National Heart, 

Lung, and Blood 

Institute 

CONGRESSIONAL JUSTIFICATION 

FY 2022 

Department of Health and Human Services 

National Institutes of Health 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DEPARTMENT OF HEALTH AND HUMAN SERVICES 

NATIONAL INSTITUTES OF HEALTH 

National Heart, Lung, and Blood Institute (NHLBI) 

FY 2022 Budget Table of Contents Page No. 

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

IC Fact Sheet........................................................................................................................... 9 

Major Changes in Budget Request ......................................................................................... 11 

Budget Mechanism Table ...................................................................................................... 13 

Appropriations Language ...................................................................................................... 14 

Summary of Changes............................................................................................................. 15 

Budget Graphs ...................................................................................................................... 16 

Organization Chart ............................................................................................................... 17 

Budget Authority by Activity ................................................................................................ 18 

Justification of Budget Request.............................................................................................. 19 

Program Descriptions ............................................................................................................ 19 

Appropriations History.......................................................................................................... 29 

Authorizing Legislation......................................................................................................... 30 

Amounts Available for Obligation ......................................................................................... 31 

Budget Authority by Object Class ......................................................................................... 32 

Salaries and Expenses ........................................................................................................... 33 

Detail of Full-Time Equivalent Employment (FTE) ............................................................... 34 

Detail of Positions ................................................................................................................ 35 

Cover page: The endothelial cells that line the inside of blood vessels are held tightly together by specialized proteins including 

actin (red) and cadherin (blue). Photo credit: Christopher V. Carman and Roberta Martinelli, Harvard Medical School, Boston, 

Mass. 

NHLBI-1 
NHLBI-2 
 

 

 

 

 

 

 

 

 

 

 

 

Director’s Overview 

The need for research across the spectrum—from discovery science 

to disease epidemiology and clinical trials—has perhaps never been 

more critical to the Nation’s health than it is right now. The National 

Heart, Lung, and Blood Institute (NHLBI) is committed to building 

on its legacy of excellence in research, training, and health education 

and outreach to reduce the burden of heart, lung, sleep, and blood 

disorders. By leveraging its established population-based studies, 

clinical trial networks, data science platforms, and other assets, 

NHLBI is at the vanguard of research to contain the COVID-19 

pandemic and the long-term consequences of SARS-CoV-2 infection, 

as well as a concerning rise in maternal morbidity and mortality. In 

all these endeavors, the Institute is committed to ensuring that the 

research process and its advances reach underserved communities 

where the risk and prevalence of chronic disease is highest, toward 

improving the health of all Americans. 

Investing in Discovery to Develop Future Treatments and Cures 

Benjamin Franklin once said, “Investment in knowledge pays the best interest.” That still rings 

true today. Investments in basic research fuel the knowledge and innovation that can bring 

forward new interventions, treatments, and even cures. For decades, NHLBI has supported 

research to understand the biology of the many cell types involved in blood flow. This includes 

red blood cells that carry oxygen throughout the body, platelets that come together to form clots 

and heal wounds, and endothelial cells that line the inside of blood vessels. Fundamental 

research has revealed a trove of sticky cell-surface proteins that regulate interaction among these 

cell types. One of these, P-selectin, has been eyed as a target of potential new therapies against 

metastatic cancer, as well as the blood clots that lead to heart attacked and stroke. In the early 

2000s, NIH/NHLBI-funded researchers found that P-selectin contributes to abnormal blood flow 

in patients with sickle cell disease, creating masses of sickled red cells that can lead to episodes 

of severe pain or crisis.1,2 With further support from NHLBI and industry, researchers ultimately 

developed an antibody that inhibits P-selectin, crizanlizumab, which is now approved for 

reducing sickle cell crises.3 

Remarkably, our understanding of platelet aggregation and blood clotting (coagulation) has 

proven useful in understanding the pathogenesis of COVID-19, as well as potential treatments. 

Researchers have noted that people with severe COVID-19 tend to have a high risk of blood 

clots, now called COVID-19-associated coagulopathy (CAC), which can lead to fatal blockages 

in the brain, heart, or lungs. 4 A robust armamentarium of anticoagulant drugs could be one of 

our best options for preventing severe illness and death from COVID-19. 

