Goal 2: Reduce Human Disease

A Program of Research in the Prevention of Chronic Heart Failure

There is a need to address chronic heart failure (HF) through improved identification of patients at risk for HF and of patients with pathological ventricular remodeling who have minimal evidence of clinical HF, and more focused and individualized pharmacologic and lifestyle treatments and monitoring of patients with HF risk. Approaches would include big data collection, omics, statistical modeling, and focused clinical ...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 :

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

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17 net votes
28 up votes
11 down votes
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Goal 3: Advance Translational Research

Using Social Media to Promote Healthy Behaviors

Since most people know that there are behaviors that they need to do to be healthy, can we leverage peer or family pressure or use social media to create a “grass roots” groundswell of health-promoting behaviors?

How might social media platforms such as Facebook and Meetup.com be leveraged for designing low-cost research studies and interventions that promote sustainable healthy lifestyle and behaviors?

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 :

Given the massive use of mobile devices and social media in our society, engaging this critical challenge would have a significant impact on our understanding how this technology can be used in disease prevention and health promotion.

Feasibility and challenges of addressing this CQ or CC :

It is feasible, timely, and cost-effective to study and incorporate into our interventions the use of social media because these applications are already so widely used.

Even if people haven’t memorized the American Heart Association’s seven factors related to heart health (get active, control cholesterol, eat better, manage blood pressure, lose weight, reduce blood sugar, stop smoking), most know that these are the behaviors that they need to do to be healthy. Despite this knowledge, heart disease is still the leading cause of death in the United States; about 1 in 3 U.S. adults has high blood pressure; diabetes affects nearly 26 million in the U.S.; and about 19% of U.S. adults are smokers. According to the CDC, in 2011 over 50% of those 18 years of age or older did not meet the recommended goal for aerobic exercise (150 minutes per week of moderate-intensity activity such as walking). Obesity is an epidemic: about one-third of American adults are obese (BMI ≥ 30 kg/m2). People know what to do, but why don’t they do it? Our built environments and culture do not intrinsically promote a healthy lifestyle. In the absence of a culture that promotes walking or biking over driving cars and that promotes fast and fattening food over more healthy food choices, can we use peer networks to promote healthy behaviors? For example, Meetup.com is a tool that people use to meet for activities that include hiking, tennis, and physical fitness boot camps.

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

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17 net votes
52 up votes
35 down votes
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Goal 1: Promote Human Health

Qigong and Tai Chi for Chronic Disease Prevention

Non-pharmacological interventions for pain and stress have gained tremendous momentum. Mind-Body Practice -- Qigong and Tai Chi -- are group based and inexpensive to implement. The evidence base suggests that these practices are safe and effective for a multitude of preventable chronic disorders.. THE QUESTION: Given safety and efficacy, should there be vigorous research on implementation of Qigong and Tai Chi and ...more »

Submitted by (@rogerjahnke)

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

Details on the impact of addressing this CQ or CC :

What can we do to assure that safe, effective, inexpensive non-parmacological approaches like Qigong and Tai Chi become widely diffused into communities, agencies, organizations, schools, health systems and businesses.

Feasibility and challenges of addressing this CQ or CC :

We have participated in a number of studies that have contributed to the evidence base for Mind-Body Practice as a safe and effective non-pharmacological programming.

 

The key -- group based. For the financing, group based is inexpensive. For the efficacy group based supports compliance.

Name of idea submitter and other team members who worked on this idea : Dr Roger Jahnke, http://IIQTC.org

Voting

2 net votes
33 up votes
31 down votes
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Goal 2: Reduce Human Disease

Primary prevention statin trial in indivduals >75 years of age

Compelling question: There is insufficient randomized trial evidence for statins for primary prevention after age 75 years, as summarized in the recent 2013 ACC/AHA cholesterol guideline. T

Submitted by (@jennifergrobinson)

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 paradigm of "net benefit" introduced in this guideline cannot be applied in the absence of evidence that statins reduce ASCVD events and the adverse event rate of statins in this age group. There are likely significant differences in net benefit in subgroups of older adults as well due to competing causes of morality, comorbidities, and increase potential adverse effects on muscle function and quality of life.

Feasibility and challenges of addressing this CQ or CC :

This can be addressed in pragmatic trial design, but must include individual level randomization and placebo control to accurately assess treatment effects

Name of idea submitter and other team members who worked on this idea : Jennifer Robinson MD MPH

Voting

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

Cardiovascular risk and adverse event prediction & estimating net benefit in statin-treated individuals

Compelling Question: There is insufficient data to personalize the use of nonstatin or other preventive therapies in statin-treated patients. Equations could then be developed to predict CVD risk and to predict the risk of adverse events in statin-treated patients to guide intensification of therapy.

Submitted by (@jennifergrobinson)

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 2013 ACC/AHA cholesterol guideline recommends statin therapy for the prevention of CVD events in moderate-high risk individuals. Many patients are still at increased CVD risk on statin therapy.

 

The potential for net benefit from CVD risk reduction therapies added to statin therapy depends on the absolute CVD risk in the statin-treated patient, the relative reduction in CVD risk from the added therapy, and the potential for net benefit.

