National Heart, 

Lung, and 

Blood Institute

CONGRESSIONAL JUSTIFICATION 

FY 2023

Department of Health and Human Services

National Institutes of Health
[THIS PAGE INTENTIONALLY LEFT BLANK]
NHLBI-1 

DEPARTMENT OF HEALTH AND HUMAN SERVICES

NATIONAL INSTITUTES OF HEALTH

National Heart, Lung, and Blood Institute (NHLBI) 

FY 2023 Budget Table of Contents 

Director’s Overview ................................................................................................................... 3

Fact Sheet ................................................................................................................................... 7

Major Changes in the Fiscal Year 2023 President’s Budget Request ........................................ 9

Budget Mechanism Table ......................................................................................................... 10

Appropriations Language ......................................................................................................... 11

Summary of Changes ................................................................................................................ 12

Budget Graphs .......................................................................................................................... 13

Organizational Chart ................................................................................................................. 14

Budget Authority by Activity Table ......................................................................................... 15

Justification of Budget Request ................................................................................................ 16

Appropriations History ............................................................................................................. 25

Authorizing Legislation ............................................................................................................ 26

Amounts Available for Obligation ........................................................................................... 27

Budget Authority by Object Class ............................................................................................ 28

Salaries and Expenses ............................................................................................................... 29

Detail of Full-Time Equivalent Employment (FTE) ................................................................ 30

Detail of Positions ..................................................................................................................... 31

Cover page: Bone marrow in a mouse model of sickle cell disease, showing widespread pathologic angiogenesis 

(arteries in green, sinusoids in red). Photo credit: Shin-Young Park, Boston Children’s Hospital and Harvard 

Medical School, Boston, MA
NHLBI-2

[THIS PAGE INTENTIONALLY LEFT BLANK]
NHLBI-3

Director’s Overview

The National Heart, Lung, and Blood Institute (NHLBI) supports 

research to reduce the burden of disorders that affect the vital 

interconnected biology of the heart, the lungs, blood, and sleep. 

Indeed, three of the Nation’s leading causes of death (heart disease, 

chronic lung disease, and stroke), as well as COVID-19, fall within 

NHLBI’s portfolio, making the Institute’s research critical for 

reducing death and disability and improving quality of life for our 

citizens. To that end, the NHLBI takes a life-course approach to 

understand and enhance heart, lung, and blood health, as well as the 

restorative power of sleep, at every stage of life, from before birth 

through adulthood. In FY 2023, the NHLBI will continue to support 

a robust spectrum of basic to applied research to develop effective 

approaches for early diagnosis, treatment, and prevention of heart, 

lung, blood, and sleep disorders for all ages and populations of our 

diverse Nation. 

Investing in Discovery Science to Improve Public Health 

NHLBI recognizes that the path to medical breakthroughs often begins with research focused on 

understanding fundamental principles of biology. For example, based on an approach first 

developed and tested 20 years ago to map simple cellular pathways involved in yeast 

metabolism,1,2 researchers are now able to examine gene expression patterns in the human body, 

over time and in different organs. Recently, an NHLBI-funded team used this approach to 

identify genetic pathways involved in heart failure with preserved ejection fraction (HFpEF), a 

complex disease with few treatments.3 Such findings have set the stage for NHLBI’s new 

HeartShare program, which is analyzing clinical, laboratory, and imaging data from patients 

with HFpEF to define its mechanisms. In addition, NHLBI’s Trans-Omics for Precision 

Medicine (TOPMed) program is analyzing genomic and other data for clues to a variety of 

heart, lung, blood, and sleep disorders—and has assembled one of the world’s largest, most 

diverse genomic databanks. (For more information, see Program Portrait on page 17

The path from a therapeutic target to a safe, effective therapy requires distinct resources and 

expertise. The NHLBI anticipates that the Accelerating Medicines Partnership® (AMP®), 

which brings together the National Institutes of Health (NIH), the U.S. Food and Drug 

Administration (FDA), and industry to rapidly develop new therapeutics, will include a project 

focused on heart failure. Working together, these partners will systematically analyze data from 

HeartShare, TOPMed, and other programs to identify potential drug targets, and advance these to 

drug development and testing. The NHLBI Catalyze program is also helping turn laboratory 

discoveries into novel interventions for heart, lung, blood, and sleep disorders. In addition to 

research funding, Catalyze provides academic investigators with technical assistance, training, 

and mentorship to prepare new drugs, diagnostics, and devices for testing in clinical trials. For 

example, one project is developing a robotic sensor to more precisely locate and silence the 

1 pubmed.ncbi.nlm.nih.gov/15499008/

2 pubmed.ncbi.nlm.nih.gov/11340206/

3 pubmed.ncbi.nlm.nih.gov/33118835/

Dr. Gary H. Gibbons, Director
NHLBI-4

abnormal cardiac tissue that causes arrhythmias. (For more information, see Program Portrait on 

page 20.)

Reducing Chronic Disease Burden and Achieving Health Equity

Although NIH has fueled progress in reducing deaths from many chronic diseases over the past 

50 years, that progress appears to be slowing, particularly for underserved and vulnerable 

populations. The NHLBI is amplifying its efforts to better understand and address social 

determinants of health (SDOH)—living conditions that influence our susceptibility and resilience 

to disease. Research shows that heart, lung, blood, and sleep disorders are sensitive to a variety 

of SDOH, from individual and household-level factors such as income and healthcare access, to 

more complex factors such as institutional racism and climate change—which is increasing air 

pollution, extreme weather, and wildfires in some communities.

With FY 2020 funding, the NHLBI expanded its support for initiatives to reduce health 

disparities by addressing SDOH. For example, an NHLBI-funded study launched in 2019 aims 

to identify the risk factors that contribute to high rates of chronic heart and lung diseases in rural 

America. The RURAL study is deploying a mobile examination unit equipped with the latest 

diagnostic technologies to examine participants living in rural Alabama, Kentucky, Louisiana, 

and Mississippi. The NHLBI also plans to expand efforts to understand and address the health 

needs of a growing segment of our society, Asian Americans, Native Hawaiians, and Pacific 

Islanders (AANHPI), including a new cohort study to examine how biological and social factors 

impact the health of AANHPI subgroups.

Another new program, Disparities Elimination through Coordinated Interventions to 

Prevent and Control Heart and Lung Disease Risk (DECIPHeR), is translating knowledge 

about SDOH into strategies to achieve health equity. DECIPHeR supports projects that are 

testing new ways to bring evidence-based interventions into broader practice in communities 

with a high burden of heart and lung disease. The program funded its first six community-based 

projects in 2021. For example, in Louisiana, the program is investigating whether bringing heart 

health education sessions into Black churches can help community members reduce their risk of 

heart disease. In Colorado, researchers are testing whether they can improve asthma outcomes 

for children from low-income families by integrating school nurses and asthma navigators into 

the children’s primary care, and by connecting the families to resources that address SDOH. 

Improving Maternal Health through Evidence-Based Care across the Lifespan

The need for a life-course approach to health is evident in our Nation’s high rates of maternal 

morbidity and mortality, especially in communities of color. Cardiovascular disease (CVD) is a 

leading cause of adverse pregnancy outcomes including deaths, which have increased nationally 

over the past decade. Over the same time period, pre-pregnancy hypertension among women 

aged 15-44 nearly doubled, with the highest rates among Black women and women from rural 

areas.

4

 NHLBI’s Chronic Hypertension and Pregnancy (CHAP) trial is examining the 

benefits of medication to treat mild hypertension in pregnancy, which is typically deferred for 

severe hypertension.

4 pubmed.ncbi.nlm.nih.gov/33183896/
NHLBI-5

The Institute also has committed funding through 2027 for the nuMOM2b Heart Health Study, 

which is examining how pregnancy impacts a woman’s future cardiovascular health. The study 

recently showed that early measures of metabolic health (such as blood sugar and fatty acid 

levels) predict a woman’s risk of hypertension years after childbirth.5

 NHLBI-funded research 

also suggests that improving a woman’s CV health during pregnancy can improve the child’s

future CV health, too, with a robust association seen even in the preteen years.6

 Such research 

reaffirms the value of preserving and promoting maternal health.

The NHLBI has established new programs that address heart, lung, blood, and sleep health 

during critical windows of a woman’s life using implementation science—the study of how to 

bring proven interventions into wider practice. NHLBI’s Maternal Health Community 

Implementation Program is testing community-based strategies in four U.S. regions where 

maternal death rates are high. Another effort, the Early Intervention to Promote 

Cardiovascular Health of Mothers and Children (ENRICH) program, will tap into existing 

federal home visiting programs that serve at-risk families to determine if adding a CV 

intervention will enhance maternal and early childhood outcomes for approximately 3,000 

mother-child pairs.