Dr. Gary H. Gibbons, 

Director 

1 pubmed.ncbi.nlm.nih.gov/11535535/

2 pubmed.ncbi.nlm.nih.gov/15280090/ 

3 pubmed.ncbi.nlm.nih.gov/27959701/

4 pubmed.ncbi.nlm.nih.gov/32840379/ 

NHLBI-3 
 

 

 

 

 

 

 

Rapid Mobilization to Address Urgent Public Health Needs 

Soon after COVID-19 emerged, it became clear that the disease has severe effects on the heart, 

lungs, blood, and blood vessels; and that people with underlying health conditions such as 

chronic lung disease, cardiovascular disease, obesity, and diabetes are at higher risk for severe 

outcomes from COVID-19. Bolstered by $103.4 million in additional support from the 

Coronavirus Aid, Relief, and Economic Security Act (CARES Act), NHLBI quickly developed a 

multi-pronged response strategy to address the high risk of COVID-19 in people with preexisting 

chronic conditions and to identify treatments that could slow or stop its punishing effects on the 

body. A key part of this strategy was to leverage existing assets, including clinical trial networks 

and community-based cohort studies, to conduct research at an unprecedented pace. The 

Institute took a similar approach in rapidly mobilizing to address an outbreak of lung injury and 

deaths related to vaping in 2019. (See box on p. 18.) 

In August 2020, NHLBI launched the Collaborating Network of Networks for Evaluating 

COVID-19 and Therapeutic Strategies (CONNECTS), 5 which brings together multiple existing 

clinical trial networks to quickly test therapies with the potential to slow or stop COVID-19 

progression. As part of the Accelerating COVID-19 Therapeutic Interventions and Vaccines 

(ACTIV) initiative, CONNECTS is conducting a series of clinical trials to evaluate the safety 

and effectiveness of anticoagulants (blood thinners) to treat adults with COVID-19. (See box on 

p. 23 for more about NHLBI’s response to COVID-19.) Supported by funding provided to NIH 

through the Consolidated Appropriations Act of 2021, the NHLBI is also leading an initiative to 

address "Long COVID" and other unexplained symptoms that can persist or appear long after 

acute SARS-CoV-2 infection, known as post-acute sequelae of SARS-CoV-2 (PASC). The 

initiative seeks to understand the underlying biology of PASC and its clinical spectrum, and 

ultimately to identify effective means of treatment and prevention. 

Understanding and Reducing Health Disparities in COVID-19 and Chronic Disease 

In the United States, COVID-19 has taken its toll on almost every community. But some 

groups—especially African Americans, Hispanic/Latinos, and American Indian/Alaska 

Natives—have suffered more than others, with increased rates of infection, hospitalization, and 

deaths compared to whites. Again, building on its established history of engaging communities 

in research, NHLBI co-leads a trans-NIH effort with the National Institute of Minority Health 

and Health Disparities (NIMHD) called the Community Engagement Alliance (CEAL) Against 

COVID-19 Disparities. 6 This initiative connects researchers to trusted leaders and organizations 

in communities hardest hit by COVID-19, helping them work together to address 

misinformation, increase the use of practices to prevent spread of the virus, and ensure that 

clinical trials include people in these communities, so that the treatments and vaccines developed 

will work for everyone. 

The high toll of COVD-19 in communities of color stems in part from other health disparities, 

such as severe obesity, which is more than twice as prevalent in Black (13.0 percent) and 

5 nhlbi-connects.org/ 6 covid19community.nih.gov/ 

NHLBI-4 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

Hispanic (12.9 percent) adolescents than in Whites (4.9 percent).7 Research increasingly shows 

that social determinants of health—conditions in the places where people live, learn, work, and 

play—have a role in these disparities.8 For these reasons, NHLBI continues its long-standing 

support of cohort studies of minority and rural populations, such as the Jackson Heart Study 

(JHS) of cardiovascular health in African Americans. A new community engagement 

component of JHS is putting 20 years of the study’s findings into action by turning traditional 

gathering places, like barbershops and churches, into health information hubs. NHLBI has 

broadened its reach and launched a new study to address the high burden of chronic disease in 

rural America. The Risk Underlying Rural Areas Longitudinal (RURAL) study will include 