Feasibility and challenges of addressing this CQ or CC :

This could be a pooling project of existing data from observational databases and clinical trials. Sophisticated pharmacoepidemiologic methods would be needed (and likely need to be developed) to draw appropriate inferences for application to clinical practice.

Name of idea submitter and other team members who worked on this idea : Jennifer Robinson MD MPH

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3 net votes
11 up votes
8 down votes
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Goal 1: Promote Human Health

Prevention of Obesity

What are the behavioral factors that predispose to excessive weight gain and development of obesity? And, which intervention strategies can effectively prevent excessive weight gain and obesity? NHLBI, other NIH institutes and the society at-large have invested heavily in research and clinical practice aimed at treatment of obesity (i.e, weight loss in those who are already overweight). However, much less research ...more »

Submitted by (@rpate0)

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

Details on the impact of addressing this CQ or CC :

Reducing the prevalence of obesity is one of the great public health challenges of the 21st century. Research should be focused, first and foremost, on prevention, not treatment, of this problem. It seems highly likely that improving the behaviors that can prevent obesity would produce a wide range of important public health benefits.

Feasibility and challenges of addressing this CQ or CC :

Two generations ago the prevalence of obesity was much lower than it is today. The prevalence was lower then, not because overweight people were better at losing weight; rather rates were lower because far fewer people became overweight in the first place. It is high time that the scientific community, clinicians, and public health practitioners invested their efforts in prevention first, where there is every reason to believe we could be successful. These efforts should be informed by a robust body of knowledge, and it is recommended that NHLBI lead the effort to expand the body of knowledge on primary prevention of obesity.

Name of idea submitter and other team members who worked on this idea : Russell Pate

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6 net votes
8 up votes
2 down votes
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Goal 2: Reduce Human Disease

Understanding COPD Manifestations in Subjects without Overt Airflow Obstruction

What is the pathogenesis and appropriate treatment for subjects with chronic respiratory symptoms or imaging abnormalities who do not have overt airflow obstruction (and thus are not currently categorized as having COPD)?

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 :

COPD is currently diagnosed by spirometry, but many other individuals (primarily smokers) have respiratory symptoms and/or imaging abnormalities that suggest lung damage. Identifying subjects with pre-obstruction manifestations of COPD could lead to more effective treatment and prevention.

Feasibility and challenges of addressing this CQ or CC :

COPD subjects often develop ongoing inflammation that persists long after smoking cessation. It is unknown when this cycle of inflammation begins or what causes it.

Name of idea submitter and other team members who worked on this idea : Ed Silverman, James Crapo and the COPDGene Executive Committee

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32 net votes
47 up votes
15 down votes
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Goal 2: Reduce Human Disease

Restoring Balance to Stroke Prevention in Older AFib Patients

Improving Tools for Anticoagulation Decision-Making

Submitted by (@cbens0)

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

Details on the impact of addressing this CQ or CC :

AFib increases stroke risk by five-fold and doubles the risk that a stroke will result in permanent disability. While oral anticoagulation (OAC) is highly effective at reducing stroke risk, elderly patients are often under-anticoagulated. This is in part due to an under-appreciation of the stroke risk associated with AFib and the tendency of some health care professionals to prioritize perceived bleeding risk over stroke prophylaxis. Because current bleeding risk assessment tools are imperfect and largely unable to predict patients who are likely to have bleeding complications, they are often not utilized—or if used, do not truly predict which patients are at risk of a bleed. An improved bleeding risk tool is critical to improved risk assessment in the elderly. That bleeding risk tool should then be combined with the stroke risk tool for single risk stratification to streamline anticoagulation decision-making.

Feasibility and challenges of addressing this CQ or CC :

Developing effective integrated risk assessment tools is feasible only if there is consensus on the validity of the clinical information being provided. The approach to this critical challenge is two-fold. First, needed research that improves the reliability of bleeding risk assessment in the elderly should be pursued. Second, stroke and bleeding risk tools should be combined into a single risk stratification tool. This will require significant investment and focus, but the resulting bleeding risk assessment combined with the accepted CHA2DS2-VASc score, would significantly impact the 40 - 60% of patients who are currently not on an anticoagulant and are at increased risk of stroke and death.

Name of idea submitter and other team members who worked on this idea : AFib Optimal Treatment Task Force

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11 net votes
19 up votes
8 down votes
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Goal 3: Advance Translational Research

Develop an Effective and Functional Biological Pacemaker

There is a need to develop a biological pacemaker for pediatric patients that would react to neurohumoral factors that normally modulate heart function, as well as adapt to the growing heart.

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 :

Reduce risks associated with the increasing use implantable pacemakers. Increase reliability of artificial electrical pacemakers.

Feasibility and challenges of addressing this CQ or CC :

Animal studies have already demonstrated feasibility of cell- and gene-based as well as hybrid approaches.

