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 1: Promote Human Health

The Human Virome and Host Interactions in Heart, Lung, and Blood

What are the unknown elements of the human virome, and what host-virome interactions affect the heart, lung, and blood health and diseases?

A major challenge has been the need for in vitro culture systems and animal models for studying the virome, which is a significant limitation that has forced current studies of the virome to be mostly descriptive. NHLBI has supported one research group to identify human virome and... 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 virome contains the most abundant and fastest mutating genetic elements on Earth. The human virome is constituted of viruses that infect host cells, virus-derived elements in our chromosomes, and viruses that infect the broad array of other types of organisms that inhabit us. The virome may influence the host in profound ways independent of classical viral disease. The immune system is continuously stimulated by chronic systemic viruses and this aspect of host-microbiome interactions appears specific to the virome. The virome is considered one of the drivers of idiopathic systemic inflammation that has been linked to many of the most severe public health threats, including cardiovascular diseases. Disruptions in immunity by immunosuppressing events can undoubtedly alter the interactions of the virome with the host. However, little research has been done in all of these aspects other than limited descriptive studies to identify the presence or composition of the human virome. The NHLBI Microbiome Working Group in June 2014 clearly identified under-representation of studies of the human virome. Identification and characterization of unknown viral elements of the human virome and research on the interactions with the host will allow exploration of their impact on heart, lung and blood health and diseases, including impact in the presence of immunosuppression with the host such as in AIDS or HIV infection.

Feasibility and challenges of addressing this CQ or CC

This initiative is feasible because of new technologies that have been developed recently such as the deep sequencing techniques. The initiative is also timely in that research supported by the NIH Human Microbiome Program and other programs has allowed us to better understand microbiome, especially bacteria in and on humans, and we began to realize the magnitude of the virome. This initiative will attract more investigators to not only identify more elements of the virome but more importantly to understand the roles of the human virome in heart, lung and blood health and diseases, and eventually to help develop diagnostic and intervention strategies.

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

Voting

13 net votes
29 up votes
16 down votes
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Goal 2: Reduce Human Disease

Pulmonary Vascular Diseases

Does pulmonary rehabilitation or regular exercise improve outcomes in patients with PVD?

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

Details on the impact of addressing this CQ or CC

This is a view of problems in the field.
Pulmonary Hypertension Clinical Research: Current Problems and Possibilities
Current studies limited to the short term, with soft outcomes.
No mechanistic studies embedded in trials.
Control of phenotype is weak.
Small n: lumping of cohorts.
No factorial of advanced design.
No biological samples obtained for study.
Failure to study basic management issues.

Name of idea submitter and other team members who worked on this idea ATS Member

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

Biologic mechanisms of prolonged morbidity in survivors of ARDS and sepsis

What are the biologic mechanisms and risk factors that lead to prolonged morbidity in survivors of ARDS and sepsis? What factors during the acute disease phase distinguish patients that recover from those that develop long-term physical, psychological, or cognitive deficits?

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

Details on the impact of addressing this CQ or CC

Reductions in mortality rates for ARDS and sepsis have led to an increase in the number of survivors. Many of these survivors develop new or worsened physical, mental, or cognitive morbidities that persist months or years after hospital discharge. Identifying the biologic mechanisms and risk factors during the acute disease phase that lead to prolonged morbidity could help develop therapies to prevent/treat the long-term morbidities and determine the subgroup of patients that interventions should target.

Feasibility and challenges of addressing this CQ or CC

Research over the past several years has highlighted the increasing number of survivors of ARDS and sepsis that are at risk for long-term physical, psychological, and cognitive impairments. One challenge to answering this question is the limited availability of data and biospecimens of patients with ARDS or sepsis linked to long-term outcomes. Developing a robust resource for this work would require facilitation by NHLBI (potentially in collaboration with other NIH institutes).

Voting

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

Definitive Evidence of the Effectiveness of Pulmonary Rehabilitation

What is the clinical effectiveness of pulmonary rehabilitation in reducing hospital admissions and readmissions, improving health outcomes such as exercise tolerance and dyspnea, and positively impacting patient centered outcomes. Does this effectiveness vary based on the types of settings rehab is conducted in, urban vs rural environments, the components to the program, the timing of the program and the overall support... 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

Pulmonary rehabilitation is a critical component in the treatment of COPD patients but several barriers persist that have resulted in very limited access to rehab, low referral rates for eligible patients and limited standardization of best practices within the rehab facilities that do exist. Large, definitive studies accounting for patient subgroups, site characteristics and program components can generate the level of evidence needed to expand access, educate providers and improve referral systems and create quality programs. This level of evidence is necessary to change policy to properly value the role of pulmonary rehabilitation and to convince integrated health systems in a value based market that pulmonary rehabilitation is beyond a doubt, a requirement of providing quality COPD care.