4,600 people ages 25-64 in 10 low-income counties in the South, to work toward understanding 

and reducing rural health disparities.9 

We believe that research to address health disparities is more effective when researchers work in 

partnership with the impacted communities. In keeping with that principle, a new initiative— 

Disparities Elimination through Coordinated Interventions to Prevent and Control Heart Disease 

Risk (DECIPHeR)—will work to address disparities through community-based participatory 

research. For sickle cell disease (SCD), an inherited blood disorder that primarily affects African 

Americans, patients are working with researchers through the SCD Implementation Consortium 

to address challenges in providing evidence-based care for SCD, and they are playing an integral 

part in the Cure Sickle Cell Initiative, which aims to bring gene-based therapies for SCD into 

clinical trials in the next several years. 

Improving the Heart Health of Young Women and Mothers 

Another tragic health disparity that requires rigorous scientific study is the high rate of maternal 

morbidity and mortality in the United States, especially among women of color, who are two to 

four times more likely to die from a pregnancy complication than White women.10 

Cardiovascular disease is the leading cause of pregnancy-related death, and an increasing 

number of young American women have one or more cardiovascular risk factors—such as 

obesity, sleep apnea, or high blood pressure. A recent analysis looking at blood pressure 

trajectories over decades found that in women, blood pressure elevation occurs earlier and 

progresses more rapidly throughout life, compared to men.11 For these reasons, addressing 

maternal morbidity and mortality will require a life-course approach that focuses on improving 

women’s heart health before, during, and after reproductive age. 

NHLBI supports a spectrum of mechanistic and clinical studies to understand the impact of sex 

as a biological variable and to improve women’s heart health across the lifespan. For example, 

the Chronic Hypertension and Pregnancy (CHAP) trial is examining the safety and effectiveness 

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

severe hypertension.12 Enrollment of 2,400 women of diverse race and ethnicity from 62 sites 

across the United States is nearly complete and study results are expected by the end of 2021. 

7 pubmed.ncbi.nlm.nih.gov/32857101/ 

8 www.cdc.gov/socialdeterminants/index.htm 

9 www.theruralstudy.org/

10 www.cdc.gov/reproductivehealth/maternalinfanthealth/pregnancy-relatedmortality.htm 11 pubmed.ncbi.nlm.nih.gov/31940010/ 12 clinicaltrials.gov/ct2/show/NCT02299414 

NHLBI-5 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Other research has shown that sleep disorders during pregnancy can adversely impact maternal 

and child health. For example, a study of 1.4 million maternal and newborn records found that 

children born to mothers with sleep apnea during pregnancy were more likely to have birth 

defects, be admitted to neonatal ICU, or require resuscitation at birth.13 A trial funded in part by 

the NHLBI is now investigating whether treating sleep apnea among pregnant women can 

improve outcomes for mother and child.14 

Making Data Science More Accessible and Training the Next Generation 

With recent funding increases, NHLBI has been able to build one of the world’s largest and most 

ethnically diverse collections of health-related data from research volunteers, including wholegenome sequencing data (a person’s complete set of DNA). NHLBI’s Trans-Omics for Precision 

Medicine (TOPMed) program has amassed nearly four petabytes of de-identified genomic, 

clinical, imaging, and environmental data from more than 161,000 participants in 80 diverse 

population-based studies, including NHLBI’s landmark Framingham Heart Study, the Jackson 

Heart Study, and the Hispanic Community Health Study/Study of Latinos. These data are 

available through a secure cloud-based platform called the BioData Catalyst, which has tools for 

analyzing large datasets, and sharing results in real-time. The BioData Catalyst provides a 

virtual collaborative workspace that makes TOPMed data findable, accessible, interoperable, and 

reusable (FAIR) to all qualified researchers, the vast majority of whom lack their own data 

science resources. 

