NHLBI Working Group

Strategic Directions in Congestive Heart Failure

Executive Summary

The National Heart, Lung, and Blood Institute convened a Working Group of investigators on July 14, 2003, in Bethesda, Maryland. This Working Group brought together experts in basic, clinical, and applied scientific research to address the future research directions and needs in the area of congestive heart failure. The Working Group evaluated the current state of knowledge, identified critical gaps in our knowledge, understanding and application of research tools, and developed specific recommendations to be used by the NHLBI in planning its future research agenda in the area of heart failure.

The Working Group participants considered five major areas of discussion: 1) diastolic heart failure; 2) genetics/genomics of heart failure; 3) treatment of heart failure with drugs; 4) treatment of heart failure with transplantation or devices; and 5) biomarkers and proteomics as applied to heart failure. The Working Group addressed perceived needs and barriers in each of these areas and developed recommendations further our understanding of the etiology, treatment and prevention of heart failure.

The Working Group identified specific areas where the NHLBI could provide leadership or direction in research efforts over the next five to ten years. The recommendations of the Working Group are to:

• Consider a clinical trial in patients with congestive heart failure involving strategic approaches to the use of diuretics.
• Conduct a carefully designed treatment trial of aldosterone blockade in patients with diastolic heart failure.
• Conduct clinical studies to define the underlying pathophysiology in heart failure patients with preserved left ventricular function.
• Support the standardized collection of samples from patients in clinical trials or population based studies for genomic/genetic and proteomic analysis.
• Develop appropriate studies to identify and eventually treat asymptomatic individuals with left ventricular dysfunction.
• Develop strategies for the management of individuals in end-stage heart failure.
• Develop a multidisciplinary approach to understanding the cardio-renal connection in heart failure.
• Create investigative teams, such a clinical research networks, with access to congestive heart failure patients to investigate new approaches to the characterization, management, and treatment of patients with this disease.
  

Members:

• Daniel Burkhoff, M.D., Ph.D., Department of Medicine, Columbia University College of Physicians and Surgeons
• Maria Rosa Costanzo, M.D., Edward Cardiovascular Institute, Naperville, IL
• Marvin A. Konstam, M.D., Department of Medicine, Tufts-New England Medical Center
• Daniel Levy, M.D., NHLBI, Framingham Heart Study, Framingham, MA
• Stephen Liggett, M.D., Department of Internal Medicine, University Of Cincinnati
• Barry Massie, M.D., Department of Medicine, University of California, San Francisco
• Bertram Pitt, M.D., Department of Internal Medicine, University of Michigan Medical School
• Bruce M. Psaty, M.D., Ph.D., M.P.H., Cardiovascular Health Research Unit, University of Washington
• Margaret Redfield, M.D., Department of Internal Medicine, Mayo Clinic
• Lynne Warner Stevenson, M.D., Department of Medicine, Brigham and Women's Hospital
• Jennifer Van Eyk, Ph.D., Institute of Molecular Cardiobiology, Johns Hopkins University
• Michael R. Zile, M.D., Department of Medicine, Medical University of South Carolina