Building on Prior Research, Tools, and Talent to Combat COVID-19

Because COVID-19 can have severe effects on heart, lung, blood and sleep (HLBS) systems, and 

poses a higher risk for people who have pre-existing HLBS conditions, the NHLBI has played a 

significant role in the Nation’s COVID-19 research response. To support research on COVID’s 

short-and long-term effects on the body—including therapies to prevent the most severe effects 

and save lives—the NHLBI successfully leveraged a variety of prior investments, including 

clinical trial networks and community-based studies. NHLBI’s trial networks were critical for 

rapidly standing up the NIH Accelerating COVID-19 Therapeutic Interventions and 

Vaccines (ACTIV) program, which supports adaptive trials that can rapidly change direction or 

stop based on emerging data. NHLBI-funded trials have focused on potential treatments for 

moderate-to-severe COVID-19 and its effects on the respiratory and cardiovascular systems, 

including life-threatening blood clots. The ACTIV-4 anticoagulant trials found that a 2-week 

regimen of the blood thinner heparin reduced the need for organ support, such as mechanical 

ventilation, for moderately ill hospitalized patients, but not for critically ill patients in intensive 

care. Importantly, ACTIV and other NHLBI-supported trial networks also have demonstrated 

that some proposed treatments for COVID-19 do not work; for example, a trial launched in April 

2020 found that hydroxychloroquine did not help hospitalized COVID-19 patients, a result 

confirmed by other trials internationally;7 another NHLBI-funded study found that convalescent 

plasma was not helpful for non-hospitalized patients.8

To address high rates of COVID-19 hospitalization and death in underserved and racial-ethnic 

minority communities, the NIH Director asked the NHLBI to partner with the National Institute 

5 pubmed.ncbi.nlm.nih.gov/33619977/ 6 pubmed.ncbi.nlm.nih.gov/33591345/

7 covid19treatmentguidelines.nih.gov/therapies/antiviral-therapy/chloroquine-or-hydroxychloroquine-and-orazithromycin/ 8 https://pubmed.ncbi.nlm.nih.gov/34407339/
NHLBI-6

on Minority Health and Health Disparities (NIMHD) to mobilize and expand existing 

community-based research partnerships though the NIH Community Engagement Alliance 

(CEAL) Against COVID-19 Disparities initiative. CEAL research teams, now active in more 

than 21 states, have worked with local leaders and health officials to ensure research inclusion 

and address vaccine hesitancy in Black, Latino, Native American, Asian American, and Pacific 

Islander communities—which have been historically excluded from, and wary of, medical 

research. Importantly, the NHLBI anticipates that beyond the pandemic, CEAL will provide a 

robust platform for research to reduce other pervasive health disparities and achieve health 

equity.

Thanks to a $1.15 billion Congressional appropriation to NIH in December 2020 and NHLBI’s 

lead role in understanding how COVID-19 damages the body’s organs and tissues, the NHLBI 

was asked to lead an initiative to understand—and ultimately treat and prevent—its potential 

long-term effects, often called Long COVID. At the heart of this initiative, called Researching 

COVID to Enhance Recovery (RECOVER), is a cohort expected to enroll tens of thousands of 

diverse individuals, including adults and children, from established NIH cohort studies and Long 

COVID clinics. (See the “Cross-Cutting Initiatives” section of the NIH FY 2023 Congressional 

Justification for more information.)

Training and Sustaining the Next Generation of Diverse Biomedical Researchers

As part of its commitment to improve health for all Americans, the NHLBI works to ensure that 

the pool of biomedical researchers reflects the Nation’s talent and diversity. The Institute has an 

array of programs—including individual fellowships and institutional training programs—

designed to support the mentorship and development of emerging investigators from 

underrepresented backgrounds. The NHLBI also invests about $15 million annually in diversity 

supplement grants, which provide additional support for funded investigators to train and mentor 

underrepresented individuals at nearly any scientific career stage, from high school student to 

faculty. Recently, the NHLBI began offering diversity supplements to small business innovation 

research (SBIR) grantees who diversify their research teams.

To establish a pathway for diverse students to gain hands-on research experience, the NHLBI has 

leveraged research programs focused on diverse communities. For example, the Strong Heart 

Study (SHS)—a partnership with American Indian tribes in Arizona, Oklahoma, and the 

Dakotas—provides pathways for Native students to excel in biomedical research; indeed, an 

SHS co-principal investigator first joined the team as a student in an institutional training 

program. In Arizona, the NHLBI also supports the new Data Warriors Fellowship, a 

partnership between academic investigators and Intertribal Council of Arizona to train Native 

students in data science, indigenous data governance, and health disparities research.

Throughout the pandemic, NHLBI’s support for heart, blood, lung, and sleep research has 

remained robust. Indeed, the Institute’s investments during the pandemic—for example, the 

assembly of large networks to coordinate adaptive clinical trials and community-based 

research—are likely to pay dividends for many years into the future, as the Institute works to 

reduce the burden of heart, lung, blood, and sleep disorders for all Americans. 
NHLBI-7

Fact Sheet

February 2022

ABOUT THE NHLBI • The NHLBI is the nation’s leader in supporting research and training on

the prevention and treatment of heart, lung, blood, and sleep disorders.

• We were established in 1948 to address rising rates of cardiovascular

disease — which includes heart disease and stroke and has been the

nation’s leading cause of death for 100 years.

• Our mission has expanded to lead NIH research efforts in lung

diseases,including asthma and chronic obstructive pulmonary disease

(COPD).

• We lead research on blood transfusion and blood diseases, such as

sickle cell disease.

• In 1993, we became the home for the National Center on Sleep

Disorders Research (NCSDR), which coordinates NIH programs 

related to sleep biology and disorders.

• NHLBI’s research advances scientific knowledge, improves public

health, and saves lives.

Current Major Initiatives

• The NHLBI Trans-Omics for 

Precision Medicine (TOPMed)

program aims to harness data

science to develop personalized

therapies for people with heart, lung,

blood, and sleep disorders. TOPMed

has assembled one of the world’s

largest, most diverse collections of

genomic, clinical, and environmental

data, derived from participants in

NIH-funded studies. The NHLBI

BioData Catalyst, a secure cloudbased research ecosystem, hosts 

TOPMed and other large datasets

and offers data analysis tools to

support researchers.

• The NHLBI supports research 

to reduce maternal morbidity 

and mortality, especially among 

African American and American 

Indian/ Alaska Native women,

who are at higher risk than 

white women. NHLBI’s approach 

takes into account women’s 

health across their lifespan —

before, during, and after their

reproductive years.

• Because COVID-19 affects heart, 

lung, and blood health, the NHLBI 

is leading clinical trials to identify

life-saving treatments for people

who get sick, as well as community

engagement efforts to ensure that

the hardest-hit communities are

included in research and benefit

from its findings.

• The NHLBI Catalyze Program

helps researchers turn basic 

scientific discoveries into therapeutics,

devices, and diagnostics ready for

human testing.

Gary H. Gibbons, M.D., is director of 

the National Heart, Lung, and Blood 

Institute (NHLBI). He received his M.D. 

from Harvard Medical School and has 

served on the faculty at Harvard, Stanford 

University, and Morehouse School of 

Medicine in Atlanta. He received a 2021 

Service to America Award.

Facts and Figures

Full-Time Staff** 863

RPG Awards** 916

Principal Investigators** 1,259

ESI Success Rates*** 32.4%

K Award Success

Rates***

37.7%

**Full-time staff, awards, and extramural principal investigators are FY 2021 data. *** These success rates were averaged over 3 years (FY 2019-2021) and calculated

as (# awards/# of percentiled applications x 100). For more about percentiles, see https://grants.nih.gov/grants/peer-review.htm#Summary.

$3,383 $3,488 $3,727 * $3,654 $3,664 

0

1000

2000

3000

4000

FY18 FY19 FY20 FY21 FY22 CR

Dollars in Millions

Fiscal Year

FUNDING HISTORY

*In FY20, NHLBI received $103 million in supplemental appropriations through the 

CARES Act (not shown). The FY23 President’s budget request is $3,823 million.
NHLBI-8

Photos from the Jackson Heart, RURAL, and Strong Heart Studies. Accomplishments in...

Heart Health

• For more than 70 years, the Framingham Heart Study 

(FHS) has uncovered risk factors and preventionstrategies 

for heart disease, and it is now examining links between

heart and brain health.

• The SPRINT trial found that intensive blood pressure

treatment can reduce the risk of death from cardiovascular

disease among people over age 50. These findings helped

change the 2017 national hypertension guidelines.

• Out-of-hospital cardiac arrest is often deadly. The

ARREST trial showed that patients who received an

advanced type of mechanical life support, extra corporeal

membrane oxygenation (ECMO), early had improved

survival rates (43%) compared with standard care (7%).

• The Bench to Bassinet Program supports research that

has helped many children with congenital heart disease

(CHD) thrive. It has amassed genomic data on 10,000+

patients and is being leveraged to conduct a 5-year study

on multisystem inflammatory syndrome in children 

(MIS-C), a rare condition affecting some children with

COVID-19, as part of the NIH CARING for Children with

COVID effort.