The BioData Catalyst is also building a community of practice that will help train the next 

generation of data scientists. In 2019 and 2020, the NHLBI funded early-career investigators 

across the country as part of a new BioData Catalyst Fellows program. 15 One fellow with a 

background in astrophysics found that her true passion was grappling with the complexities of 

massive datasets; she is one of more than 30 uniquely skilled individuals who are exploring and 

refining this new data ecosystem. NHLBI expects to fund additional fellows and is supporting 

other innovative programs, such as Challenge competitions, to train early-stage investigators and 

leverage their talents to support the NHLBI mission. For example, many data scientists and 

early-stage investigators competed in the Big Data Heart Failure Challenge launched in 2020 and 

helped bring new ideas forward to improve management of heart failure, a disorder that affects 

about 6.5 million Americans. In addition, a new Hope for Sickle Cell Challenge is intended to 

build awareness about sickle cell disease, while creating opportunities for college and graduate 

students to be mentored in community-based team research. 

NHLBI will continue to be dedicated and accountable in its mission to improve diagnosis, 

treatment, and prevention of heart, lung, blood, and sleep disorders, including emergent public 

health threats such as COVID-19. It is critical for these efforts to focus on vulnerable and 

underserved populations—including racial/ethnic minorities and women—and to be carried out 

in partnership with patients, professional societies, foundations, federal and state agencies, and 

the Nation’s brightest scientific talent. 

13 pubmed.ncbi.nlm.nih.gov/31981755/ 14 clinicaltrials.gov/ct2/show/NCT02086448 15 biodatacatalyst.nhlbi.nih.gov/fellows/cohort1 

NHLBI-6 
 

 

 

 

Overall Budget Policy: 

The FY 2022 President’s Budget request is $3,845.7 million, an increase of $181.0 million or 4.9 

percent compared with the FY 2021 Enacted level. Included in this amount is $30.0 million for 

the CEAL initiative, which will connect researchers to trusted leaders and organizations in 

communities hardest hit by COVID-19, helping them work together to ensure that the treatments 

and vaccines developed will work for everyone. In addition, the request includes $50.0 million 

for health disparities research, including DECIPHeR and other initiatives to address health 

disparities. Increases are distributed across all programmatic, basic, epidemiologic, translation, 

and clinical research areas. 

NHLBI-7 
NHLBI-8 
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.

• The NHLBI’s research advances scientific knowledge, improves public 

health and saves lives.

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

National Heart, Lung, and Blood 

Institute (NHLBI), the third largest 

institute at NIH. He received his M.D. 

from Harvard Medical School and has 

served on the faculty at Harvard, 

Stanford University, and the Morehouse 

School of Medicine in Atlanta.

Current Major Initiatives

• The NHLBI supports the TransOmics for Precision Medicine 

(TOPMed) program, which has 

collected whole genome sequences 

from 155,000+ participants in NHLBI 

cohort studies who represent many 

different races, ethnicities, and 

geographic areas. TOPMed also 

includes clinical and environmental 

data and will help researchers 

decipher the complex mechanisms 

of chronic heart, lung, blood, and 

sleep disorders.

• The NHLBI’s new BioData Catalyst

is a data science platform where 

researchers can collaborate and 

innovate. It provides researchers 

with tools to access, share, and 

analyze large-scale datasets, 

including TOPMed data, that they 

would not be able to collect or 

maintain on their own.

• 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. The 

NHLBI’s approach takes into 

account women’s health across their 

lifespan – before, during, and after 

their reproductive years. 

• Because COVID-19 impacts heart, 

lung, and blood health, the NHLBI 

has a multi-pronged strategy to 

address the pandemic, including 

clinical trials to identify new 

therapies and population-based 

studies to examine outcomes, as 

well as risk and protective factors.

** FTEs, awards, and extramural principal investigators are FY20 data. Awards = non-competing research project grant awards. 

*** These success rates were averaged over 3 years (FY18, 19, 20) and calculated as (# awards/# of percentiled applications x 100). For 

more about percentiles, see https://grants.nih.gov/grants/peer-review.htm#Summary.
A highly magnified image of SARS-CoV-2 virions (red) produced by human airway epithelial 

cells in the lungs. Credit: Camille Ehre, Ph.D., University of North Carolina School of Medicine.

Accomplishments in... 

