The National Heart, Lung, and Blood Institute (NHLBI), its partner organizations, and the biomedical community have responded to the COVID-19 pandemic with speed and dedication, yielding lifesaving vaccines and treatments that emerged at an unprecedented pace. Still, many continue to suffer severe illness and death, some are coping with loss, and others are coping with continued-ill health. As we enter a third year of the COVID-19 pandemic—with even more effective therapeutics and hope that we are through the worst of it—this is a time to reflect, recharge, refocus, and work together to plan our path forward. At the same time, we have reinforced efforts to sustain and grow research supporting the Institute’s mission to reduce the burden of heart, lung, blood, and sleep disorders.

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Mobilizing to Defeat COVID-19

As the pandemic unfolded, we quickly saw disparities in the impact of COVID-19, with rates of infection and severe outcomes highest in the same communities that experience higher rates of chronic heart, lung, blood, and sleep disorders. It also soon became clear that COVID-19 can have life-threatening effects not only on the lungs but also on the heart, blood, and blood vessels. For these reasons, NHLBI has been at the vanguard of the NIH response to COVID-19.

  • With the National Institute on Minority Health and Health Disparities (NIMHD), NHLBI launched the Community Engagement Alliance (CEAL) Against COVID-19 Disparities. CEAL has forged partnerships between researchers and community organizations in more than 20 states. It has helped people in hard-hit communities engage in vaccine research, get vaccinated, and garner important, tailored resources on COVID-19.
  • NHLBI’s clinical research networks helped investigate potential therapies for acute COVID-19. One such trial found that the blood thinner, heparin, used in non-critically ill patients increased the probability of survival to hospital discharge as compared with usual-care; other trials found that treatments once considered promising were, in fact, not effective—including convalescent plasma in at-risk outpatients seeking emergency room care.
  • In late 2020, as a growing number of COVID-19 survivors continued to experience debilitating illness, NHLBI was asked to co-lead the NIH Researching COVID to Enhance Recovery (RECOVER) initiative, which is investigating the causes of Long COVID and is expected to begin testing potential therapies in 2022.

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Dr. Gary Gibbons
NHLBI Director Gary H. Gibbons, M.D.
three women of color wearing masks

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Advancing Health Equity

COVID-19 reaffirmed NHLBI’s ongoing commitment to community-based research to address health disparities. NHLBI’s investments in this area have continued to grow from population health studies that seek to identify the causes of disparities to intervention studies seeking to reduce them. The latter includes DECIPHeR, a new community-based participatory research network that has researchers in several states testing new approaches to expand the use of evidence-based interventions for heart and lung diseases in high-risk communities.

Two other new programs focus on the high rates of maternal morbidity and mortality in women of color. Early Intervention to Promote Cardiovascular Health of Mothers and Children (ENRICH) will examine whether cardiovascular health modules delivered through federal home visiting programs can enhance maternal and early childhood heart health. And the Maternal Health Community Implementation Project will fund regional coalitions of organizations, researchers, and networks to test a variety of evidence-based interventions before and during pregnancy to reduce high maternal death rates in four U.S. regions.

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Investing in Data Science to Drive Precision Medicine

The Institute continues to break new ground in data science, providing researchers with the tools they need to explore the biology of heart, lung, blood, and sleep disorders and set the stage for precision medicine. NHLBI’s TOPMed program has supported collection and analysis of whole genome and other molecular and clinical data from more than 200,000 participants in 90 diverse cohort studies. NHLBI’s BioData Catalyst platform houses TOPMed, other large datasets, and a suite of analytic tools, enabling researchers to explore potential new disease mechanisms and therapeutic targets. These programs also provide training opportunities for early-career investigators interested in using data science to solve public health problems.

Eight circles with four colored circles in the middle
Meeting NHLBI Strategic Vision Objectives 1, 2, and 7

Sustaining Investigator-Initiated Research

Despite the challenges of the past year, the Institute has maintained its support for investigator-initiated research, with success rates for R01 research project grants around 20 percent or better. By prioritizing support for early-stage investigators (ESIs), NHLBI increased the ESI RO1 success rate from 28.6 percent in fiscal year (FY) 2020 to 36.8 percent in FY 2021. In addition, to foster next-generation investigators, January 2022 we have adapted our training and career development programs and clinical trial networks. Ongoing efforts such as our Programs to Increase Diversity among Individuals Engaged in Health-Related Research (PRIDE) continue to successfully prepare junior faculty from underrepresented backgrounds for research careers. NHLBI also participates in trans-NIH efforts to boost inclusive excellence, such as the Maximizing Opportunities for Scientific and Academic Independent Careers (MOSAIC) and Faculty Institutional Recruitment for Sustainable Transformation (FIRST) programs, that work to increase the representation of faculty from groups underrepresented in biomedical science.

Success rates for NHLBI r01 Applications: 2015 to 2021
The NHLBI consistently sets a higher payline for early stage investigators than for established investigators to ensure support for the next generation of scientists.
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Lessons Learned and Looking Ahead

Although the COVID-19 pandemic is not yet firmly behind us, as a community, we’ve worked together to set a path forward. We’ve learned how frontline partnerships between NIH and community organizations can improve inclusion in research and access to results. We’ve gained experience in quickly mobilizing clinical research networks, and we’ve conceived new flexibilities to sustain researchers in times of crisis. Now it’s time to build on these new insights and assets to address persistent challenges in heart, lung, blood, and sleep disorders—including the need to reduce health disparities and to develop therapies tailored to each patient’s unique profile.