Lung and Sleep Health

• Based on findings that unique types of asthma require

unique therapies, the Precision Interventions for 

Severe and/or Exacerbation-Prone Asthma (PrecISE) 

Network is developing precision medicine approaches

for severe asthma.

• In collaboration with federal and nonfederal partners, the

NHLBI developed the COPD National Action Plan,which is

guiding efforts to reduce the burden of COPD, especially in

rural and underserved communities.

• Climate change and related environmental factors,

such as pollution and wildfires, pose substantial threats 

to human health — for example, by increasing the risk 

and severity of asthma. The NHLBI is working with others 

at NIH to support research on the health impacts of 

climate change.

• A newly released NIH Sleep Research Plan serves

As a blueprint for sleep and circadian scientific

priorities andcollaborative research across federal 

agencies and external partners.

Blood Health

• The Cure Sickle Cell Initiative is working to bring 

new gene-based therapies into clinical trials, and a

collaborationwith the Bill & Melinda Gates 

Foundation will help bring these cures to lowresource settings.

• The Recipient Epidemiology and Donor Evaluation 

Study (REDS), first launched 30+ years ago to help

keep the blood supply safe from HIV, is now

expanding the reachof antibody tests for COVID-19.

• For people with hemophilia, a rare genetic disorder that 

can cause severe bleeding, NHLBI-funded research 

helped develop factor replacement therapy — the 

infusion of clotting proteins into the blood.

Health Disparities

• Modeled after FHS, the Jackson Heart Study (JHS)

and Strong Heart Study are shedding light on heart

disease riskin African Americans and American

Indians, respectively. JHS has a new director as of

September 2021.

• The newly established Risk Underlying Rural Areas 

Longitudinal (RURAL) Cohort Study seeks to

understand the high rate of chronic heart and lung 

diseases in rural communities in the Southeastern U.S.

• The Disparities Elimination through Coordinated 

Interventions to Prevent and Control Heart and Lung 

Disease Risk (DECIPHeR) program is studying how to

move evidence-based interventions into communities

where the burden of chronic disease is high.

NHLBI’S COVID-19 RESPONSE

Because COVID-19 impacts heart, lung, and blood health,

the NHLBI has taken an all-hands-on-deck approach

to address the pandemic. The NHLBI established the

Collaborating Network of Networks for Evaluating COVID19 and Therapeutic Strategies (CONNECTS) to test

therapies that may slow or stop COVID-19 progression.

CONNECTS has played a major role in identifying both

effective and ineffective treatments through the NIH

Accelerating COVID-19 Therapeutic Interventions

and Vaccines (ACTIV) trials. ACTIV-3 trials showed that

monoclonal antibodies did not help hospitalized patients.

ACTIV-4 trials found that blood thinners helped moderately

ill patients but not those who were critically ill. The Institute

also co-leads the following:

• The NIH Community Engagement Alliance (CEAL) 

Against COVID-19 Disparities network connects

researchers with trusted community leaders across 

the country to reach people hardest hit by the

pandemic,ensure research inclusion, and improve 

vaccine uptake and access.

• The NIH Researching COVID to Enhance 

Recovery (RECOVER) Initiative will follow 

tens of thousands of adults and children to

help us understand Long COVID and other 

persistent complications that can follow

SARS-CoV-2 infection.
NHLBI-9

Major Changes in the Fiscal Year 2023 President’s Budget Request

Major changes by budget mechanism and/or budget activity detail are briefly described below.

Note that there may be overlap between budget mechanisms and activity detail; and these 

highlights may not sum to the total change for the FY 2023 budget request for the NHLBI, which 

is $3,823.0 million, an increase of $158.2 million from the FY 2022 Continuing Resolution (CR) 

annualized level. In FY 2023, the overall increase of 4.3 percent is distributed across multiple 

programmatic areas including basic, translational, and clinical research. NHLBI is committed to 

the continuous support for key strategic priorities along with other scientific areas of the 

Institute’s research portfolio. Within the framework of the administration’s fiscal policy goals for 

the Federal Government, NHLBI will pursue its highest research priorities through strategic 

investments and careful stewardship of the appropriated funds.

Research Project Grants (RPGs) ($125.6 million; total $2,674.9 million):

NHLBI will increase funding for RPGs by 4.9 percent in FY 2023, which will fund 1,017 

competing RPGs and 2,881 noncompeting RPG awards, and 182 awards to small businesses to 

stimulate research technology in key strategic areas. 

Other Research ($6.2 million; total $222.4 million):

NHLBI will increase funding for Other Research by 2.9 percent, which is a $6.2 million 

compared to the FY 2022 CR level. The increase will support major initiatives and are 

distributed across all programmatic areas and basic, translational or clinical research.

Research and Development (R&D) Contracts ($5.7 million; total $377.5 million):

NHLBI will increase funding for Research and Development Contracts by 1.5 percent, which is a 

$5.7 million increase compared to the FY 2022 CR Level of $371.8 million. These increases are 

distributed across all programmatic areas and basic, translational or clinical research to continue 

stimulating research and development focused on strategic priorities and programmatic goals.

Intramural Research (IR) ($12.6 million; total $253.8 million):

NHLBI will increase funding for Intramural Research by 5.2 percent, which is a $12.6 million 

increase compared to the FY 2022 CR Level of $241.2 million. These increases are distributed 

across scientific and clinical research that leads to better understanding of biology and clinical 

pathology. 

Research Management and Support (RMS) ($6.5 million; total $156.2 million):

NHLBI will increase funding for Intramural Research by 4.3 percent, which is a $6.5 million 

increase compared to the FY 2022 CR level of $149.7 million. These increases are distributed 

across all programmatic areas of RMS.
NHLBI-10

Budget Mechanism Table

NATIONAL INSTITUTES OF HEALTH

National Heart, Lung, and Blood Institute

Budget Mechanism *

(Dollars in Thousands)

Mechanism FY 2021 Final FY 2022 CR FY 2023 President's

Budget

FY 2023 +/- FY 2022

Number Amount Number Amount Number Amount Number Amount

Research Projects:

Noncompeting 2,860 $1,847,817 2,863 $1,846,193 2,881 $1,921,535 18 $75,342

Administrative Supplements (136) $14,142 (79) $8,022 (0) $8,780 -79 $758

Competing:

Renewal 136 $99,366 140 $102,220 152 $111,641 12 $9,422

New 780 $466,160 801 $478,859 865 $516,512 64 $37,653

Supplements 0 $0 0 $0 0 $0 0 $0

Subtotal, Competing 916 $565,526 941 $581,079 1,017 $628,153 76 $47,074

Subtotal, RPGs 3,776 $2,427,485 3,804 $2,435,293 3,898 $2,558,468 94 $123,174

SBIR/STTR 183 $116,087 179 $114,071 182 $116,449 3 $2,378

Research Project Grants 3,959 $2,543,571 3,983 $2,549,365 4,080 $2,674,917 97 $125,552

Research Centers

Specialized/Comprehensive 6 $16,329 6 $13,796 6 $13,136 0 -$661

Clinical Research 0 $0 0 $0 0 $0 0 $0

Biotechnology 1 $642 0 $0 0 $0 0 $0

Comparative Medicine 0 $455 0 $455 0 $445 0 -$10

Research Centers in Minority Institutions 0 $0 0 $0 0 $0 0 $0

Research Centers 7 $17,426 6 $14,251 6 $13,581 0 -$671

Other Research:

Research Careers 796 $137,856 784 $135,308 793 $137,759 9 $2,452

Cancer Education 0 $0 0 $0 0 $0 0 $0

Cooperative Clinical Research 39 $10,718 39 $10,268 35 $9,283 -4 -$984

Biomedical Research Support 0 $0 0 $0 0 $0 0 $0

Minority Biomedical Research Support 0 $573 0 $554 0 $650 0 $96

Other 142 $78,458 126 $70,080 129 $74,680 3 $4,600

Other Research 977 $227,605 949 $216,209 957 $222,373 8 $6,164

Total Research Grants 4,943 $2,788,602 4,938 $2,779,826 5,043 $2,910,870 105 $131,045

Ruth L Kirschstein Training Awards: FTTPs FTTPs FTTPs FTTPs

Individual Awards 522 $25,117 515 $26,547 509 $27,051 -6 $504

Institutional Awards 1,426 $91,647 1,406 $95,687 1,413 $97,505 7 $1,818

Total Research Training 1,948 $116,764 1,921 $122,234 1,922 $124,556 1 $2,322

Research & Develop. Contracts 597 $373,240 581 $371,785 572 $377,505 -9 $5,720

SBIR/STTR (non-add) (4) ($2,679) (6) ($4,234) (5) ($6,000) -(1) ($1,766)

Intramural Research 504 $231,231 556 $241,231 556 $253,782 0 $12,551

Res. Management & Support 359 $143,863 410 $149,736 410 $156,247 0 $6,511

SBIR Admin. (non-add) (0) ($234) (0) ($1,480) (0) ($1,200) (0) -($280)