Heart Health 

• For more than 70 years, the Framingham Heart Study 

(FHS) has uncovered risk factors and prevention 

strategies for heart disease, and 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. 

• An NHLBI-funded study shows the power of leveraging 

community norms to bring proven interventions to 

high-risk communities. Blood pressure screening at 

barbershops helped reduce high blood pressure among 

African American men in the study. 

• 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 five-year

study on multisystem inflammatory syndrome in

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

children with COVID-19. 

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. 

• NHLBI-funded research in mice has found that chronic 

disturbed sleep can disrupt the production of a key 

RESPONDING TO COVID-19 

The NHLBI established the Collaborating Network of 

Networks for Evaluating COVID-19 and Therapeutic 

Strategies (CONNECTS) to test therapies that may slow 

or stop COVID-19 progression. By leveraging its diverse 

population studies, the NHLBI is examining factors that 

affect the risk of severe acute illness from SARS-CoV-2 

infection. The Institute also has taken a leadership role in: 

• The NIH Community Engagement Alliance (CEAL) 

Against COVID-19 Disparities, which aims to 

hormone that reduces inflammation, which can lead to 

an increased risk for atherosclerosis. 

• Researchers supported by NCSDR discovered the genes 

and cellular pathways that regulate the body’s internal 

clock, earning them the 2017 Nobel Prize in medicine. 

Blood Health 

• The Cure Sickle Cell Initiative is working to bring 

new gene-based therapies into clinical trials, and a 

collaboration with the Bill & Melinda Gates Foundation 

will help bring these cures to low-resource 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 

reach of 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 and 

Strong Heart Study are shedding light on heart 

disease risk in African Americans and American Indians, 

respectively. 

• The newly established RURAL study will focus on the 

lung and heart health of people living in rural counties 

of the Southeastern United States. 

• 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. 

reduce the impact of COVID-19 on the hardest hit 

communities by providing accurate, timely information 

about COVID-19 research and preventive measures, 

including vaccines. 

• An initiative launched in February 2021 to address 

“Long COVID” and other unexplained symptoms 

that can persist or appear long after acute SARSCoV-2 infection, known as post-acute sequelae 

of SARS-CoV-2 (PASC). 
 

 

 

 

 

 

 

 

 

 

Major Changes in the Fiscal Year 2022 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 2022 budget request for the NHLBI, which 

is $3,845.7 million, an increase of $181.0 million from the FY 2021 Enacted level. In FY 2022, 

the overall increase of 4.9 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 FY 2022 request level, NHLBI will pursue its highest research priorities through strategic 

investments and careful stewardship of the appropriated funds. 

Research Project Grants (RPGs) ($127.7 million; total $2,661.2 million): 

NHLBI will increase total funding for RPGs by 5.0 percent in FY 2022, resulting in funding 

1,013 competing RPGs, approximately 2,844 noncompeting RPG awards, and 193 awards to 

small businesses to stimulate research technology. 

Research Centers (-$3.0 million; total $17.3 million): 

A shift in the receipt of research applications that are normally supported under this mechanism 

to other Program Announcements and/or Funding Opportunity Announcements for research 

projects will reduce funding requirements in this mechanism and increase other research 

mechanisms. 

Other Research ($24.0 million; total $287.2 million): 

NHLBI will increase funding for Other Research by 9.1 percent, which is a $24.0 million 

increase compared to the FY 2021 Enacted level. The increase will support major initiatives and 

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

CEAL initiative is a large part of the increase which targets community engagement in response 

to COVID-19. 

Research and Development (R&D) Contracts ($18.4 million; total $371.2 million): 

NHLBI will increase funding for Research and Development Contracts by 5.2 percent, which is a 

$18.4 million increase compared to the FY 2021 Enacted level of $352.8 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) ($6.9 million; total $237.4 million): 

NHLBI will increase funding for Intramural Research by 3.0 percent, which is a $6.9 million 

increase compared to the FY 2021 Enacted level of $230.5 million. These increases are 

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

and clinical pathology. 

NHLBI-11 
Research Management and Support (RMS) ($4.3million; total $147.2 million): 

NHLBI will increase funding for Intramural Research by 3.0 percent, which is a $4.3 million 

increase compared to the FY 2021 Enacted level of $142.9 million. These increases are 

distributed across all programmatic areas of RMS. 

