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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

Basic research in glycobiology is urgently needed

There are two areas in which glycobiology has been very successful: technology development and disease correlation. Through efforts exemplified by the CFG, major strides in mass spectroscopy and the creation of novel technologies for probing glycan-protein interactions (e.g. glycan microarrays) have been seen. Likewise, the success of the Programs of Excellence in Glycoscience and those of us focused on disease have also... 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

If my experience as a standing member of a study section and as a PI who submits greater
than ten R01 applications for every one funded, the reason for this gap in our knowledge is not an inability to
pursue such projects, nor is it a lack of desire within the field. The reason is that these studies never make it
through study section. Why? I believe the explanation is found in the nature of glycosylation: heterogeneity.
The strong bias in modern molecular-based science is that if something is not isolatable in a pure pristine
homogeneity, it cannot be studied. Not only is this short-sighted, it fundamentally betrays the nature of biology.

Feasibility and challenges of addressing this CQ or CC

Part of the solution for these issues is improving education in glycobiology. The other part of the solution is below:

  1. Provide opportunities for R01 and individual PI-focused fundamental glycobiology studies. Promote the dissection of fundamental pathways of regulation and function within in vivo settings so that we might
    begin to convert disease correlation into pathways ripe for therapeutic targeting. There is nothing to translate to the clinic without detailed knowledge of these fundamental pathways.
  2. Provide opportunities to expand local expertise and infrastructure in glycosciences across the country, rather than focusing on a few centers of strength. My experience tells me that investigators outside of glycobiology are far more likely to engage a local collaborator and/or core facility to help explore a glycan-related topic than to deal with a large center in a far-off university – at which they know no one.
  3. There should be a push to promote individual labs with diverse interests and systems to broaden the impact by integrating glycobiology across multiple fields, rather than on concentrating expertise in a small number of large centers.

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

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

A Diverse world in prevention and provision of care

Why don’t we have a program that is easy to follow in maintaining at an early age that extends all the way to Senior Citizenship? Culturally diverse staff can improve everyones chances of getting needed care that is multi-cultural.

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

Details on the impact of addressing this CQ or CC

We need a strike team of diverse brainstormers to address social issues that may be responsible for deseases do to associations and life styles. The majority of healthcare concerns are diverse and need someone who can retrofit services to be more responsive to all groups.

Feasibility and challenges of addressing this CQ or CC

Most federal and state funding go to organizations that are high profile but not necessarily in touch with some peoples realities. Grassroot organizations need to be funded like in the past whose door don’t close at 4 or 5 PM when there is greater vulnerability.

Name of idea submitter and other team members who worked on this idea James E. Cummings Sr

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-19 net votes
2 up votes
21 down votes
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Goal 3: Advance Translational Research

New Targets for the Treatment of Heart Failure

Heart failure (HF) is one of the major health challenges in the 21st Century. Its prevalence is due a growing number of patients who survive heart attacks, who later develop heart failure; and the high incidence of diabetes leading to diabetic cardiomyopathy. Current treatments for HF only slow the progression of the disease; no treatment stops or reverses this adverse sequence. These limitations provoke the question... 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 current treatment regimens for patients with heart failure (HF) focus on strategies to reduce cardiac work (by reducing heart rate, beta-blockers), afterload reduction (ACE inhibitors), and decrease in preload/blood volume (ACE inhibitors, aldosterone antagonists, diuretics). None of these treatments stop or reverse the progression of the disease. A recent gene therapy trial designed to improve cardiac contractility and calcium handling in HF has failed in clinical trials. Perhaps the reason that the current and experimental treatments have not produced an outcome of stopping or reversing the progression of the disease relates to the "cell" they are targeting. In this regard, the current treatments principally target cardiac myocytes, but there is evidence that vascular perfusion abnormalities may also be involved in the disease. One such piece of evidence relates to the diffuse fibrosis occurring in the failing hearts. Such fibrosis is often referred to as replacement fibrosis in that the fibrotic tissue has replaced cardiac myocytes which died. This death could be the result of a perfusion abnormalities caused by inadequate dilation of the coronary resistance vessels. Thus, is heart failure a pathology involving both the coronary circulation and cardiac muscle? In this regard, future investigations of heart failure consider cardiac-coronary interactions leading to perfusion abnormalities as a key factor in the progression of heart failure.