Construction $0 $0 $0 $0

Buildings and Facilities $0 $0 $0 $0

Total, NHLBI 863 $3,653,700 966 $3,664,811 966 $3,822,961 0 $158,150 * All items in italics and brackets are non-add entries.
NHLBI-11

Appropriations Language

NATIONAL HEART, LUNG, AND BLOOD INSTITUTE

For carrying out section 301 and title IV of the PHS Act with respect to cardiovascular, lung, 

and blood diseases, and blood and blood products, $3,822,961,000.
NHLBI-12

Summary of Changes

NATIONAL INSTITUTES OF HEALTH

National Heart, Lung, and Blood Institute

Summary of Changes

(Dollars in Thousands)

FY 2022 CR $3,664,811

FY 2023 President's Budget $3,822,961

Net change $158,150

FY 2022 CR FY 2023 President's

Budget

Built-In Change from

FY 2022 CR

CHANGES FTEs Budget

Authority FTEs BudgetAuthority FTEs Budget

Authority

A. Built-in:

1. Intramural Research:

a. Annualization of January 2022 pay increase & benefits $98,341 $107,819 $652

b. January FY 2023 pay increase & benefits $98,341 $107,819 $3,330

c. Paid days adjustment $98,341 $107,819 -$374

d. Differences attributable to change in FTE $98,341 $107,819 $0

e. Payment for centrally furnished services $37,564 $38,315 $751

f. Cost of laboratory supplies, materials, other expenses, and

non-recurring costs $105,326 $107,647 $2,322

Subtotal $6,681

2. Research Management and Support:

a. Annualization of January 2022 pay increase & benefits $75,090 $79,981 $497

b. January FY 2023 pay increase & benefits $75,090 $79,981 $2,539

c. Paid days adjustment $75,090 $79,981 -$285

d. Differences attributable to change in FTE $75,090 $79,981 $0

e. Payment for centrally furnished services $2,050 $2,091 $41

f. Cost of laboratory supplies, materials, other expenses, and

non-recurring costs $72,595 $74,175 $1,579

Subtotal $4,372

Subtotal, Built-in $11,053

FY 2022 CR FY 2023 President's

Budget

Program Change from

FY 2022 CR

CHANGES No. Amount No. Amount No. Amount

B. Program:

1. Research Project Grants:

a. Noncompeting 2,863 $1,854,215 2,881 $1,930,315 18 $76,100

b. Competing 941 $581,079 1,017 $628,153 76 $47,074

c. SBIR/STTR 179 $114,071 182 $116,449 3 $2,378

Subtotal, RPGs 3,983 $2,549,365 4,080 $2,674,917 97 $125,552

2. Research Centers 6 $14,251 6 $13,581 0 -$671

3. Other Research 949 $216,209 957 $222,373 8 $6,164

4. Research Training 1,921 $122,234 1,922 $124,556 1 $2,322

5. Research and development contracts 581 $371,785 572 $377,505 -9 $5,720

Subtotal, Extramural $3,273,844 $3,412,932 $139,088

6. Intramural Research 556 $241,231 556 $253,782 0 $5,870

7. Research Management and Support 410 $149,736 410 $156,247 0 $2,139

8. Construction $0 $0 $0

9. Buildings and Facilities $0 $0 $0

Subtotal, Program 966 $3,664,811 966 $3,822,961 0 $147,097

Total built-in and program changes $158,150
NHLBI-13 

Budget Graphs

History of Budget Authority and FTEs: 

Distribution by Mechanism: 

Change by Selected Mechanisms:

3,482.4 3,625.3 3,653.7 3,664.8 3,823.0

Funding Levels by Fiscal Year (Dollars in Millions)

2019 2020 2021 2022 2023

$0

$500

$1,000

$1,500

$2,000

$2,500

$3,000

$3,500

$4,000

$4,500

840 817 863

966 966

FTEs by Fiscal Year

2019 2020 2021 2022 2023

0

200

400

600

800

1000

1200

4.92%

-4.71%

2.85%

1.90%

1.54%

5.20%

4.35%

FY 2023 Estimated Percent Change from FY 2022 Mechanism

Research Project Grants

Research Centers

Other Research

Research Training

R&D Contracts

Intramural Research

RMS

-6.00% -4.00% -2.00% 0.00% 2.00% 4.00% 6.00%
NHLBI

-14

Organizational Chart

Director

Gary H. Gibbons, M.D.

Deputy Director

Vacant

Deputy Director for Clinical Research 

and Strategic Initiatives

Amy P. Patterson, M.D.

NHLBI Board of Scientific 

Counselors

National Heart, Lung, and Blood 

Advisory Council

Director, Office of Science Policy, 

Engagement, Education, and 

Communications 

Lenora E. Johnson, Dr.PH, M.P.H.

Director, Office of Management

Kathleen B. O’Sullivan, M.S., 

M.B.A.

Director, Division of Lung 

Diseases

James P. Kiley, Ph.D.

Director, Division of Blood 

Diseases and Resources

W. Keith Hoots, M.D

Director, Division of

Extramural Research 

Activities

Laura K. Moen, Ph.D.

Director, Division of 

Intramural 

Research

Robert S. Balaban, Ph.D.

Director, Center for 

Translation Research and 

Implementation Science

George A. Mensah, M.D.

Director, Division of 

Cardiovascular Sciences

David C. Goff, M.D., Ph.D.

NATIONAL INSTITUTES OF HEALTH

NATIONAL HEART, LUNG, AND BLOOD INSTITUTE
NHLBI-15

Budget Authority by Activity Table

NATIONAL INSTITUTES OF HEALTH

National Heart, Lung, and Blood Institute

Budget Authority by Activity *

(Dollars in Thousands)

FY 2021 Final FY 2022 CR FY 2023 President's

Budget

FY 2023 +/- FY

2022 CR

Extramural Research FTE Amount FTE Amount FTE Amount FTE Amount

Detail

Center for Translation, Implementation

Sciences $57,036 $56,953 $100,642 $43,689

Heart and Vascular Diseases $1,953,714 $1,950,877 $2,008,731 $57,854

Lung Diseases $774,489 $773,364 $796,299 $22,935

Blood Diseases and Resources $493,367 $492,650 $507,260 $14,610

Subtotal, Extramural $3,278,606 $3,273,844 $3,412,932 $139,088

Intramural Research 504 $231,231 556 $241,231 556 $253,782 0 $12,551

Research Management & Support 359 $143,863 410 $149,736 410 $156,247 0 $6,511

TOTAL 863 $3,653,700 966 $3,664,811 966 $3,822,961 0 $158,150 * Includes FTEs whose payroll obligations are supported by the NIH Common Fund.
NHLBI-16

Justification of Budget Request

National Heart, Lung, and Blood Institute

Authorizing Legislation: Section 301 and Title IV of the Public Health Service Act, as amended.

Budget Authority (BA) :

FY 2021 Final FY 2022 CR

FY 2023 

President's 

Budget

FY 2023 +/-

FY 2022

BA $3,653,700,000 $3,664,811,000 $3,822,961,000 $158,150,000

FTE 863 966 966 0

Program funds are allocated as follows: Competitive Grants/Cooperative Agreements; 

Contracts; Direct Federal/Intramural and Other.

Overall Budget Policy: The FY 2023 President’s Budget request is $3,823.0 million, an increase 

of $158.2 million or 4.3 percent compared with the FY 2022 CR level. Included in this amount 

is an increase of $30.0 million for the CEAL initiative, which will provide continued support to 

connect researchers to trusted leaders and organizations in communities hardest hit by COVID19, helping them work together to ensure that the treatments and vaccines developed will work 

for everyone. In addition, the request includes an increase of $50.0 million for health disparities 

research to support strategic initiatives, in chronic heart disease, pulmonary lung fibrosis, blood 

diseases and disorders, and community engagement to promote strategies to enhance education, 

awareness, access and inclusion of underserved communities in research in FY 2023. Increases 

are distributed across all programmatic, basic, epidemiologic, translation, and clinical research 

areas.

Program Descriptions and Accomplishments

Heart and Vascular Diseases: The cardiovascular disease (CVD) program supports research to 

advance understanding of and interventions for promoting heart and vascular health across the 

lifespan. It supports research aimed at preventing and treating pediatric and adult cardiovascular

diseases, including heart attack and heart failure, stroke, complications of diabetes and obesity, 

high blood pressure, congenital heart disease, and other heart and vascular diseases. 

NHLBI’s CVD program continues to invest heavily in research to prevent and treat heart failure 

(HF), a major cause of mortality, morbidity, and poor quality of life. HF develops when the 

heart cannot pump enough blood to meet the body’s needs. In about half of patients who have 

HF, the heart pumps well, but does not fill sufficiently with blood. There are few effective 

medications for this complex condition, called HF with preserved ejection fraction (HFpEF). 

