm of CA, and what is the phenotype?

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 :

There is a critical need to address continuous shift in the primary rhythm of CA from VT/VF to PEA/asystole with new strategies to improve survival.

Feasibility and challenges of addressing this CQ or CC :

Data from major registries, such as ROC, CARES and other provide the needed population base and platform to analyze existing strategies, explore and develop and test new resuscitation strategies.

With the continuous decline in VT/VF proportion as the primary rhythm leading to cardiac arrest (CA), pulseless electrical activity (PEA) and asystole have become the dominant rhythms in CA. In early 70's VT/VF constituted more than half of the CA, which currently is ~ 28%. Major effort and defibrilation and resuscitation strategies have been successfully targeted toward VT/VF. The survival of PEA/asystole is dismal.

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

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-4 net votes
7 up votes
11 down votes
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Goal 2: Reduce Human Disease

Problem of sudden cardiac death

Among major causes of cardiac mortality cardiac arrest stands as a cause of death that rivals all other causes in terms of frequency. There has been at best only modest improvement in resuscitation over recent years. No wonder with so little NHLBI funding going into this cause compared to acute MI and heart failure. Hopefully the IOM report on cardiac resuscition will be a call to action that will highlight these NIHBI ...more »

Submitted by (@mlw500)

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

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0 net votes
4 up votes
4 down votes
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Goal 2: Reduce Human Disease

Therapeutic hypothermia and CPR

Is intra-arrest therapeutic hypothermia feasible during CPR, and does it improve outcomes?

Submitted by (@rebecca.lehotzky)

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 : AHA Staff & Volunteers

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

Surveillance systems to prevent in-hospital cardiac arrest

Can surveillance systems be developed to prevent in-hospital cardiac arrest outside the ICU?

Submitted by (@rebecca.lehotzky)

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 : AHA Staff & Volunteers

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

Arrhythmia Therapies Based on Understanding Mechanisms

There is a need to translate these new insights of genetic, molecular, cellular, and tissue arrhythmia mechanisms into the development of novel, safe, and new therapeutic interventions for the treatment and prevention of cardiac arrhythmias.

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 :

Reduced socioeconomic burden of cardiac arrhythmias. Development of new technologies and recognition of new arrhythmia mechanisms.

Feasibility and challenges of addressing this CQ or CC :

Several studies have already recognized the unexpected antiarrhythmic effects of some therapies intended for other cardiovascular disease. For example statins, aldosterone blockers, and possibly some essential fatty acids may reduce arrhythmia burden in patients receiving these interventions. Clinical trials should be developed to demonstrate the efficacy of these interventions, and arrhythmia endpoints, including those for atrial fibrillation and sudden cardiac death, should be incorporated into other large clinical trials. Research into novel antiarrhythmic might focus on (a) drug development; (b) cell/gene-based therapy and tissue engineering; and (c) improvements in development and use of devices and ablation to prevent or inhibit arrhythmic electrical activity. Continued research might also focus on targeting of upstream regulatory cascades of ion channel expression and function. Continued antiarrhythmic strategies might include the exploration of novel delivery systems (e.g., utilizing advances in nanotechnology and microelectronics), biological pacemakers, AV node repair/bypass, and treatment and/or reversal of disease-induced myocardial remodeling and tachyarrhythmias. Evaluation of new therapies should include a cost analysis. Studies in both children and adults with congenital heart are needed. New interventions might include new pharmacologic approaches as well as advances in electrophysiologic imaging and improved approaches to ablation.

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

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51 net votes
86 up votes
35 down votes
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