Faculty Bibliography

Four decades ago, U.S. life expectancy was within the same range as other high-income peer countries. However, during the past decades, the United States has fared worse in many key health domains resulting in shorter life expectancy and poorer health-a health disadvantage. The National Heart, Lung, and Blood Institute convened a panel of national and international health experts and stakeholders for a Think Tank meeting to explore the U.S. health disadvantage and to seek specific recommendations for implementation research opportunities for heart, lung, blood, and sleep disorders. Recommendations for National Heart, Lung, and Blood Institute consideration were made in several areas including understanding the drivers of the disadvantage, identifying potential solutions, creating strategic partnerships with common goals, and finally enhancing and fostering a research workforce for implementation research. Key recommendations included exploring why the United States is doing better for health indicators in a few areas compared with peer countries; targeting populations across the entire socioeconomic spectrum with interventions at all levels in order to prevent missing a substantial proportion of the disadvantage; assuring partnership have high-level goals that can create systemic change through collective impact; and finally, increasing opportunities for implementation research training to meet the current needs. Connecting with the research community at large and building on ongoing research efforts will be an important strategy. Broad partnerships and collaboration across the social, political, economic, and private sectors and all civil society will be critical-not only for implementation research but also for implementing the findings to have the desired population impact. Developing the relevant knowledge to tackle the U.S. health disadvantage is the necessary first step to improve U.S. health outcomes.

BACKGROUND: The prevalence and significance of right ventricular dysfunction (RVD) in patients with cardiogenic shock due to acute myocardial infarction (AMI-CS) has not been well characterized. We hypothesized that RVD is common in AMI-CS and associated with worse clinical outcomes. METHODS AND RESULTS: We retrospectively analyzed patients with available hemodynamics enrolled in the SHould we emergently revascularize Occluded coronaries for Cardiogenic shocK (SHOCK) Trial (n=139) and Registry (n=258) to identify RVD in AMI-CS. RVD was defined by an elevated central venous pressure (CVP), elevated CVP/ pulmonary capillary wedge pressure (PCWP) ratio, decreased pulmonary artery pulsatility index (PAPi), and decreased right ventricular stroke work index (RVSWI). A p value of less than 0.01 was used to infer significance. In both the SHOCK trial and registry, 38% and 37% of patients had RVD, however RVD was not associated with 30-day or 6-month survival (HR 1.51 (0.92, 2.49) p=0.10). RV failure using inclusion criteria from the Recover Right Trial for RV failure (RR-RVF) requiring percutaneous mechanical circulatory support included an elevated CVP, CVP/PCWP ratio, and a low cardiac index despite >/=1 inotrope or vasopressor. In both the SHOCK trial and registry, 45% (n=63/139) and 38% (n=98/258) of patients met RR-RVF criteria respectively. The RR-RVF criteria were not significantly associated with 30-day mortality in the registry cohort (HR 1.44 (1.01,2.04), p=0.04), or in the trial cohort (HR 1.51(0.92,2.49), p=0.10). CONCLUSIONS: Hemodynamically defined RVD is common in AMI-CS. Routine assessment with PA catherization allows detection of RVD; however, further work is needed to identify interventions that will result in improved outcomes for these patients.

Almost three-quarters (74%) of all the noncommunicable disease burden is found within low- and middle-income countries. In September 2014, the National Heart, Lung, and Blood Institute held a Global Health Think Tank meeting to obtain expert advice and recommendations for addressing compelling scientific questions for late stage (T4) research-research that studies implementation strategies for proven effective interventions-to inform and guide the National Heart, Lung, and Blood Institute's global health research and training efforts. Major themes emerged in two broad categories: 1) developing research capacity; and 2) efficiently defining compelling scientific questions within the local context. Compelling scientific questions included how to deliver inexpensive, scalable, and sustainable interventions using alternative health delivery models that leverage existing human capital, technologies and therapeutics, and entrepreneurial strategies. These broad themes provide perspectives that inform an overarching strategy needed to reduce the heart, lung, blood, and sleep disorders disease burden and global health disparities.