NHLBI-12 
NATIONAL INSTITUTES OF HEALTH 

National Heart, Lung, and Blood Institute 

Budget Mechanism - Total1 

(Dollars in Thousands) 

MECHANISM FY 2020 Final FY 2021 Enacted FY 2022 President's Budget 

FY 2022 

+/-

FY 2021 Enacted 

Research Projects: 

Noncompeting 

Administrative Supplements 

Competing: 

Renewal 

New 

Supplements 

No. Amount No. Amount No. Amount No. Amount 

2,809 

(140) 

140 

828 

0 

$1,781,079 

21,470 

83,735 

515,482 

0 

2,821 

(105) 

143 

834 

0 

$1,797,063 

15,974 

85,374 

525,571 

0 

2,844 

(106) 

140 

873 

0 

$1,894,505 

14,500 

87,764 

550,287 

0 

23 

(1) 

-3 

39 

0 

$97,442 

-1,474 

2,390 

24,716 

0 

Subtotal, Competing 968 $599,217 977 $610,945 1,013 $638,051 36 $27,106 

Subtotal, RPGs 3,777 $2,401,766 3,798 $2,423,982 3,857 $2,547,056 59 $123,074 

SBIR/STTR 187 109,591 186 109,529 193 114,151 7 4,622 

Research Project Grants 3,964 $2,511,356 3,984 $2,533,511 4,050 $2,661,207 66 $127,697 

Research Centers: 

Specialized/Comprehensive 

Clinical Research 

Biotechnology 

Comparative Medicine 

Research Centers in Minority Institutions 

5 

0 

0 

0 

0 

$15,011 

0 

806 

455 

0 

10 

0 

0 

0 

0 

$19,261 

0 

642 

455 

0 

10 

0 

0 

0 

0 

$16,886 

0 

0 

455 

0 

0 

0 

0 

0 

0 

-$2,374 

0 

-642 

0 

0 

Research Centers 5 $16,271 10 $20,358 10 $17,341 0 -$3,017 

Other Research: 

Research Careers 

Cancer Education 

Cooperative Clinical Research 

Biomedical Research Support 

Minority Biomedical Research Support 

Other 

801 

0 

39 

0 

0 

152 

$141,928 

0 

12,847 

0 

0 

108,298 

779 

0 

39 

0 

0 

152 

$139,820 

0 

10,534 

0 

0 

112,862 

763 

0 

39 

0 

0 

166 

$140,853 

0 

10,268 

0 

0 

136,078 

-16 

0 

0 

0 

0 

14 

$1,033 

0 

-267 

0 

0 

23,216 

Other Research 992 $263,073 970 $263,216 968 $287,199 -2 $23,983 

Total Research Grants 4,961 $2,790,701 4,964 $2,817,085 5,028 $2,965,748 64 $148,663 

Ruth L Kirschstein Training Awards: 

Individual Awards 

Institutional Awards 

FTTPs 

519 

1,500 

$24,822 

94,628 

FTTPs 

521 

1,538 

$25,742 

95,647 

FTTPs 

523 

1,538 

$26,368 

97,766 

FTTPs 

2 

0 

$626 

2,119 

Total Research Training 2,019 $119,450 2,059 $121,389 2,061 $124,134 2 $2,745 

Research & Develop. Contracts 

(SBIR/STTR) (non-add) 

Intramural Research 

Res. Management & Support 

SBIR Admin. (non-add) 

Construction 

Buildings and Facilities 

566 

(8) 

409 

408 

(0) 

$347,093 

(11,090) 

226,275 

141,740 

(581) 

0 

0 

577 

(7) 

467 

495 

(0) 

$352,808 

(10,000) 

230,503 

142,918 

(650) 

0 

0 

596 

(5) 

482 

480 

(0) 

$371,175 

(7,500) 

237,418 

147,206 

(300) 

0 

0 

19 

(-2) 

15 

-15 

(0) 

$18,367 

(-2,500) 

6,915 

4,288 

(-350) 

0 

0 

Total, NHLBI 817 $3,625,258 962 $3,664,703 962 $3,845,681 0 $180,978 

1 All items in italics and brackets are non-add entries. 

NHLBI-13 
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, [$3,664,811,000]$3,845,681,000. 