The introduction of implantable medical devices using electrical impulses through electrodes placed in the heart to regulate its beating in patients whose native cardiac pacemakers fail— i.e., implantable electronic pacemakers— have permitted hundreds of thousands of individuals to live extended, relatively normal lives. Many advances since the introduction of implantable pacemakers into medical practice during the latter half of the 20th century have improved reliability, but their use still carries significant risks; e.g., lead fracture, infection, malfunction, and the need for replacement.

To date experimental cell therapy, gene therapy, and hybrid approaches have been used to create biological pacemakers in animal models. These incorporate the use of human embryonic stem cells or induced pluripotent stem cells or overexpression of the transcription factor, TBX18, to produce functional biological pacemakers in large animal models. Other gene therapy approaches have also been used to generate functional biological pacemakers in animals. These include overexpression of ion channels impacting diastolic membrane depolarization and excitability in non-pace making regions of large animal hearts. Beta-2 receptor or adenylyl cyclase overexpression represent other strategies that have been employed. Finally, a hybrid approach has used human mesenchymal stem cells loaded with the pacemaker gene HCN2is to induce pacemaker activity in large animals. Thus multiple approaches exist and collaboration is needed between investigative groups to overcome the challenge of creating and testing an effective and reliable biological pacemaker in humans.

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

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8 net votes
23 up votes
15 down votes
Active

Goal 1: Promote Human Health

What motivates adults to exercise?

Getting people to change from a sedentary to active lifestyle is difficult. What institutional supports are most effective? What is the cost benefit of prevention versus treating cardiovascular disease.

Submitted by (@heartpathacupuncture1)

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

Details on the impact of addressing this CQ or CC :

Reducing the costs of treating cardiovascular disease (and possibly some cancers)

Feasibility and challenges of addressing this CQ or CC :

Considering the money spent on treatment this strategy should be feasible.

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

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21 net votes
39 up votes
18 down votes
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Goal 2: Reduce Human Disease

Can Psychological Science Improve Weight Loss?

Will sensitivity to the psychological aspects of obesity, including lifestyle priorities and motivations, improve the efficacy of long-term effectiveness of weight loss and obesity prevention interventions?

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 :

A primary focus on principles of psychology may result in significantly improved control of the obesity epidemic. Effective interventions could reduce the risk of diabetes, sleep apnea, and hypertension. This research could also affect clinical practice guidelines for weight loss and obesity treatment.

Feasibility and challenges of addressing this CQ or CC :

Psychological science has been successful in developing effective treatments for a number of conditions, including sleep disorders, depressive symptoms, anxiety and phobias. Many of the behavioral principles employed in such interventions (e.g., cognitive restructuring, motivational methods) could be translated for the prevention and treatment of obesity within a reasonable time frame. Additional attention should be directed to the needs of population subgroups in which obesity is most prevalent.

In their Viewpoint article on weight loss intervention research, Pagoto and Appelhans (JAMA, 2013, see attachment) question whether a continued focus on dietary factors in research on weight loss and obesity is warranted. Their commentary raises the importance of attention to the individual psychological characteristics that influence adherence to weight loss interventions rather than dietary composition.

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

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51 net votes
104 up votes
53 down votes
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Goal 2: Reduce Human Disease

Environmental induction of congenital heart defects and finding means of prevention

Congenital heart defects (CHDs) continue to be the leading cause of death among all infants with birth defects. It is reported that approximately 10% of cardiac congenital anomalies have a genetic basis. An equal percentage, or ~10%, is due to environmental factors. For ~60% the etiology is unknown and considered to have a multifactorial basis, eg, environmental agents having a role against a specific genetic background, ...more »

Submitted by (@kerstilinask)

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

Details on the impact of addressing this CQ or CC :

College drinking is up especially among young women. Women of both high and low income levels drink, may be smoking marijuana, or are exposed to other environmental toxicants. Are there gender effects, as it has been reported that in the US, more male babies undergo severe cardiac surgeries than female. Few grants are presently funded that take a teratological approach to understanding mechanisms underlying induction of congenital heart defects that can occur before a women realizes being pregnant. The embryo may already have been harmed by then and the effects last a lifetime for the child. High dose folate may be preventative of CHDs and this needs to be better defined and the effects of high folate doses on the adult and fetus need to be analyzed. A possible role for gender should be defined.

Feasibility and challenges of addressing this CQ or CC :

A recommended goal is to emphasize the submission of grants specifically addressing the etiology of congenital heart defects due to environmental factors and their prevention, using cell and molecular teratological approaches. Reinstate a study section on Teratology and Toxicology of Birth Defects made up of PIs working in those fields. There used to be four such study sections and were all removed years back. One such section should be reinstated. Current study sections lack such individuals on the panels due to this area receiving little funding. The neural field is way ahead in funding this topic and as a result the heart tends not to be mentioned in available literature that is provided to women of child-bearing age. Yet the risk for heart anomalies is equally as high and important as are effects on neural development. Similarly, both have lifelong consequences for the individual physically and psychologically and in cost to society with repeating hospitalizations and surgeries. Effects on the heart may be so severe that death occurs already in utero and may not always be counted among the epidemiological studies.

Name of idea submitter and other team members who worked on this idea : Kersti K. Linask, PhD

Voting

-7 net votes
16 up votes
23 down votes
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