This need, coupled with new opportunities in data science, led the NHLBI to launch 

HeartShare, an effort to define mechanisms of HFpEF by analyzing clinical, laboratory, and 
NHLBI-17 

imaging data from 1,500 patients. Data from 

this new cohort will be integrated with existing 

NIH patient data and images housed within 

TOPMed and BioData Catalyst (See Program 

Portrait). These large datasets could help 

investigators discover new targets for therapy, 

and the NHLBI anticipates speeding this 

discovery through the Accelerated Medicines 

Partnership (AMP), a collaboration of NIH, 

FDA, and industry. In a related effort to 

address HF, the NHLBI recently completed its 

Big Data Analysis Challenge. This program 

sought new models and artificial intelligence 

(AI) tools to define different subtypes of heart 

failure, and some of the winning solutions are 

being folded into HeartShare’s analyses.9

HeartShare thus brings together innovative data 

science, AI, and precision medicine approaches 

to meet the challenges of treating heart failure. 

The NHLBI is also making progress in helping 

patients who suffer from HF and atrial 

fibrillation (AFib), the most common cardiac 

arrhythmia. NHLBI’s Catheter Ablation 

Versus Antiarrhythmic Drug Therapy for 

AF (CABANA) is the largest clinical trial to 

date comparing ablation (a procedure to 

destroy arrhythmic cardiac tissue) versus drug 

therapy for patients with HF and AFib. The 

study found that ablation improved survival, 

freedom from AFib recurrence, and quality of 

life compared to drug therapy.10

The NHLBI is also working to improve 

survival after out-of-hospital cardiac arrest, 

which has a 90 percent fatality rate. The phase 

2 ARREST trial examined the potential to treat 

such patients with extracorporeal membrane 

oxygenation (ECMO), which uses a machine 

outside the body to oxygenate and pump blood. When provided to patients as soon as they 

arrived at the hospital, ECMO improved survival and neurologic function at six months 

compared to standard-of-care.11 

9 https://www.nhlbi.nih.gov/grants-and-training/funding-opportunities-and-contacts/NHLBI-heart-failure-datachallenge

10 pubmed.ncbi.nlm.nih.gov/33554614/ 11 pubmed.ncbi.nlm.nih.gov/33197396/

TOPMed: Powering Precision Medicine 

for All with Diverse Genomic Data 

The NHLBI developed the Trans-Omics for 

Precision Medicine (TOPMed) program to 

advance precision medicine by exploring 

genomic and other factors underlying complex 

diseases. TOPMed has banked over 180,000 

whole genome sequences from ethnically 

diverse participants from more than 85 longterm cohort studies of heart, lung, blood, and 

sleep-related disorders. TOPMed is integrating 

these genomic data with other molecular data, 

as well as behavioral, environmental, and 

clinical measures that have been collected over 

decades. These types of connections will 

enable researchers to unravel complex risk 

factors for disease and develop more targeted 

and personalized therapies. For example, 

TOPMed data were recently used to identify 

genetic and non-genetic factors affecting how 

airway cells respond to SARS-CoV-2 (the virus 

that causes COVID-19) infection,1 and to 

compare airway responses to SARS-CoV-2 

with other coronaviruses, generating data that 

may help explain the unusual severity of 

COVID-19 relative to other coronavirus 

diseases. Nearly 3.5 petabytes (i.e., 3.5 million 

gigabytes) of data from TOPMed and other 

programs are made available to researchers 

through NHLBI’s BioData Catalyst, a cloudbased platform that provides tools and a secure 

workspace for analyzing large datasets. 

Importantly, the TOPMed dataset represents 

one of the most diverse genomic reference 

panels available, with nearly 60 percent of 

samples coming from individuals of nonEuropean ancestry. This diversity, combined 

with the high-quality and deeply integrated 

clinical and molecular data, make TOPMed a 

valuable resource to advance precision

medicine approaches for heart, lung, blood, and 

sleep disorders. 

1 pubmed.ncbi.nlm.nih.gov/33883027/
NHLBI-18

The Institute is also investing in AI technology to improve CVD screening and treatment. 

Familiar tests, such as cholesterol and blood pressure measurements, help predict a patient’s risk 

of future heart problems, but a newer test called coronary artery calcium (CAC) imaging is even 

more accurate; it uses a specialized CT scan to measure calcium build-up in the heart’s arteries. 

CAC imaging requires specialized skills and equipment, but NHLBI-funded researchers have 

developed an AI system that can measure CAC in routine CT chest scans to predict CVD 

outcomes years later.12 This information can help patients and physicians make treatment 

decisions earlier. AI is also being used to improve early diagnosis of congenital heart disease 

(CHD), the most common birth defect. While ultrasound can detect CHD, this requires an expert 

eye; in clinical practice, prenatal ultrasound fails to identify CHD in 60-70 percent of cases. 

Using about 1,300 prenatal echocardiograms and ultrasounds, researchers were able to train AI 

systems to detect CHD with a sensitivity of 90-95 percent, about the same as expert clinicians.13

NHLBI’s Pediatric Heart Network (PHN) has been at the forefront of pediatric cardiology 

research for two decades. With nine clinical hubs and affiliated sites across the country, the 

PHN continues to support new studies, invest heavily in training, and work with collaborators 

and families to improve outcomes and quality of life for children and adults with CHD. After a 

recent clinical trial that compared and ultimately validated the use of two medications for 

Marfan syndrome—a rare genetic connective tissue disorder that can affect the heart—

researchers conducted a follow-up study to determine what contributed to the trial’s high 

retention and adherence rates. In addition to partnering with a large patient-focused organization 

(Marfan Foundation), strategies at the most successful PHN hubs included asking for family 

feedback on trial procedures and using a smartphone app to remind participants to take their 

medications.14 The PHN recently began an observational study of multisystem inflammatory 

syndrome in children (MIS-C), a rare but potentially serious complication of SARS-CoV-2 

infection in young people. The study has enrolled more than 800 children who will be followed 

for 5 years to gain insights into MIS-C, its risk factors, and potential interventions.15

The NHLBI is also leading efforts to reduce CVD health disparities, and to improve the heart 

health of women. For example, the NHLBI recently launched the RURAL cohort study to 

better understand the high burden of heart and lung disease among the 60 million Americans 

who live in rural areas. In addition, the new ENRICH program is investigating whether 

incorporating heart-healthy lifestyle interventions into federally sponsored home visiting 

programs can reduce CVD and its risk factors in mothers and their children (0-5 years old) living 

with low income, in low-resource rural or urban communities, or in U.S. regions with a high 

burden of CVD. The NHLBI also recognizes the need to advance science and health equity for 

the Nation’s diverse Asian American, Native Hawaiian, and Pacific Islander populations

(AANHPI).16 Thus, the Institute plans to lead a collaborative effort with other NIH Instiutes, 

Centers, and Offices to support a large multi-center cohort study of AANHPI individuals to help 

inform prevention and treatment of high-burden diseases in these populations. The CVD 

12 pubmed.ncbi.nlm.nih.gov/33514711/ 13 pubmed.ncbi.nlm.nih.gov/33990806/ 14 pubmed.ncbi.nlm.nih.gov/32820647/ 15 covidmusicstudy.com/study-results/ 16 nhlbi.nih.gov/events/2021/identifying-research-opportunities-asian-american-native-hawaiian-and-pacific-islander
NHLBI-19

program also continues to invest in established cohort studies, such as the Jackson Heart Study 

(JHS), the nation’s largest and longest-running study of cardiovascular health in African 

Americans. In 2021, after a rigorous search, the Institute announced a new JHS director who 

will bring to the study significant experience in community-engaged research; she is also the first 

female director in the study’s 23-year history.17

Additionally, the NHLBI is leading efforts to reduce the disparate impact of COVID-19 on 

racial/ethnic minority groups. The Collaborative Cohort of Cohorts for COVID-19 

Research (C4R) study includes over 50,000 adults recruited from 14 existing NHLBI cohort 

studies—including the Jackson Heart Study, the Strong Heart Study of American Indians, and 

Hispanic Community Health Study/Study of Latinos. C4R will explore the risk factors that 

influence the severity and long-term health impacts of COVID-19. 

Budget Policy:

The FY 2023 President’s Budget request for NHLBI heart and vascular disease research is 

$2,008.7 million, an increase of $57.9 million or 3 percent compared with the FY 2022 CR level.

Lung Diseases: The lung diseases program supports research on the causes, diagnosis, 

prevention, and treatment of lung diseases and sleep disorders, while also training the next 

generation of pulmonary researchers. Some areas covered include asthma, chronic obstructive 

pulmonary disease (COPD), cystic fibrosis, sleep-disordered breathing, acute lung injury, 

pediatric lung diseases, pulmonary fibrosis and other rare lung disorders, including 

lymphangioleiomyomatosis (LAM) and sarcoidosis.

NHLBI’s lung program supports a robust portfolio from discovery science to clinical research, 

including the Progenitor Cell Translational Consortium (PCTC), which translates advances in 

progenitor cell biology into clinical applications. Progenitor cells are early descendants of stem 

cells and serve as valuable models to study disease mechanisms and potential therapies. 

