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

Maternal mortality due to Hemostatic Disorders

Can we decrease maternal mortality and morbidity due to hemorrhage or thrombosis?

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

Details on the impact of addressing this CQ or CC

Hemorrhage and thrombosis remain major causes of maternal mortality in the US. New approaches are needed to decrease these tragic deaths.

Feasibility and challenges of addressing this CQ or CC

Clinical/basic study of risk factors/biomarkers to better define women at risk and clinical trials are needed to compare treatments.

Voting

-3 net votes
12 up votes
15 down votes
Active

Goal 2: Reduce Human Disease

Acetaminophen and asthma

Prospective studies on acetaminophen and asthma - randomized/controlled/adequately powered - use in pregnancy and asthma development in utero, use in early childhood

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

Name of idea submitter and other team members who worked on this idea American Thoracic Society

Voting

1 net vote
1 up votes
0 down votes
Active

Goal 2: Reduce Human Disease

What types of questions are most likely to improve the health of the public? The importance of discovery science.

Congressional eagerness to see research funding translate into improvements in health care may make studies that address “how-to-deliver-care-questions” seem attractive. But the answers to “how–questions” are often so context dependent that the findings are neither generalizable nor durable. The answers to “how–questions” too often become obsolete when the health-care system, the electronic medical record, or the insurance... more »

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

Details on the impact of addressing this CQ or CC

Improvement in the health of the public.

Feasibility and challenges of addressing this CQ or CC

It is easily a matter of focus.

Name of idea submitter and other team members who worked on this idea Psaty & Tracy

Voting

22 net votes
29 up votes
7 down votes
Active

Goal 2: Reduce Human Disease

Optimizing Cardiovasular (CV) Prevention Medicine Use

Heart attacks and strokes cause substantial morbidity and mortality, while implementation of cholesterol and other CV prevention guidelines remain low. Proposed NCQA on-statin in the last year among those with DM was 46% in national field testing, and about 75% in Kaiser Permanente (KP). KP has had some success overcoming barriers to statin, aspirin, and blood pressure medicine adherence. If the nation as a whole is... more »

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

Details on the impact of addressing this CQ or CC

Improving treatment rates to CV guidleines improves the population health and can be cost saving to the system. Currently statin use among DM and in those with ASCVD Risk >= 7.5% is about 40%. If treatment improved to 60 or 80% many CV avents would be averted and downstream cost savings.

Feasibility and challenges of addressing this CQ or CC

KP has achieved blood pressure control rates of about 90% demonstrating possibility of high control / treatment rates. Improving treatment rates where there is a treatment gap in cost saving CV prevention should be a priority.

Name of idea submitter and other team members who worked on this idea Ronald D Scott, MD. Kaiser Permanente Integrated Cardiovascular Health Team

Voting

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

Control of the molecular and cellular characteristics of regional variations in the lung

What are the regional variations in cellular and molecular characteristics (from epigenetics to microbiome) in the lung, and what controls these variations?

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

Details on the impact of addressing this CQ or CC

Advance in this research will help to understand the heterogeneity of lung disease

Feasibility and challenges of addressing this CQ or CC

Novel technologies, e.g. single cell analysis and imaging have been developed to get high resolution characterization of the cells in the lung.
Many lung diseases are heterogeneous with regional variations, which are not fully characterized at the molecular and cellular level. Mechanisms underlying the formation of the regional variations are also poorly understood.

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

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0 net votes
12 up votes
12 down votes
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Goal 4: Develop Workforce and Resources

Training Programs Go Green

Training programs may consider a more green approach by producing easy to access on-line materials and resources to be shared with other training programs and trainees, with a common website repository where such information is archived.

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

Details on the impact of addressing this CQ or CC

Analogous applications include the repositories for genome-wide data and results, and the PMCID repositories where publications using NIH support are stored. Archived information may include, e.g., training manuals and lectures (both PowerPoint presentation as well as audio-visual materials). Such a system would need a front end that describes the purpose and goals of the program for which the materials are developed, reference to the authors, copyright information (who has open access versus secured access), etc.

