Division of Cardiovascular Diseases Strategic Plan

EXECUTIVE SUMMARY

Introduction

In 2006, The National Heart, Lung, and Blood Institute (NHLBI) initiated a process to develop strategies for facilitating research, training, and application of research advances in areas related to its mission. This process began with the convening of 23 Working Groups.  More than 600 experts from around the nation were invited to attend and asked to provide the NHLBI with recommendations.  These initial meetings resulted in “Level One Final Reports”, and their recommendations were consolidated into a final report. Following a period of modification based on public comment, the report was published as the NHLBI Strategic Plan:  Shaping the Future of Research. The NHLBI Strategic Plan, as well as the 23 Level One Final Reports, can be accessed from the NHLBI Public Site, at http://www.nhlbi.nih.gov.  The NHLBI Strategic Plan is intended to guide the NHLBI’s scientific direction for the next five to ten years and will be updated periodically as implementation/progress proceeds.

The NHLBI Strategic Plan encompasses 3 goals and 8 strategies for achieving them.  These are broad and cross-cutting, providing themes and approaches that are applicable across the spectrum of priorities for research and training related to cardiovascular (CV), lung, and blood diseases, and sleep disorders.  The challenge now turns to implementing these strategies.

The NHLBI Division of Cardiovascular Diseases (DCVD) provides leadership for basic, translational, and clinical extramural research in the area of CV health and disease. DCVD staff has embarked on implementing the strategies outlined in the NHLBI Strategic Plan by defining a series of goals, related to specific clinical problems, disease states, enabling technologies, research methodologies, and training needs.  These 35 goals for research and training accomplishments over approximately the next 5 years constitute the DCVD Strategic Plan.  They were derived principally from the Level One Final Report recommendations germane to the DCVD mission (see below) as well as from other workshops and working groups participated in by the scientific and clinical community.

The Division of Cardiovascular Diseases

The DCVD provides leadership for a national and international extramural program in cardiovascular diseases that integrates basic science and clinical research, including translational research, networks, and multicenter clinical trials.  It designs, conducts, supports, and oversees research on the causes, prevention, and treatment of diseases and disorders such as atherothrombosis, coronary artery disease, myocardial infarction and ischemia, heart failure, arrhythmia, sudden cardiac death, adult and pediatric congenital heart disease, CV complications of diabetes and obesity, and hypertension.  It also supports and oversees research in vascular medicine and biology, and valvular, cerebral, renal, peripheral, and other CV disorders.  The DCVD fosters biotechnological research in genomics, proteomics, nanotechnology, imaging, device development, cell- and tissue-based therapeutics, and gene therapy and in their uses as they relate to CVD.  It also supports training and career development programs in CV research at all educational levels from high school students to academic faculty, including programs for individuals from diverse populations.

Organization of the DCVD Strategic Plan

This document is organized into 3 sets of goals related to 1) enabling technologies and methodologies, 2) clinical problems or disease states, and 3) research training and career development.  Each goal is responsive to recommendations from one or more Level One Final Reports and/or recent specific workshops or working groups.  Each amplifies one or more NHLBI Strategic Plan goals to the level of a specific clinical problem, disease state, technology, methodology, or training need related to CV disease and DCVD’s mission.  Each provides examples of directions that may drive progress toward the goal, though stopping short of specifying research initiatives or project proposals.  For most research goals, progress will require basic, translational, and clinical investigation.  Wherever possible, the examples provided in this document span the entire range of research.

Future Directions

The DCVD intends to develop initiatives directed toward achieving the goals identified within its Strategic Plan.  These initiatives will focus on complementing, rather than replicating, ongoing investigator-initiated research.  Toward this end, our next task (ongoing) is to survey research funding, activity, and publications to identify and prioritize research opportunities responsive to the DCVD Strategic Plan goals that would most benefit from stimulation/support from the NHLBI.

Many of the goals articulated in this DCVD Strategic Plan are shared by other Divisions within the NHLBI and by Divisions of other Institutes. In pursuing these goals, DCVD particularly intends to partner with the NHLBI Division of Prevention and Population Sciences, Division of Lung Diseases, Division of Blood Diseases and Resources, and Division of the Application of Research Discoveries.

The NHLBI boosts support for areas of research through funding opportunity announcements (FOAs) such as Requests for Applications (RFAs; grants with set-aside funding), Requests for Proposals (RFPs; contracts with set-aside funding), and Program Announcements (PAs; grant programs usually with no specific set-asides).  In addition, the DCVD/NHLBI may convene targeted stand-alone workshops that generate research recommendations from the extramural research community (see http://www.nhlbi.nih.gov/resources/docs/index.htm for Executive Summaries and their research recommendations for recently held workshops).  Finally, the Small Business Innovation Research (SBIR) and the Small Technology Transfer Research (STTR) programs provide excellent opportunities for bringing technology and methodology to market readiness. These programs are funded by grants and contracts and have legislatively mandated set-asides.