Through the PCTC, investigators have used single cell RNA sequencing to build a detailed atlas 

of cell types in the developing and adult lung in mice. Recently, these investigators charted 

key steps in the development of the alveoli, the tiny air sacs required for gas exchange.18 Their 

findings shed light on potential pathways for repairing the lungs after injury or disease, which 

could lead to new therapeutics. 

To address COPD, the NHLBI is implementing the national COPD National Action Plan 

developed with the Institute’s partners in 2017. The Institute has established an online system to 

track the plan’s progress, and continues to support research to better understand mechanisms of 

this complex disease and to develop effective interventions. Using TOPMed data, researchers 

recently performed a large-scale, multi-ethnic whole genome sequence analysis of patients with 

COPD, and found an association with 22 new genes, including 3 genes involved in metabolizing 

phosphorus,19 which is critical for cellular energy stores. Through its Learn More Breathe 

Better ® program, the NHLBI also supports community organizations working to raise COPD 

awareness, including a new effort to reach rural healthcare providers in the Appalachian region. 

17 https://www.nhlbi.nih.gov/news/2021/nhlbi-announces-new-director-jackson-heart-study 18 pubmed.ncbi.nlm.nih.gov/33707239/ 19 pubmed.ncbi.nlm.nih.gov/33057025/
NHLBI-20 

Finally, NHLBI’s new Air You Wear Challenge aims to stimulate the development of lighter, 

more portable oxygen devices for the more than 1.5 million Americans who use supplemental 

oxygen for COPD and other conditions. 

The NHLBI also continues to invest in precision medicine approaches to treat asthma, which

affects 1 in 13 Americans, up to 10 percent of whom have severe asthma. To rapidly evaluate 

multiple therapies for severe asthma, the NHLBI 

established the PrecISE clinical trial network, 

which is testing six therapies, including two 

immunotherapy drugs, that are tailored to each 

trial participant based on their unique biomarker 

profile. PrecISE is enrolling 650 teens and adults 

with severe asthma at 30 sites nationally.

Given that climate change and other 

environmental factors, such as air pollution and 

wildfires, increase the risk and severity of asthma 

and other lung diseases, the NHLBI supports a 

number of efforts to reduce the health impacts of 

climate change. For example, the AIRHEALTH 

study is investigating how acute and chronic 

exposures to air pollution lead to 

cardiopulmonary disease. The Lung Health 

Cohort, the RURAL study, and other NHLBI 

cohort studies include measures to investigate the 

impact of environmental health on personal 

health. The NHLBI also participates in the 

Human Health Exposure Analysis Resource 

(HHEAR) program, which provides services for 

researchers to add or expand exposure analysis in 

their studies.

A lung transplant can be effective for patients 

with end-stage lung disease. Although the 

survival rate for lung transplantation is lower than 

for other organs, the NHLBI has supported 

encouraging advances in the field over the past 

year. A phase I clinical trial of regadenoson, a 

drug typically used to prepare heart patients for 

an X-ray to measure blood flow, has shown promising results in preventing lung graft failure.20 

Another small study has shown that patients given a high dose of the diabetes drug sitagliptin, in 

addition to standard medications, had lower rates of graft-versus-host disease, where the graft 

launches an immune attack on the body.21 To build on this momentum, the Institute is 

20 pubmed.ncbi.nlm.nih.gov/32503727/ 21 pubmed.ncbi.nlm.nih.gov/33406328/ 

NHLBI Catalyze: Speeding Translation 

from Bench to Bedside

Translating discoveries from bench to 

bedside is critical if gains in research are to 

improve public health. However, navigating 

the complex path of pre-clinical 

development and testing is often a 

challenge for academic researchers, which 

can prevent potential therapeutics from 

reaching human trials. The NHLBI Catalyze 

program is designed to provide coordinated 

and comprehensive services to 

investigators working to develop therapeutic 

and diagnostic technologies across the 

spectrum of heart, lung, blood, and sleep 

disorders. The program uses milestonebased funding, as well as expert guidance, 

to help coordinate all stages of pre-clinical 

drug evaluation and testing. Catalyzesponsored projects are also encouraged to 

partner with business accelerators that 

have expertise in commercializing medical 

products. The program also emphasizes 

developing researchers’ entrepreneurial 

skills, helping to further grow the pool of 

researchers capable of bringing new drugs 

and devices to market. Catalyze has 

supported 14 projects to date, including an 

effort to develop a novel small-molecule 

therapeutic for opioid-induced respiratory 

distress (OIRD), a frequent cause of opioid 

deaths. The investigators have received 

support from an industry partner and held a 

pre-clinical meeting with the FDA 1 year 

ahead of schedule. 
NHLBI-21

assembling a multi-site Lung Transplant Consortium that will coordinate clinical research to 

improve lung transplant outcomes.

The National Center of Sleep Disorders Research (NCSDR), housed within NHLBI, supports 

research on sleep and circadian biology, and coordinates sleep research across federal agencies. 

In 2020, the Institute named a new NCSDR director, who has been working with her colleagues 

across NIH and stakeholder communities to develop a new NIH Sleep Research Plan. An 

emerging focus of study is the role that sleep plays at different life stages, including infancy, 

and how early sleep patterns might impact later health outcomes. A recent study showed that the 

well-known association between lack of sleep and obesity seen in adults can begin in infancy; 

during the first six months of life, infants who slept less were more likely to be overweight.22

Such research highlights the need to better understand the linkages between obesity and sleep.

 

Budget Policy:

The FY 2023 President’s Budget request for NHLBI lung disease research is $796.3 million, an 

increase of $22.9 million or 3 percent compared with the FY 2022 CR level.

Blood Diseases and Resources: The blood program is a leader in research on the causes, 

prevention, and treatment of non-cancerous blood diseases. The program also helps ensure the 

adequacy and safety of the nation’s blood supply and supports scientific advances in stem cell 

biology and new gene and cell-based therapies to repair and regenerate human tissues and 

organs.

The NHLBI has a legacy of supporting research that has improved health outcomes for people 

with sickle cell disease (SCD), an inherited blood disorder that can lead to chronic pain, organ 

failure, and premature death. New medications and other interventions have improved life 

expectancy and quality of life for the approximately 100,000 people with SCD in the U. S. 

Moreover, recent progress in gene therapy is allowing researchers to tackle SCD at its 

molecular roots—specifically, inherited mutations in the gene encoding adult hemoglobin (Hb), 

which is needed for red blood cells to transport oxygen. Approaches to replace, repair, or 

compensate for the adult Hb gene are being tested in clinical trials, and early results are 

promising. For example, a pilot trial found that gene therapy to reactivate a fetal form of Hb 

reduced the number of pain crises and need for transfusions among six patients with severe SCD 

followed for six months.23 Because risks of gene therapy include immune reactions or cell 

abnormalities that could lead to cancer, the NHLBI has been working closely with researchers to 

enhance screening and monitoring of trial participants to reduce those risks. 

The Institute is also supporting more immediate efforts to relieve suffering for people with SCD. 

For example, the SCD Implementation Consortium is investigating strategies to bring proven 

treatments for SCD into broader practice. The NHLBI is also leveraging the NIH Helping to 

End Addiction Long-termSM (HEAL) initiative to systematically determine the most effective 

approaches to improve SCD pain management. Many of these SCD-focused domestic efforts 

and findings are also being shared with resource-limited parts of the world, such as sub-Saharan 

22 pubmed.ncbi.nlm.nih.gov/34676870/ 23 pubmed.ncbi.nlm.nih.gov/33283990/
NHLBI-22

Africa, which has the highest SCD burden worldwide. NHLBI’s Sickle Pan-African Research 

Consortium has shown that widespread newborn screening for SCD is feasible in sub-Saharan 

countries, and has identified opportunities and barriers for achieving sustainability.24 These 

efforts hold lessons for improving newborn screening programs in the U.S.; while all states 

mandate screening for SCD, some have reported gaps in follow-up counseling and care. 

During the COVID-19 pandemic, the high need for blood transfusions to treat critically ill 

patients, combined with intermittent lockdowns, emphasized the importance of maintaining a 

robust national blood supply. The NHLBI supports a large research portfolio in transfusion 

medicine, including the Recipient Epidemiology and Donor Evaluation Study (REDS), a 

multicenter program that aims to strengthen the blood supply and improve transfusions. Given 

that blood donors are diverse in blood type and other characteristics that can affect transfusion 

therapies, it is important that the national blood supply is balanced and well maintained. A new 

genome-wide study looking at donated blood samples identified 27 genetic variables that could 

influence the shelf-life of stored blood.25 Further research on these variables could advance 

donor screening and storage policies and improve transfusion outcomes. The portfolio also 

includes clinical trials to improve transfusion, such as the American Trial Using Tranexamic 

Acid in Thrombocytopenia (A-TREAT). This trial will examine whether a pro-clotting drug 

can reduce bleeding in patients with low platelets (the cells that form blood clots) due to 

chemotherapy or bone marrow transplantation.