Feasibility and challenges of addressing this CQ or CC

The challenge of addressing a coronary vascular contribution to heart failure would involve an interdisciplinary approach using genetic models with cardiac and/or vascular (smooth muscle and endothelium) expression or knock-out of key genes involved in cardiac function and vascular control. Sophisticated measurements of cardiac function and metabolic status of the heart using echocardiography, MRI, PET and a L-Band EPR would provide insight into flow-function-metabolism-oxygenation relations in the normal and failing heart.

Name of idea submitter and other team members who worked on this idea William M Chilian

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13 net votes
18 up votes
5 down votes
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Goal 2: Reduce Human Disease

Predict the needs for inter and intra-hospital transfer for acute care surgery patients with respiratory failure

Density mapping of the need and flow of patients requiring acute care surgery vis-a-vis inter-facility transfer, care hand-off failures, post-acute care resource mismatch to articulate a funding plan resource allocation and development akin to what has been done for trauma care.

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 Society of Critical Care Medicine Executive Committee/Council

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2 up votes
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Goal 3: Advance Translational Research

Smoking cessation

Smoking cessation

a. Enhance our understanding of the behavioral issues that lead to smoking addiction

b. Explore effective behavioral and pharmacological and non-pharmacological mechanisms to reverse smoking addiction

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
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Goal 2: Reduce Human Disease

The missing ingredient in diet and cardiovascular disease prevention research

Determining the dietary patterns and dietary constituents that are most effective in preventing cardiovascular disease events. In addition to the obvious challenge of limited resources, the challenge is overcoming the tension between desire for comparable data produced from low-cost tools and need for higher quality data. Many studies continue using low-cost self-reported diet assessment instruments that produce data... 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

Addressing the challenge of a dietary assessment method that harnesses recent technological advances in novel biomarker assessments and in metabolomics and microbiome research with best practices in self-reported assessment instruments would enable a giant leap forward in nutrition and cardiovascular disease prevention research. Self-reported instruments require repeated measurements which are expensive or are instruments hampered by measurement error that attenuates estimates of the diet-disease association. Progress on this critical challenge would enable research questions to be addressed using more accurate methods, including questions that ask about best overall diet pattern to prevent cardiovascular disease as well as questions targeted to specific nutrients or diet constituents. Overcoming this obstacle would enable research to move forward in population science research where knowledge of the diet of free-living individuals or community populations is needed as well as among patients in clinical research (other than expensive feeding trials where exact diet is known). There is great potential in stored specimens from epidemiology cohorts and clinical trials to be used with new biomarker assessments to associate earlier diet with hard outcomes accrued in these studies.

Feasibility and challenges of addressing this CQ or CC

Advances in microbiome research and metabolomics technologies illustrate that progress in the field of biomarker assessments of dietary status is not only feasible but may sharpen our understanding of the relationship of dietary constituents with HLB disease pathologies. In the field of energy balance measurement there are calls for movement away from self-reported diet measures and for researchers and sponsors to focus development on objective measures (http://www.nature.com/ijo/journal/vaop/naam/abs/ijo2014199a.html ). Leadership from NHLBI in this area can move the field forward in validating tools and making them more cost effective.
“You are what you eat” is a familiar aphorism, but research progress on what dietary patterns and dietary constituents are most effective in preventing cardiovascular disease events is impeded by inadequate dietary assessment tools. This critical challenge calls for a major effort, in collaboration with other ICs, to develop methods and innovations in measures using blood, urine, feces, saliva, or other bodily fluids or tissues. These tools eventually need to be cost effective, valid, and reproducible.

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

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14 net votes
31 up votes
17 down votes
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Goal 3: Advance Translational Research

Clinical Tools for Pediatric CVD Risk Reduction and Asthma Treat

What are effective strategies and clinical decision support tools that can maximize pediatric care providers’ adoption of evidence-based recommendations for assessment and treatment of cardiovascular risk factors and/or asthma?