Name of idea submitter and other team members who worked on this idea Treva Rice for the PRIDE (Programs to increase diversity among individuals engaged in health-related research): Joe GN “Skip” Garcia, Francisco Moreno Girardin Jean-Louis, Gbenga Ogedegbe, DC Rao, Victor Davila-Roman, Mohamed Boutjdir, Betty Pace, Juan Gonzales, Bettina M Beech, Keith Norris, Marino Bruce, Alicia Fernandez, Kirsten Bibbins-Domingo, and Margaret Handley.

Voting

0 net votes
6 up votes
6 down votes
Active

Goal 2: Reduce Human Disease

What are the molecular mechanisms of lung injury, and how do they differ in children?

Both adults and children have significant morbidity and mortality due to lung injury, but have different etiologies and outcomes. It is possible that the underlying pathobiology in the two groups is different. There are no targeted therapies for lung injury, indicating that the cause is still not understood.

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

Details on the impact of addressing this CQ or CC

Mortality rates for acute lung injury in pediatrics vary from about 10-30%. Immunosuppressed patients and those with cancer have higher rates. Morbidity following long ICU stays have social impacts on family and education, and can put patients at risk of future lung complications.

Though ECMO shows promise of improving outcomes, large clinical studies are lacking. ECMO is also fraught with signifiant risks and high costs. A molecular understanding of the pathobiology of lung injury could lead to specific therapies to improve survival and decrease morbidity.

Feasibility and challenges of addressing this CQ or CC

(1) The heterogeneity of both adults and children with lung injury hinders the applicability of clinical and translational studies. (2) Reliable animal models of pediatric lung injury are lacking.

Name of idea submitter and other team members who worked on this idea Rebecca Turcotte

Voting

4 net votes
4 up votes
0 down votes
Active

Goal 2: Reduce Human Disease

Improving cardiorespiratory fitness prior to hematopoietic cell transplantation

Can cardiorespiratory fitness prior to hematopoietic cell transplantation be improved and will this limit morbidity and mortality following transplantation?

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

Details on the impact of addressing this CQ or CC

HCT is associated with high rates of morbidity and mortality from transplant-related complications. Reduction in transplant-related mortality would lead to more favorable risk/benefit assessments for the ability of transplant to cure life-threatening hematologic disorders including non-malignant conditions. Comorbidity and patient-reported functional status impairment are known to increase the risk for transplant-related mortality. Single institution studies suggest that cardiorespiratory fitness may serve a similar role as a predictive pre-transplant variable. Unlike comorbidity, cardiorespiratory fitness is potentially modifiable. However, the optimal way to improve cardiorespiratory fitness through pre-transplant exercise and lifestyle interventions is not known. Understanding how to improve cardiorespiratory fitness through a short term intervention would also benefit other health conditions relevant to the NHLBI in which future treatment is intensive and associated with significant risk.

Feasibility and challenges of addressing this CQ or CC

Understanding how to improve cardiorespiratory fitness in a short period of time will require a research agenda that addresses the following challenges: how to measure cardiorespiratory fitness in a generalized and scalable way, which may or may not require maximal exercise testing for all participants; how to design intensive exercise interventions that are at least partially home-based, in order to minimize resource burden on patients and centers; and how to personalize intervention delivery and testing in a way that is tailored to the baseline fitness levels and capabilities of each participant. Meeting these challenges will enable large-scale, personalized exercise testing and intervention delivery in other non-transplant populations.

Name of idea submitter and other team members who worked on this idea William Wood, Thomas Shea

Voting

21 net votes
42 up votes
21 down votes
Active

Goal 2: Reduce Human Disease

Mental health and wellness in sickle cell disease

A growing concern among the sickle cell community surrounds the lack of mental health and wellness services. Many in the community deal with anxiety and depression. It is well known how intricately connected mental and physical health are. So if we know that stress can trigger a psychological crisis which in turn triggers a physical pain crisis, why do we not automatically include mental health services within patient... more »

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

Details on the impact of addressing this CQ or CC

Many in the SCD community feel like providers do not take a proactive approach to mental health. A comprehensive approach to developing mental health and wellness services and programs provides an opportunity to address factors contributing to morbidity, and perhaps mortality, in the SCD community, outside of the hospital walls.