Budget Policy:

The FY 2023 President’s Budget request for this research program is $507.3 million, an increase 

of $14.6 million or 3 percent compared with the FY 2022 CR level.

Center for Translation Research and Implementation Sciences (CTRIS): This program was 

established in 2014 to help plan, foster, and support research to ensure the successful integration 

of evidence-based interventions within clinical and public health settings, such as health centers, 

worksites, communities, and schools. 

The COVID-19 pandemic provided a stark reminder of how social determinants of health can 

contribute to health disparities; for example, demographic groups that tend to have large 

numbers of essential workers, higher density housing, and lower access to healthcare saw the 

worst infection rates and outcomes. To reach those Americans hardest hit by the pandemic, the 

NHLBI worked with the NIMHD to establish the NIH Community Engagement Alliance 

(CEAL) Against COVID-19 Disparities. CEAL connects researchers with community-based 

organizations and trusted leaders to help communities fight COVID-19—by participating in 

research and by supporting vaccination and other preventive health measures. CEAL research 

teams have developed a variety of innovative approaches to community engagement. For 

example, teams in Michigan and North Carolina held contests that invited community members 

to develop poems, songs, graphics, and videos encouraging their neighbors to mask up and get 

vaccinated. The CEAL network, now active in 21 U.S. regions, provides a model and lessons 

learned to address other long-standing health disparities.

24 pubmed.ncbi.nlm.nih.gov/33652550/ 25 pubmed.ncbi.nlm.nih.gov/34014839/
NHLBI-23

NHLBI’s DECIPHeR program addresses health disparities through implementation science. In 

2020, the program began funding several projects to test new ways of delivering proven 

interventions for heart and lung disease to high-risk communities. One project has researchers 

working with 24 community mental health program sites in Michigan and Maryland to test 

evidence-based CVD interventions in people with serious mental illness (SMI). People with 

SMI comprise five percent of the U.S. population and as a group, they experience a mortality 

rate two times higher with death 10-20 years earlier than the national average. Other DECIPHeR 

projects are working with communities to improve hypertension control, increase use of smoking 

cessation programs, and reduce asthma attacks in children.

The NHLBI also supports programs to train early-career researchers in community engagement 

and implementation science, while delivering real benefits to patients. For example, the Hope 

for SCD Challenge called for college teams to work together to come up with innovative 

solutions—such as digital tools, video games, and mobile devices—to help people with SCD live 

longer, healthier lives. One of the winning concepts, a trivia game about SCD, is now being 

tested to see how well it improves knowledge among patients, caregivers, and healthcare 

providers.26

Budget Policy:

The FY 2023 President’s Budget request for CTRIS is $100.6 million, an increase of $43.7

million or 76.7 percent compared with the FY 2022 CR level.

Intramural Research: The NHLBI Division of Intramural Research (DIR), located at the NIH 

campus in Bethesda, Maryland, performs robust scientific and clinical research leading to a 

better understanding of biology and pathology of heart, lung, and blood systems. The research 

portfolio is broad, encompassing the basic principles of molecular, cellular, and organ-level 

biology and their relationship to disease, and goes all the way to conducting clinical trials and 

training.

DIR investigators are playing a significant role in federal research efforts to address COVID-19. 

One DIR group has designed a peptide (protein fragment) that can bind to and inactivate 

triglycerides (fat molecules in blood) to treat heart disease and other conditions. The group is 

now applying their expertise to design a peptide capable of inactivating SARS-CoV-2. Another 

group uses biophysics to study enzymes that control or modify DNA, and has also expanded its 

efforts to support a pandemic-related project. The team is studying how such enzymes regulate 

the complex replication process of SARS-CoV-2 to help improve antiviral therapies.27 Another 

group is leveraging their expertise on biomarkers of tissue injury to support research that could 

lead to early predictive markers of COVID-19 outcomes.

DIR investigators also continue to lead innovative research in the treatment and prevention of 

heart, lung, blood and sleep disorders. For example, researchers working on SCD have found 

that damaged DNA fragments from mitochondria (the powerhouses within our cells) can trigger 

26 nhlbi.nih.gov/news/2021/innovating-sickle-cell-disease-education-models 27 nihrecord.nih.gov/2021/08/06/neuman-lab-looks-examine-coronavirus-inhibitors
NHLBI-24

inflammation in patients with SCD, and could serve as a marker of disease progression.28 

Another group is continuing to improve bone marrow transplantation (BMT) for patients with 

SCD, while collaborating with academic institutions to assess the long-term health effects of 

BMT and other curative therapies on the heart, lung, and kidney—organs that when damaged are 

associated with early death in adults with SCD. 

Finally, DIR has established a new branch to investigate how and why health and disease differ 

among diverse populations. The Epidemiology and Community Health Branch will 

investigate these questions using the NIH Clinical Center’s resources for deep phenotyping— the 

analysis of detailed, molecular data related to a person’s health. This new branch will 

complement and strengthen NHLBI’s broader efforts to study and improve population health, 

especially in diverse populations. 

Budget Policy:

The FY 2023 President’s Budget request for NHLBI intramural research is $253.8 million, an 

increase of $12.6 million or 5.2 percent compared with the FY 2022 CR level.

Research Management and Support (RMS): RMS activities include administrative and 

technical functions that support and enhance the effectiveness of the Institute’s research 

investments. This includes providing administrative, budgetary, logistical, and scientific support 

in the review, award, and monitoring of research grants and clinical trials, training awards, and 

research and development contracts. RMS functions also encompass strategic planning, transNHLBI and NIH coordination, evaluation of the Institute’s programs, regulatory compliance, 

international coordination, interactions with other Federal agencies and Congress, and 

dissemination of research findings to the public.

Budget Policy:

The FY 2023 President’s Budget request for RMS at NHLBI is $156.2 million, an increase of 

$6.5 million or 4.3 percent compared with the FY 2022 CR level.

28 pubmed.ncbi.nlm.nih.gov/33661274/
NHLBI-25

Appropriations History

NATIONAL INSTITUTES OF HEALTH

National Heart, Lung, and Blood Institute

Appropriations History

Fiscal Year Budget Estimate

to Congress

House

Allowance

Senate

Allowance Appropriation

2014 $3,098,508,000 $3,077,916,000 $2,988,605,000

Rescission $0

2015 $2,987,685,000 $2,997,870,000

Rescission $0

2016 $3,071,906,000 $3,035,062,000 $3,135,519,000 $3,115,538,000

Rescission $0

2017 1 $3,113,533,000 $3,190,474,000 $3,242,685,000 $3,206,589,000

Rescission $0

2018 $2,534,803,000 $3,256,521,000 $3,322,774,000 $3,383,201,000

Rescission $0

2019 $3,112,032,000 $3,423,604,000 $3,490,171,000 $3,488,335,000

Rescission $0

2020 $3,002,696,000 $3,658,822,000 $3,694,771,000 $3,624,258,000

Rescission $0

Supplemental $103,400,000

2021 $3,298,004,000 $3,655,428,000 $3,728,307,000 $3,664,811,000

Rescission $0

2022 $3,845,681,000 $3,866,828,000 $3,841,998,000 $3,664,811,000

Rescission $0

2023 $3,822,961,000

1 Budget Estimate to Congress includes mandatory financing.
NHLBI-26

Authorizing Legislation

NATIONAL INSTITUTES OF HEALTH

National Heart, Lung, and Blood Institute

Authorizing Legislation

PHS Act/

Other Citation

U.S. Code

Citation

2022 Amount

Authorized

FY 2022 CR 2023 Amount

Authorized

FY 2023 President's

Budget

Research and Investigation Section 301 42§241 Indefinite Indefinite

$3,664,811,000 $3,822,961,000

National Heart, Lung, and

Blood Institute Section 401(a) 42§281 Indefinite Indefinite

Total, Budget Authority $3,664,811,000 $3,822,961,000
NHLBI-27

Amounts Available for Obligation

NATIONAL INSTITUTES OF HEALTH

National Heart, Lung, and Blood Institute

Amounts Available for Obligation 1

(Dollars in Thousands)

Source of Funding FY 2021 Final FY 2022 CR

FY 2023

President's

Budget

Appropriation $3,664,811 $3,664,811 $3,822,961

Mandatory Appropriation: (non-add)

Type 1 Diabetes ($0) ($0) ($0)

Other Mandatory financing ($0) ($0) ($0)

