Charting The Future Together

Objectives

The National Heart, Lung, and Blood Institute (NHLBI) Strategic Vision provides a decade-long research framework to prevent and treat heart, lung, blood and sleep diseases, improve health and longevity, and reduce their population burden. It combines four mission-oriented goals, eight objectives and 132 research priorities to guide research opportunities and investment decisions.[1][2][3][4]

• Understand normal biological function and resilience across the life course, including the molecular, cellular, physiological, behavioural, social and environmental factors that sustain health, support healthy ageing and shape transitions from health to disease.[5][4][6]
• Investigate disease mechanisms, onset, progression and conversion from chronic to acute illness, using improved models and tools to identify preventive, diagnostic and therapeutic opportunities.[5][7][8]
• Explain population differences in susceptibility, resilience, disease course and outcomes, including differences associated with age, sex, race, ancestry, behaviours, socioeconomic conditions and biological factors, to reduce inequitable morbidity and mortality.[9][10]
• Identify individual variation in disease biology and treatment response, supporting predictive models, biomarkers, imaging, deep phenotyping and more precise prevention, diagnosis and medical intervention.[9][11][12]
• Develop and optimise diagnostics, treatments and potential cures for heart, lung, blood and sleep conditions, including regenerative medicine, gene therapy, transplantation, safer blood products, anticoagulation, emergency cardiac care, sleep health and bioengineered implants.[9][12][13][14]
• Improve clinical and implementation research, use data science to integrate diverse information sources, and sustain a diverse, skilled biomedical workforce and research-resource base.[9][15][16][17]

The intended long-term advances include personalised precision medicine; earlier disease identification; better understanding of environmental, behavioural and molecular influences; tissue repair; and new treatments or potential cures, including for sickle cell disease.[1]Enduring principles are to value investigator-initiated discovery science, maintain a balanced cross-disciplinary portfolio, support implementation science, strengthen workforce diversity, and pursue evidence-based elimination of health inequities.[2][3][18]

Implementation

NHLBI will implement the Vision through a dynamic, portfolio-based research approach that links investigator-initiated discovery with targeted Institute initiatives, spanning basic science, population research, clinical studies, implementation research and community-centred work. Research priorities are intended to stimulate rather than constrain scientific creativity, and to be periodically refined as science and opportunities evolve.[1][4][7][18]

• Support extramural research through Funding Opportunity Announcements and other Institute activities aligned with Strategic Research Priorities, while retaining investigator-initiated science as the principal foundation for discovery.[18][1]
• Apply computational biology, bioengineering, nanotechnology, molecular imaging, high-throughput omics, single-cell analytics, sensors and advanced data methods alongside behavioural, clinical and population research.[1][7][11][16]
• Develop representative investigational models from cells to animals, standardise cell-culture protocols, broaden access to relevant cell lines, and improve reproducibility, including attention to sex- and gender-based variation.[7]
• Use NHLBI-supported cohorts, electronic health records, registries, trial networks, personal health data and existing datasets to link biological, clinical, environmental, social and behavioural information with patient outcomes.[7][15][16]
• Embed clinical epidemiology, trials and implementation-science programmes in learning health-care systems, strengthen participant recruitment and trial management, and examine how findings are adopted into clinical care, community programmes and policy.[15][19]
• Build multidisciplinary partnerships across academia, non-profit organisations, industry, professional groups, health-care workers and communities to accelerate translation from discovery to products and clinical applications.[12][19]
• Strengthen workforce development from school education to senior research careers through mentoring, virtual learning, interdisciplinary team science, cultural competency, communication training and preparation for regulatory, intellectual-property and commercialisation issues.[17][20][21]

Development and continuing implementation involve NHLBI staff, the National Heart, Lung, and Blood Advisory Council, the Board of External Experts, scientific and medical communities, patients and advocates, policymakers, professional organisations and the public. A crowdsourcing forum enabled community members to submit, vote on and comment on proposed priorities; advisory bodies reviewed them for timeliness, feasibility and potential impact.[22][2][3][18]