Name of idea submitter and other team members who worked on this idea Sickle Cell Warriors, Inc. community members

Voting

25 net votes
38 up votes
13 down votes
Active

Goal 2: Reduce Human Disease

Cellular senescence and age-related lung disease?

What is the role of cellular senescence in age-related lung disease? Do environmental factors, including smoking, contribute to the pathogenesis of lung disease through their ability to induce premature senescence? Does the accumulation of senescent cells in distal organs contribute to age-related lung disease through systemic inflammation?

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 Ferruccio Galbiati

Voting

-6 net votes
4 up votes
10 down votes
Active

Goal 1: Promote Human Health

New technologies for Personalized health monitoring: too much or not enough

The development of personalized medicine and the increasing amount of information extracted from individual and patients throughout their life is expected to growth significantly. Multiple types of physiological sensors are currently embedded in everyday-life objects and yet their clinical value and their potential to improve health care is not well defined. It seems fundamental that the NIH develops a core research group/... more »

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 impact of this compelling question would promote the development of the right technologies for monitoring physiological signals at long-term. Also, this question should be addressed in collaboration with other federal agencies and institutes such as the NSF and the FDA. Both these agencies are currently supporting and reviewing new-long term technologies but the understanding of the impact of these novel techniques remains to be studied.

Feasibility and challenges of addressing this CQ or CC

none

Voting

5 net votes
13 up votes
8 down votes
Active

Goal 2: Reduce Human Disease

Reducing Patient Delay Times with ACS especially STEMI

The major barrier to further reducing mortality from ACS in particular STEMI remains patient delay. Symptoms are either ignored or misinterpreted and this behavior has not changed despite community education efforts. The advance of social media as well as smartphones and other internet based tools suggests that there is a new opportunity to potentially help change human behavior.

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

Details on the impact of addressing this CQ or CC

The current patient delay time from symptom onset to seeking medical care is 2 hours. If we could reduce this to 1 hour we could further reduce ACS especially STEMI related mortality

Feasibility and challenges of addressing this CQ or CC

The use of social media and smartphones to actively change public behaviors when experiencing potential medical conditions should be possible. Companies like Google and Facebook that have an interest in health could be approach to partner in this effort

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

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0 net votes
2 up votes
2 down votes
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Goal 3: Advance Translational Research

Multilevel and stepped-care approaches to improving adherence

What are successful multilevel combinations of strategies (involving patients, providers and the health care system) and/or stepped-care approaches (tailoring adherence interventions to patient needs) that can be used to improve adherence to behavioral and medical regimens for heart, lung, blood, sleep diseases and disorders?

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

Details on the impact of addressing this CQ or CC

Estimates are that 50% of patients do not adhere to their medications or medical/behavioral regimens. Improving rates of adherence is critical for realizing the full benefits of medical treatments for heart, lung, blood, sleep diseases and disorders.

Feasibility and challenges of addressing this CQ or CC

Research has identified individual strategies that improve adherence but we do not know what combinations of strategies work best or whether tailoring the strategies to the individual is effective in improving adherence.

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

Voting

12 net votes
24 up votes
12 down votes
Active

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.

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
Active

Goal 2: Reduce Human Disease

e-cigarette and mental health

What is nicotine addiction in the absence of other materials? What cues are associated with smoking? We would like to see brain reward studies in special populations. We are also interested in understanding possible reduced harm in people who use e-cigarettes in cessation attempts, and understanding whether e-cigs are a gateway to other risky behaviors for young people who are experimenting.

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 Anna Adachi-Mejia for colleagues at Dartmouth

Voting

1 net vote
1 up votes
0 down votes
Active