Name of idea submitter and other team members who worked on this idea Grace Anne Dorney Koppel, COPD Foundation Board of Directors, COPD Patient Advocate

Voting

9 net votes
12 up votes
3 down votes
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Goal 2: Reduce Human Disease

Reducing CV events in breast cancer survivors -knowledge gaps

Identifying breast cancer survivors at high risk for CV morbidity and mortality to allow targeting of management strategies to reduce CV events and thereby improve overall cancer-related survival.

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

Details on the impact of addressing this CQ or CC

Chemotherapy for breast cancer stages I-III is known to be associated with or induce cardiotoxicity. Over 35% of these women develop progressive fatigue and exercise intolerance, and heart failure limiting their daily activities and frequently interfering with their ability to return to work. CV disease are the leading cause of morbidity and mortality for those surviving beyond 5 to 8 years from their breast cancer diagnosis. The excess of CV morbidity and mortality in these patients threatens to offset reductions in cancer-related survival. Identifying breast cancer survivors at high risk for CV morbidity and mortality could allow targeting of cardiovascular disease reducing therapeutic interventions.

Feasibility and challenges of addressing this CQ or CC

creating a multisite registry of women with Stage 1-3 breast cancer scheduled to receive chemotherapy and a control population women of similar demographic and CV risk profile without neoplasia, would allow to collect data at baseline and during/after cancer treatment related modern therapy, pre/post treatment functional status, including fatigue, behavioral and psychosocial risk factors and quality of life, and serum biomarkers indicative of myocardial injury, fibrosis, and heart failure.

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

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

Impact of lung remodeling on congestive heart failure progression

End stage congestive heart failure (CHF) causes intensive lung remodeling beyond the type-2 pulmonary hypertension. CHF induced lung remodeling includes profound lung fibrosis, lung vascular remodeling and lung inflammation. Understanding CHF-induced lung remodeling is also critical to understand the right ventricular failure. However, this area is largely unstudied. Regulating CHF-induced lung remodeling and the underlying... 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

To deal end-stage CHF will need team efforts from heart, lung, blood and immunology.

Name of idea submitter and other team members who worked on this idea Yingjie Chen, Associate Professor, University of Minnesota

Voting

13 net votes
15 up votes
2 down votes
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Goal 3: Advance Translational Research

Inhaled antibiotics for patients with bronchiectasis

Many pharma companies are developing inhaled antibiotics for patients with bronchiectasis, recognizing the increasing market (over 110,000 patients in the US). These drugs cost thousands of dollars per year and will be heavily marketed and heavily used, as there are limited options for these patients. It is unknown if rotating oral antibiotics (cost is a fraction of the inhaled ABx) would yield similar results.  A Cochrane... more »

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 member

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

Move beyond the use of self-report for dietary intake quantification

There is a need to move beyond the use of self-report for dietary intake quantification towards funding the development of new technology and broader use of objective measures. There is no question that the effects of diet on health, quality of life, and longevity are of great interest to many and plausibly of great importance. Because of that, tremendous research resources have been provided to study this topic. Given... 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

Virtually all authors and investigators in this area recognize that such measurements are limited in their validity; the common mantra is that while limited, these methods nevertheless have sufficient validity to merit being used in scientific investigations. In contrast, a growing group of investigators, ourselves included, think that this common mantra is not reasonable. Virtually all authors and investigators in this area recognize that such measurements are limited in their validity; the common mantra is that while limited, these methods nevertheless have sufficient validity to merit being used in scientific investigations. In contrast, a growing group of investigators, ourselves included, think that this common mantra is not reasonable. Instead we believe that the evidence clearly shows that with at least respect to self-reported energy intake, the measurements are so inaccurate that they do not warrant being used as a basis for scientific investigations and conclusions, even when no better measurement is available. Therefore, at least in investigations involving energy intake, we believe that self-report methods should be abandoned for purposes of drawing scientific conclusions about energy intake, and that funds made available for human dietary investigations be directed toward development of new, objective methods and technologies that can replace self-report methods.

Feasibility and challenges of addressing this CQ or CC

We believe that the scientific community would benefit from development of methods of measuring dietary intake that do not rely upon self-report. We are not recommending that more investment go into refining self-report methods but rather that replacement methods be sought. Some investigators are interested in devices such as smartphone photography as a way of enhancing self-report. It is our intuition that such methods will only be modest enhancements and will be subject to very substantial biases, since they rely on subject cooperation. Instead, we believe that that methods based on principles of physics, engineering, and chemistry (and generally less prone to human filtering/interference) are likely to be more useful in the long run. Investing in such methods could take at least two forms. First, funders could invest in the development of new technologies and techniques. Second, funders could invest in ways that alter the economic conditions for the use of existing techniques, notably doubly-labelled water (DLW). It is remarkable how much the cost of genotyping has decreased in the last several decades, driven by market incentives and a market initially catalyzed by NIH investment. This is not the case with DLW, which has stayed at a fairly constant price for 30 years. We suggest that it may be possible for the NIH to create a market incentive for reductions in price by initially catalyzing a large demand through an infusion of funding for research using DLW.