Ongoing engagement through webinars, workshops, think tanks and working groups is intended to identify activities that advance priorities and keep the Vision responsive to emerging needs.[1][4][18]Formal delivery responsibilities beyond NHLBI, operational timetables, performance indicators, reporting arrangements, evaluation methods and budgets are not specified in the supplied material.[4][7][12][18]

Monitoring & Evaluation

The Strategic Vision uses an adaptive, research-led learning approach rather than a formal performance-management framework. It aims to keep priorities responsive to scientific developments, emerging opportunities and continued input from scientific, clinical, patient and public communities.[1][2][3][18]

• Review and select research priorities through National Heart, Lung, and Blood Advisory Council, Board of External Experts and Council working-group processes, using timeliness, feasibility and potential impact as stated criteria.[3]
• Refresh the research agenda periodically through continuing community engagement, webinars, workshops, think tanks and working groups that identify activities to advance strategic priorities.[1][2][4][18]
• Use implementation research to assess how research findings are adopted into clinical approaches, programmes and policies, including in rare diseases and varied national settings.[19]
• Embed clinical epidemiology registries, clinical-trial networks and implementation-science programmes in learning health-care systems, linking research and practice through electronic health records, patient registries and existing datasets.[15]
• Track disease onset and progression over the life course to examine conversion from chronic to acute disease and the effects of early exposures, interventions and lifestyle change.[7]
• Identify and validate biomarkers of environmental exposure, disease onset, progression and transition from chronic to acute disease.[8]
• Assess clinical outcomes, disease manifestations, severity, and functional effects of genetic variants and gene knockouts through cohort research.[7]
• Use predictive models, biomarkers, molecular imaging, real-time individual monitoring, sleep-health algorithms and risk stratification to support clinical decision-making and assess disease and treatment risks.[12][13][14]
• Examine outcomes relevant to myocardial infarction, sudden cardiac death, morbidity, mortality, transfusion safety and effectiveness, treatment efficacy, transplantation complications, anticoagulation safety and bioengineered therapies.[12][13][14]
• Improve clinical-trial design and management to support timely completion, while using diverse data sources to enhance research efficiency, cost-effectiveness and generalisability.[19]
• Link electronic health records, registries, personal sensors, imaging and biological datasets to support risk prediction, disease-subtype definition, therapeutic-target identification and patient care.[16]
• Collect and analyse education and employment data on heart, lung, blood and sleep scientists across their careers to define metrics and predictors of individual and training-programme success.[21]

No formal monitoring framework, quantitative indicators, targets, reporting schedule, surveillance system, evaluation methodology, review timetable or named accountability mechanism is specified across the supplied excerpts.[4][7][10][12][19][21][18]

Costing & Financing

The Strategic Vision identifies resource needs and financing-related considerations for research delivery, but provides no quantified budget, allocation, funding gap, financing plan or economic assumptions.[2][4][7][10][12][18]

• Support investigator-initiated discovery science as the core of the National Heart, Lung, and Blood Institute research mission, complemented by Institute-solicited initiatives that address scientific opportunities and knowledge gaps.[18]
• Use Funding Opportunity Announcements and related activities to catalyse extramural investigations aligned with Strategic Research Priorities.[18]
• Guide research opportunities and investment decisions over the following decade through the four goals, eight objectives and 132 research priorities.[4]
• Provide research resources for clinical epidemiology registries, trial networks, implementation-science programmes, electronic health record linkage, patient registries and data repositories.[15][19]
• Expand resources needed to identify therapeutic targets, establish proof of concept and generate evidence for investigational new drug applications.[19]
• Address cost containment in clinical research and cost-effectiveness in the use of newly available data.[15][19]
• Develop workforce and research capacity through training in biostatistics, computer science, bioinformatics, data science, computational biology, quantitative population science, behavioural science and implementation science.[16][17][21]
• Support strategic education, training, mentoring and career-development interventions, particularly for under-represented groups and people from disadvantaged or medically underserved communities.[17][20]
• Strengthen multidisciplinary collaboration among academia, non-profit organisations, industry and other professional groups to accelerate translation into products and clinical applications.[19]

The supplied excerpts do not specify programme costs, expenditure figures, funding sources, financing mechanisms, resource-mobilisation arrangements, funding allocations, unfunded requirements, economic modelling or costed implementation plans.[1][13][14][17][21]