• Publication record
• Major presentations at scientific meetings
• Increased number of investigator-initiated grants in the area
• Generation of secondary/consequent hypotheses
• Production of specific technology, reagents, and devices
• Change in clinical practice guidelines
• Reductions in serious adverse events

As with the overall NHLBI Strategic Plan, the DCVD Strategic Plan is intended to be a “living” document that will be updated periodically as progress is achieved, new challenges emerge, and we gain feedback from the extramural research community.

Dedication

This Strategic Plan is dedicated to the memory of Ms. Elizabeth Pitt, who devoted herself to the NHLBI and its mission to advance cardiovascular knowledge and health for 19 years.

Goals

1. Goals in Enabling Technologies and Methodologies for Cardiovascular Disease
   1. Develop individualized/personalized medicine for cardiovascular diseases.
   2. Develop new bioinformatic tools for cardiovascular medicine.
   3. Develop dynamic, predictive computational models of cell/organelle function in health and disease.
   4. Improve biocompatibility and durability improvements for cardiovascular devices.
   5. Improve tissue engineering technologies for cardiovascular regenerative medicine.
   6. Apply nanoparticle-based targeted agents to diagnose and treat CVDs in clinical practice.
   7. Identify, characterize, and apply progenitor cells appropriate for cardiovascular regeneration and repair.
   8. Develop improved imaging technology for diagnosis and therapy for CVDs.
   9. Improve cardiovascular surgical outcomes for patients through evidence-based research.
      
      
2. Goals in Cardiovascular Clinical Problems or Disease States
   1. Congenital and Valvular Disease
      1. Explain the developmental and genetic basis of congenital heart disease.
      2. Improve evidence-based care and treatment of children with congenital and acquired pediatric heart disease.
      3. Improve evidence-based care and treatment of adults with congenital heart disease.
      4. Increase our understanding of the initiation and progression of valvular heart disease toward improving its diagnosis and therapy.
   2. Hypertension, Atherothrombosis, and Vascular Disease
      1. Develop and evaluate preventive and therapeutic strategies for cardiovascular risk factors for acquired heart disease beginning in childhood.
      2. Develop and validate new strategies to prevent target organ damage in hypertension.
      3. Prevent initiation and progression of atherosclerosis/atherothrombosis.
      4. Improve management of acute and chronic coronary syndromes.
      5. Improve prevention and treatment strategies for aortic aneurysms to prevent their progression, rupture, and dissection.
      6. Improve diagnostic and therapeutic strategies for lower extremity peripheral arterial disease.
      7. Develop new preventive and therapeutic approaches for cerebrovascular disease.
      8. Advance understanding of the fundamental mechanisms regulating the function of the lymphatic vasculature in relation to cardiovascular diseases.
      9. Improve diagnosis, prevention, and treatment of venous thromboembolism.
   3. Cardiac Arrhythmias
      1. Develop means to predict and prevent sudden cardiac arrest and subsequent death.
      2. Halt the epidemic of atrial fibrillation and its associated morbidity.
      3. Improve the dismal (5-10 percent) and stagnant success rate of out-of-hospital cardiac and life-threatening trauma resuscitation.
   4. Heart Failure, Cardiac Arrest, Recovery and Replacement Therapies
      1. Reduce the morbidity and mortality of ischemic and non-ischemic dilated cardiomyopathy by developing new treatments through improved understanding of pathophysiology.
      2. Reduce the morbidity and mortality of hypertensive heart failure.
      3. Establish strategies to prevent or reverse the phenotypic expression of genetically identifiable myocardial and rhythm disorders.
      4. Expand the application of mechanical cardiac support devices to improve clinical outcomes in patients with heart failure.
      5. Develop effective therapies for protecting the heart from ischemia and reperfusion injury.
      6. Improve outcome for cardiac transplant patients and make transplantation available to a larger number of heart failure patients.
         
         
3. Goals in Cardiovascular Research Training
   1. Meet current and anticipated future training needs of the cardiovascular scientific research community with an appropriate balance between basic, translational, and clinical investigation.
   2. Facilitate the entrance of outstanding research trainees into disciplines where larger pools of scientists are needed or where there is opportunity to hasten the acquisition of knowledge and its translation to clinical application.
   3. Facilitate the research training and establishment of research independence of individuals from under-represented groups.