Name of idea submitter and other team members who worked on this idea David B. Allison, Ph.D.; Kevin Fontaine, Ph.D.; Kathryn A. Kaiser, Ph.D.; Andrew W. Brown, Ph.D.; Edward C. Archer, Ph.D.

Voting

1 net vote
2 up votes
1 down votes
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Goal 1: Promote Human Health

Understanding normal aging

Understanding normal aging

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

Details on the impact of addressing this CQ or CC

While we are fully supportive of the recent emphasis on patient‐centered outcomes and implementation science, we are also reminded of the critical importance of investigating underlying mechanisms of pulmonary, critical care and sleep disorders. Recent discoveries have created exciting progress in the areas of cystic fibrosis, pulmonary hypertension, pulmonary fibrosis, and biological therapies in asthma. Only through further efforts to elucidate underlying mechanisms are new therapeutic approaches likely to emerge. Promoting further academic‐industry interactions are likely to yield benefits, which will ultimately lead to improvements in the health of our nation.

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

Voting

1 net vote
2 up votes
1 down votes
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Goal 1: Promote Human Health

How common is Omega 3 nutritional deficiency, and how can people make sure they're getting enough Omega 3?

If I understand correctly what I've read, it may be tough to get enough Omega 3 because Omega 3 & Omega 6 compete with each other & many people consume much more Omega 6 than Omega 3.

http://www.drweil.com/drw/u/QAA400149/balancing-omega-3-and-omega-6.html

I fear the situation might be even worse for vegetarians, because from what I've read, it appears much easier to get the DHA & EPA forms of Omega 3 from animal sources.... 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

See comments

Feasibility and challenges of addressing this CQ or CC

See comments

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

Voting

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

Community Trials for Cardiovascular Health Enhancement

There is a need to initiate innovative community trials that are: theory-based; are integrated multi-component, multi-setting, and multi-level (i.e., they target individual, family, community, and built environment); engage community stakeholders; and use community-participatory research principles to enhance cardiovascular health (CVH) in vulnerable and diverse populations.

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

Details on the impact of addressing this CQ or CC

Global impact on cardiovascular health.

Feasibility and challenges of addressing this CQ or CC

There are smaller scale community interventions but none in the literature that focuses on larger-scale multi-level trials as proposed here. This CQ would target vulnerable and diverse populations to reduce health disparities.
NHLBI supported the stroke belt initiative, and the exemplars in community CV health research: (e.g., the Stanford 5 City Project, The Minnesota Heart Health Program, The Pawtucket Heart Health). The next generation of community CVH research should harness the lessons from these studies, findings for the 8 Americas (Chris Murray), and numerous results from NHLBI cohort studies to implement large-scale community trials for cardiovascular health enhancement.
Resources for a large scale study could be a challenge. Ability to motivate a whole community, to prevent contamination, and to sustain interventions would be a challenge.

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

Voting

-1 net votes
9 up votes
10 down votes
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Goal 1: Promote Human Health

Updating level C evidence in Clinical Guidelines

Clinical Guidelines depends on good science. Despite this, only 11% of guidelines that reported level of evidence in 2009, had level of evidence A while 48% had level C. Studies have shown that recommendations based on Level of Evidence C (or their equivalence) are significantly less reliable and may be downgraded, reversed or omitted when better evidence is available.
I propose a comprehensive review of ACC/AHA... 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

Upgrading the level of evidence that recommendations are based on in clinical guidelines, will potentially improve outcomes, reduce unnecessary risk and reduce cost of all aspects of cardiovascular care.

Feasibility and challenges of addressing this CQ or CC

There are three phases:

  1. Review the current published clinical guidelines (and Appropriate Use Criteria) for recommendations relying on level of evidence of C- Very feasible.
  2. Ranking impact of clinical recommendations that only have level of evidence C- Quite feasible, but will need to set up a protocol and review committee.
  3. Designing and funding high priority studies: Feasible- especially if done under the umbrella of the NHLBI. The challenges will be to set up good studies that supply enough data to be useful in making recommendations based on Level of evidence A in the Guidelines.

Name of idea submitter and other team members who worked on this idea Gilead Lancaster, MD, Associate Clinical Professor of Medicine, Yale University School of Medicine

Voting

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

Enhancing T4 Implementation Research Expertise

We need to increase our base of T4 implementation research expertise among researchers, reviewers, and investigators.

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

Details on the impact of addressing this CQ or CC

Increase our base of expertise in a relatively new field. Increase the number of funded grants and projects that include T4 implementation research.

Feasibility and challenges of addressing this CQ or CC

Additional training for T4 implementation research can be added to the training infrastructure currently in place at the NHLBI/NIH.

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

Voting

-6 net votes
4 up votes
10 down votes
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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