Heart Failure Research

• Risk factors for heart failure with preserved ejection faction (HFpEF): The Cardiovascular Health Study (CHS) was one of the first studies to describe heart failure with HFpEF — a type of heart failure that affects primarily older adults. People with HFpEF feel tired even after resting and often experience swelling of their feet and lower legs. The NHLBI-supported study also showed that the condition is more common in people who have obesity and found that chronic inflammation increases the risk of heart failure.
• Cellular therapies for heart failure: The CONCERT-HF trial looked at whether taking cells from a person’s bone marrow and heart, multiplying them in a lab, and injecting them into the heart could successfully treat heart failure. The results showed the treatments were safe and resulted in lower rates of death and hospitalizations. The study also showed that patients treated with the cells showed improved quality of life as measured by the presence of physical symptoms, like chest pain and lower leg swelling, and emotional symptoms, such as depression and trouble sleeping.
• Improved diagnosis and treatment: The Heart Failure Network (HFN) provided infrastructure to develop and conduct 14 trials about diagnosis, management, and evaluation of novel drugs, strategies, and devices to improve heart failure outcomes. HFN studies addressed a number of management issues that provided evidence to inform clinical guidelines. Novel drugs, devices, and diagnostic strategies to treat reduced and preserved ejection fraction heart failure were evaluated. As part of the program, nearly 50 cardiology fellows received hands-on clinical trial experience as well as opportunities to participate and lead ancillary and database studies and to publish their analyses and manuscripts.
• Benefits of aerobic exercise: The HF-ACTION trial (2002-2008) showed that supervised aerobic exercise followed by home training reduced cardiovascular events and improved quality of life in patients with heart failure and reduced ejection fraction. These findings informed the decision by the Centers for Medicare & Medicaid Services (CMS) to include these patients in cardiac rehabilitation programs,
• Effective and affordable medicines: The TOPCAT trial (2007-2013) demonstrated that the mineralocorticoid antagonist spironolactone reduced heart failure hospitalizations in older adults who have HFpEF. This inexpensive generic drug represents an attractive therapeutic option for these patients.

Our Division of Cardiovascular Sciences and its Heart Failure and Arrhythmias Branch, within the Adult and Pediatric Cardiac Research Program, oversees much of the research we fund on heart failure. We focus on understanding both normal heart function, as well as what happens when the heart begins to fail. Our aim is to improve the diagnosis, treatment, and prevention of heart failure.

NHLBI in the Press

NHLBI and FNIH investigate HFpEF to improve the odds of hitting the right disease targets earlier and faster: The FNIH Announces New Research Initiative to Identify More Precise Treatment Strategies for Patients Suffering from Heart Failure.

Current research on heart failure treatments

NHLBI-supported research has contributed to heart failure treatments that have helped people around the world. However, not everyone responds to the existing treatments, which include medicines, implanted devices, and surgery.

Research is ongoing to discover alternative treatments.

• Finding new proteins or genes to treat heart failure: The AMP HF Study is investigating precision treatments for heart failure with preserved ejection fraction (HFpEF). The study uses cutting edge technologies, including digital measurements and artificial intelligence analytic methods, to treat HfpEF, a condition that is increasing as the world’s population continues to live longer.
• Heart pumps for the smallest patients: The Pumps for Kids, Infants, and Neonates (PumpKIN) clinical trial is testing a mechanical heart pump that has been designed specifically for young children and infants. Babies waiting for heart transplants are among those who need these pumps.
• How man-made cells might repair damaged heart muscle: Researchers are creating patches that contain man-made heart cells to repair damaged heart muscle. Currently, stem cells need to be carefully preserved and characterized before use. A patch with man-made cells could potentially have more widespread clinical uses.
• Risks and treatments for cardiac ischemia that leads to HFpEF: The Women’s Ischemia Syndrome Evaluation (WISE) — Mechanisms of Coronary Microvascular Dysfunction (CMD) Leading to Pre-Heart Failure with Preserved Ejection Fraction study examines people with suspected cardiac ischemia but no obstructive coronary disease to better understand the associated risks for heart damage and early mortality as well as potential targets for treatment and prevention of HFpEF.
• Cost-effective ways to study new medicines: The SPIRRIT trial is a large, relatively simple trial conducted in Sweden and the U.S. examining the effect of spironolactone on heart failure hospitalizations and cardiovascular death for patients with HFpEF. The relatively low-cost study involving minimal laboratory testing represents an attractive new model for future clinical trials.
• Comparison of diuretics to treat heart failure: The ToRsemide compArisoN with furoSemide FOR Management of HF (TRANSFORM-HF) trial compares two loop diuretics (torsemide or furosemide) commonly used to treat heart failure congestion to see which is better at stopping or slowing heart failure progression.

Current research on heart failure disparities

The NHLBI supports several projects that explore existing health disparities in the diagnosis and treatment of heart failure. One study is looking at whether some populations are underrepresented in heart failure clinical trials.

Other studies are exploring more ways to address and eliminate disparities.

• Heart health disparities in minority communities: The UCLA-UCI Center for Eliminating Cardio-Metabolic Disparities in Multi-Ethnic Populations (UC END- DISPARITIES) is working to address health disparities in a region that includes 13 million people. The center’s efforts include training disparity researchers, conducting research with community partners, and implementing interventions that improve the health of minority communities.
• Race, ethnicity, and sex differences in heart failure: The Racial/Ethnic Disparities in Heart Failure: A Cross-Cohort Collaboration study is researching the magnitude and potential causes of racial and ethnic disparities as well as sex differences in heart failure. The study will look at strategies to reduce the risk of heart failure.