Secretary's Transfer -$11,003 $0 $0

Subtotal, adjusted appropriation $3,653,808 $3,664,811 $3,822,961

OAR HIV/AIDS Transfers -$108 $0 $0

Subtotal, adjusted budget authority $3,653,700 $3,664,811 $3,822,961

Unobligated balance, start of year $0 $0 $0

Unobligated balance, end of year (carryover) $0 $0 $0

Subtotal, adjusted budget authority $3,653,700 $3,664,811 $3,822,961

Unobligated balance lapsing -$131 $0 $0

Total obligations $3,653,569 $3,664,811 $3,822,961

1 Excludes the following amounts (in thousands) for reimbursable activities carried out by this account:

FY 2021 - $20,206 FY 2022 - $20,206 FY 2023 - $20,206
NHLBI-28

Budget Authority by Object Class

NATIONAL INSTITUTES OF HEALTH

National Heart, Lung, and Blood Institute

Budget Authority by Object Class 1

(Dollars in Thousands)

FY 2022 CR FY 2023 President's

Budget FY 2023 +/- FY 2022

Total compensable workyears:

Full-time equivalent 966 966 0

Full-time equivalent of overtime and holiday hours 1 1 0

Average ES salary $201 $208 $8

Average GM/GS grade 12.8 12.8 0.0

Average GM/GS salary $128 $133 $5

Average salary, Commissioned Corps (42 U.S.C. 207) $120 $125 $4

Average salary of ungraded positions $147 $153 $6

OBJECT CLASSES FY 2022 CR FY 2023 President's

Budget

FY 2023 +/- FY 2022

Personnel Compensation

11.1 Full-Time Permanent $70,888 $77,323 $6,435

11.3 Other Than Full-Time Permanent $40,073 $43,778 $3,705

11.5 Other Personnel Compensation $5,465 $5,772 $308

11.7 Military Personnel $1,862 $1,996 $133

11.8 Special Personnel Services Payments $11,104 $11,978 $874

11.9 Subtotal Personnel Compensation $129,392 $140,846 $11,454

12.1 Civilian Personnel Benefits $42,563 $45,292 $2,729

12.2 Military Personnel Benefits $1,477 $1,663 $186

13.0 Benefits to Former Personnel $0 $0 $0

Subtotal Pay Costs $173,431 $187,800 $14,369

21.0 Travel & Transportation of Persons $861 $880 $19

22.0 Transportation of Things $549 $561 $12

23.1 Rental Payments to GSA $0 $0 $0

23.2 Rental Payments to Others $0 $0 $0

23.3 Communications, Utilities & Misc. Charges $347 $354 $8

24.0 Printing & Reproduction $2 $2 $0

25.1 Consulting Services $96,007 $104,175 $8,169

25.2 Other Services $118,354 $127,017 $8,663

25.3 Purchase of Goods and Services from Government

Accounts $199,583 $205,190 $5,608

25.4 Operation & Maintenance of Facilities $323 $324 $1

25.5 R&D Contracts $128,566 $132,917 $4,351

25.6 Medical Care $2,069 $2,154 $85

25.7 Operation & Maintenance of Equipment $24,381 $26,814 $2,432

25.8 Subsistence & Support of Persons $0 $0 $0

25.0 Subtotal Other Contractual Services $569,283 $598,591 $29,308

26.0 Supplies & Materials $13,837 $14,149 $312

31.0 Equipment $5,398 $5,676 $277

32.0 Land and Structures $997 $1,019 $22

33.0 Investments & Loans $0 $0 $0

41.0 Grants, Subsidies & Contributions $2,900,104 $3,013,926 $113,822

42.0 Insurance Claims & Indemnities $0 $0 $0

43.0 Interest & Dividends $3 $3 $0

44.0 Refunds $0 $0 $0

Subtotal Non-Pay Costs $3,491,380 $3,635,161 $143,781

Total Budget Authority by Object Class $3,664,811 $3,822,961 $158,150 1 Includes FTEs whose payroll obligations are supported by the NIH Common Fund.
NHLBI-29

Salaries and Expenses

NATIONAL INSTITUTES OF HEALTH

National Heart, Lung, and Blood Institute

Salaries and Expenses

(Dollars in Thousands)

Object Classes FY 2022 CR

FY 2023

President's

Budget

FY 2023 +/- FY

2022

Personnel Compensation

Full-Time Permanent (11.1) $70,888 $77,323 $6,435

Other Than Full-Time Permanent (11.3) $40,073 $43,778 $3,705

Other Personnel Compensation (11.5) $5,465 $5,772 $308

Military Personnel (11.7) $1,862 $1,996 $133

Special Personnel Services Payments (11.8) $11,104 $11,978 $874

Subtotal, Personnel Compensation (11.9) $129,392 $140,846 $11,454

Civilian Personnel Benefits (12.1) $42,563 $45,292 $2,729

Military Personnel Benefits (12.2) $1,477 $1,663 $186

Benefits to Former Personnel (13.0) $0 $0 $0

Subtotal Pay Costs $173,431 $187,800 $14,369

Travel & Transportation of Persons (21.0) $861 $880 $19

Transportation of Things (22.0) $549 $561 $12

Rental Payments to Others (23.2) $0 $0 $0

Communications, Utilities & Misc. Charges

(23.3) $347 $354 $8

Printing & Reproduction (24.0) $2 $2 $0

Other Contractual Services

Consultant Services (25.1) $96,007 $104,175 $8,169

Other Services (25.2) $118,354 $127,017 $8,663

Purchase of Goods and Services from

Government Accounts (25.3) $107,505 $115,034 $7,529

Operation & Maintenance of Facilities (25.4) $323 $324 $1

Operation & Maintenance of Equipment (25.7) $24,381 $26,814 $2,432

Subsistence & Support of Persons (25.8) $0 $0 $0

Subtotal Other Contractual Services $346,570 $373,364 $26,794

Supplies & Materials (26.0) $13,837 $14,149 $312

Subtotal Non-Pay Costs $362,165 $389,309 $27,144

Total Administrative Costs $535,596 $577,110 $41,513
NHLBI-30

Detail of Full-Time Equivalent Employment (FTE)

NATIONAL INSTITUTES OF HEALTH

National Heart, Lung, and Blood Institute

Detail of Full-Time Equivalent Employment (FTE)

Office

FY 2021 Final FY 2022 CR FY 2023 President's Budget

Civilian Military Total Civilian Military Total Civilian Military Total

Division of Intramural Research

Direct: 476 14 490 525 14 539 525 14 539

Reimbursable: 14 - 14 17 - 17 17 - 17

Total: 490 14 504 542 14 556 542 14 556

Office of the Director

Direct: 108 1 109 117 1 118 117 1 118

Reimbursable: - - - - - - - - -

Total: 108 1 109 117 1 118 117 1 118

Division of Blood and Resources

Direct: 20 1 21 27 1 28 27 1 28

Total: 20 1 21 27 1 28 27 1 28

Division of Lung Diseases

Direct: 31 - 31 38 - 38 38 - 38

Total: 31 - 31 38 - 38 38 - 38

Center for Translation Research and Implementation

Science

Direct: 8 - 8 12 - 12 12 - 12

Total: 8 - 8 12 - 12 12 - 12

Division of Cardiovascular Sciences

Direct: 101 1 102 114 1 115 114 1 115

Total: 101 1 102 114 1 115 114 1 115

Division of Extramural Research Activities

Direct: 88 - 88 99 - 99 99 - 99

Total: 88 - 88 99 - 99 99 - 99

Total 846 17 863 949 17 966 949 17 966

Includes FTEs whose payroll obligations are supported by the NIH Common Fund.

FTEs supported by funds from Cooperative Research

and Development Agreements. 0 0 0 0 0 0 0 0 0

FISCAL YEAR Average GS Grade

2019 12.7

2020 12.7

2021 12.7

2022 12.8

2023 12.8
NHLBI-31

Detail of Positions

NATIONAL INSTITUTES OF HEALTH

National Heart, Lung, and Blood Institute

Detail of Positions 1

GRADE FY 2021 Final FY 2022 CR

FY 2023

President's Budget

Total, ES Positions 2 2 2

Total, ES Salary $392,475 $401,404 $416,424

General Schedule

GM/GS-15 98 108 108

GM/GS-14 157 172 172

GM/GS-13 178 195 195

GS-12 70 85 85

GS-11 37 47 47

GS-10 0 0 0

GS-9 33 38 38

GS-8 3 3 3

GS-7 3 3 3

GS-6 0 0 0

GS-5 3 3 3

GS-4 5 5 5

GS-3 4 4 4

GS-2 2 2 2

GS-1 1 1 1

Subtotal 594 666 666

Commissioned Corps (42 U.S.C.

207)

Assistant Surgeon General 1 1 1

Director Grade 5 5 5

Senior Grade 6 6 6

Full Grade 5 5 5

Senior Assistant Grade 0 0 0

Assistant Grade 0 0 0

Subtotal 17 17 17

Ungraded 250 281 281

Total permanent positions 613 685 685

Total positions, end of year 863 966 966

Total full-time equivalent (FTE)

employment, end of year

863 966 966

Average ES salary $196,238 $200,702 $208,212

Average GM/GS grade 12.7 12.8 12.8

Average GM/GS salary $123,680 $128,182 $132,979

1 Includes FTEs whose payroll obligations are supported by the NIH Common Fund.