• Clinical recommendations and associated implementation tools are often incorporated into electronic medical records (EMRs). Currently there is no standard EMR format and therefore it is difficult... 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

• Cardiovascular disease (CVD) remains the leading cause of death and disability in North America. There is extensive evidence documenting the initiation of the atherosclerotic process, the pathologic basis for clinical heart disease, in childhood. Additionally, asthma a chronic condition that affects more than 7 million children in the U.S. and leading to numerous emergency visits.
• Among the major factors that are associated with increased clinical recommendation use are ease of access and feasibility. A common obstacle that providers face is the availability of proper information at the point of care.
• The Community Preventive Services Task Force recommends clinical decision-support systems for prevention of cardiovascular disease based on sufficient evidence of effectiveness in improving screening for CVD risk factors and practices for CVD-related preventive care services, clinical tests, and treatments. Mobile solutions may help to further facilitate this process.
• Successful implementation of clinical recommendations for prevention and treatment of CVD pediatric risk factors and asthma could greatly reduce the number of youth moving into adulthood at increased risk for CVD and could improve health outcomes for children with asthma.

Feasibility and challenges of addressing this CQ or CC

• Most care providers have mobile devices or computers for use in the clinical setting. There is good evidence that clinical decision support tools (and other implementation tools) can help facilitate adoption of clinical recommendation.
• It is important to test strategies in a large scale intervention that will measure clinical CVD outcomes.

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

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

Childhood Interstitial Lung Disease

What is the relationship of ChILD disorders to more common childhood respiratory diseases?

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

Details on the impact of addressing this CQ or CC

For example, what is the role of surfactant-related sequence variants in chronic lung disease of prematurity? Cystic fibrosis? Severe bronchiolitis? Refractory asthma?

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

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2 net votes
2 up votes
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Goal 2: Reduce Human Disease

Promotion of human health and reduction of human disease

Congenital heart disease (CHD) is the most common birth defect and leading cause of defect-related infant mortality. With nearly 1 in 100 babies born annually with CHD, the needs of children and adults born with CHD are ongoing and costly. More focused research into CHD promotes human health and will result in a better quality of life, reduced premature death and lower healthcare costs.

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

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0 net votes
1 up votes
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Goal 1: Promote Human Health

Developing tools/algorithms for objective evaluation of sleep health

What are the best tools/algorithms for robust and objective evaluations of sleep health biomarkers?

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

Details on the impact of addressing this CQ or CC

Sleep deficiency is pervasive in today’s society and associated with an array of threats to health and public safety. The availability of a biomarker(s) for sleep health would turn-the-curve on developing practical and feasible ways to identify individuals at risk for sleep deficiency and prevent/manage associated risks to health and public safety on a large-scale.

Feasibility and challenges of addressing this CQ or CC

Sleep and circadian regulation is coupled to an array of behavioral, physiological and molecular/genetic processes to leverage in the development of biomarkers for sleep health.
Untreated sleep disorders and sleep deficiency pose a significant burden on health and public safety. There is currently no biomarker, or point-of-care technology available to objectively measure an individual’s level of sleep deficiency or susceptibility, a significant barrier to prevention and management.

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

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124 net votes
162 up votes
38 down votes
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Goal 2: Reduce Human Disease

Repair and Regenerate the Kidney

Chronic Kidney Disease (CKD) affects millions in the US, and is one of the new diseases on the rise globally. New therapies to slow CKD and to repair and regenerate failing kidneys are drastically needed to reduce health care costs and improve lives.

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

Details on the impact of addressing this CQ or CC

New therapies to slow CKD and to repair and regenerate failing kidneys are sorely needed to reduce health care costs and improve lives.

Feasibility and challenges of addressing this CQ or CC

Our understanding of renal function and risk factors is greater than ever. Our ability to diagnose is technologically advanced. We now need to increase efforts to identify therapeutic targets and develop regenerative approaches to prevent and treat CKD.

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

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Goal 2: Reduce Human Disease

Novel technologies to save minutes and lives

There is a need to develop hand-held portable imaging or other technologies that can help paramedics to collect and transmit data when patients are undergoing cardiovascular events.

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

Details on the impact of addressing this CQ or CC

Save time and lives for patients destined to Emergency

Feasibility and challenges of addressing this CQ or CC

The component technologies are developed enough to integrate them in the next 5-10 years
Time spent waiting for an ambulance, driving to a hospital and enduring diagnostic tests before medical intervention can quickly add up, especially with patients undergoing cardiovascular events. In the era of internet, smartphones, and portable imaging and handheld technologies, saving valuable time during which paramedics can be assisting the emergency physicians in diagnosing heart attacks and help to identify and start the needed intervention at once when the patient arrive at the hospital.

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

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6 net votes
13 up votes
7 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

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13 net votes
15 up votes
2 down votes
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