Find more NHLBI-funded studies on heart failure disparities at NIH RePORTER.

NHLBI news

Learn about a study that found earlier screening may lead to faster treatment and improved outcomes: Rare gene mutation in some Black Americans may allow earlier screening of heart failure.

Current research on causes and prevention of heart failure

The NHLBI supports research into how changes in the heart muscle, reactive oxygen species, and conditions such as atrial fibrillation can cause heart failure.

The projects we fund are also looking at how physical activity and certain nutrients can help prevent heart failure.

• Long-term cardiovascular health: Since 1985, the NHLBI has funded the Coronary Artery Risk Development in Young Adults (CARDIA) study. This one-of-a- kind study began with over 5,000 people who were between the ages of 18 to 30. To complement that study, we now fund the Young Adult and Midlife Transitions in Physical Activity and Sedentary Behavior with Heart Failure Risk and Progression (CARDIA-HF) study. The additional study allows researchers to explore how mid-life changes in exercise behavior help predict the risk of a future heart failure diagnosis.
• Effective exercise for people with heart failure: The Mechanisms of Exercise Intolerance in Heart Failure With Preserved Ejection Fraction: Precision Therapy Based on Patient Specific Pathophysiology study will assign participants to one of two exercise routines for 4 months. Researchers are hoping to find which interventions best improve their ability to exercise.
• Personalized heart failure treatments: The NHLBI funds the HeartShare program to identify sub-types of heart failure so that, in the future, treatments can be personalized. Participants in HeartShare will undergo comprehensive testing to determine what subtypes of heart failure exist, allowing researchers to explore how to treat each subtype with more precision.

Find more NHLBI-funded studies on causes and prevention of heart failure at NIH RePORTER.

Current research on conditions related to heart failure

Some of our current research focuses on heart failure and its link to diabetes and HIV.

• Improved diagnostic tools: The NHLBI supports research to develop a non-invasive device for the diagnosis of heart failure in people with diabetes. The low- cost, portable device can be used in a variety of settings, from doctor’s offices to health fairs.
• Impacts of hormones on heart failure: The Avoiding (Heart) Failure: Physiologic- Based Targeting of the RAAS to Treat Subclinical HFpEF among PWH study will look at blocking a hormone called aldosterone and increase another called brain natriuretic peptide. Studies have shown that these hormones occur at abnormal levels in people with HIV. Researchers want to know if normalizing these hormone levels in this population can reduce the incidence of or slow down the progression of heart failure.

Find more NHLBI-funded studies on conditions related to heart failure at NIH RePORTER.

Many laboratories within our Division of Intramural Research (DIR) focus on the cause of heart failure.

• The Laboratory of Cardiac Physiology investigates heart muscle damage, which can cause heart failure.
• The Laboratory of Cardiovascular and Cancer Genetics studies chemotherapy-induced heart failure.
• The Laboratory of Cardiovascular Biology studies the causes of heart failure at the level of cells.
• The Laboratory of Cardiovascular Intervention develops new treatments, including devices, for heart diseases such as heart failure.

• In 2020, the NHLBI funded five winners of the Big Data Analysis Challenge: Creating New Paradigms for Heart Failure Research. Participants in the challenge were invited to submit solutions for new research tools to help heart failure researchers. See the winning solutions.

Research Feature

Read about how we support research using cutting-edge technology to better understand heart failure: Wave of the future: NHLBI contest explores machine learning to target heart failure.

• In 2017, an NHLBI Workshop identified research focus areas to advance heart failure with preserved ejection fraction (HFpEF) over the next 5 to 10 years.
• NHLBI’s Atherosclerosis Risk in Communities (ARIC) Study has led to many discoveries that have helped us better understand the causes of cardiovascular disease. Researchers use data from this study to explore biomarkers for heart failure, heart failure risk factors, and sex differences in heart failure incidence rates.
• The NHLBI created The Heart Truth® to raise awareness about heart disease as the leading cause of death in women. The Heart Truth® is focused on making sure that women know about their risk for heart disease and know that healthy lifestyle changes can lower this risk.
• The Cardiothoracic Surgical Trials Network (CTSN) is an international network that studies heart valve disease, arrhythmias, heart failure, coronary heart disease, and the complications of surgery.
• The NHLBI partners with the National Cancer Institute (NCI) through a Notice of Special Interest (NOSI) called Improving Outcomes in Cancer Treatment-Related Cardiotoxicity. This work has encouraged collaborative and innovative approaches to mitigate cardiovascular dysfunction while optimizing cancer outcomes by understanding the mechanisms of cancer treatment-related cardiotoxicity and translating the findings to improve risk stratification, early detection, prevention, and management.
• Through NHLBI’s Trans-Omics for Precision Medicine (TOPMed) program, researchers can use data from studies focused on heart disorders, including heart failure, to predict, prevent, diagnose, and treat numerous medical conditions based on a patient’s unique genes, environment, and molecular signatures. TOPMed specifically supports NHLBI’s Precision Medicine Activities.
• The Biologic Specimen and Data Repository Information Coordinating Center (BioLINCC) centralizes and integrates biospecimens and clinical data that were once stored in separate repositories. Researchers can find and request available resources on BioLINCC’s secure website, which maximizes the value of these resources and advances heart, lung, blood, and sleep research.