NHLBI-14 
NATIONAL INSTITUTES OF HEALTH 

National Heart, Lung, and Blood Institute 

Summary of Changes 

(Dollars in Thousands) 

FY 2021 Enacted 

FY 2022 President's Budget 

$3,664,703 

$3,845,681 

Net change $180,978 

CHANGES 

FY2021 Enacted FY 2022 President's Budget Built-In Change from FY 2021 

Enacted 

FTEs Budget Authority FTEs Budget Authority FTEs Budget Authority 

A. Built-in: 

1. Intramural Research: 

a. Annualization of January 2021 pay increase & benefits 

b. January FY 2022 pay increase & benefits 

c. Paid days adjustment 

d. Differences attributable to change in FTE 

e. Payment for centrally furnished services 

f. Cost of laboratory supplies, materials, other expenses, and non-recurring costs 

$91,667 

91,667 

91,667 

91,667 

31,046 

107,790 

$94,408 

94,408 

94,408 

94,408 

32,598 

110,411 

$800 

3,406 

-348 

3,056 

1,552 

-1,550 

Subtotal 

2. Research Management and Support: 

a. Annualization of January 2021 pay increase & benefits 

b. January FY 2022 pay increase & benefits 

c. Paid days adjustment 

d. Differences attributable to change in FTE 

e. Payment for centrally furnished services 

f. Cost of laboratory supplies, materials, other expenses, and non-recurring costs 

$69,436 

69,436 

69,436 

69,436 

3,562 

69,920 

$71,550 

71,550 

71,550 

71,550 

3,740 

71,915 

$6,915 

$598 

2,648 

-264 

-4,208 

178 

4,902 

Subtotal 

Subtotal, Built-in 

$3,853 

$10,769 

CHANGES 

FY2021 Enacted FY 2022 President's Budget Program Change from FY 

2021 Enacted 

No. Amount No. Amount No. Amount 

B. Program: 

1. Research Project Grants: 

a. Noncompeting 

b. Competing 

c. SBIR/STTR 

2,821 $1,813,037 

977 610,945 

186 109,529 

2,844 $1,909,005 

1,013 638,051 

193 114,151 

23 $95,968 

36 27,106 

7 4,622 

Subtotal, RPGs 

2. Research Centers 

3. Other Research 

4. Research Training 

5. Research and development contracts 

3,984 $2,533,511 

10 $20,358 

970 263,216 

2,059 121,389 

577 352,808 

4,050 $2,661,207 

10 $17,341 

968 287,199 

2,061 124,134 

596 371,175 

66 $127,697 

0 -$3,017 

-2 23,983 

2 2,745 

19 18,367 

Subtotal, Extramural 

6. Intramural Research 

7. Research Management and Support 

8. Construction 

9. Buildings and Facilities 

$3,291,282 

FTEs 

467 $230,503 

495 142,918 

0 

0 

$3,461,057 

FTEs 

482 $237,418 

480 147,206 

0 

0 

$169,775 

FTEs 

15 $0 

-15 434 

0 

0 

Subtotal, Program 962 $3,664,703 962 $3,845,681 0 $170,209 

Total built-in and program changes $180,978 

NHLBI-15 
NHLBI-16

Fiscal Year 2020 Budget Graphs

History of Budget Authority and FTEs:

 

Distribution by Mechanism:

Change by Selected Mechanisms:
NHLBI-17
NATIONAL INSTITUTES OF HEALTH 

National Heart, Lung, and Blood Institute 

Budget Authority by Activity1 

(Dollars in Thousands) 

Extramural Research 

Detail 

Center for Translation, Implementation Sciences 

Heart and Vascular Diseases 

Lung Diseases 

Blood Diseases and Resources 

Subtotal, Extramural 

FY 2020 Final FY 2021 Enacted FY 2022 President's 

Budget FY

FY 2022 

+/-

2021 Enacted 

FTE Amount 

$50,973 

1,951,800 

785,516 

468,954 

$3,257,243 

FTE Amount 

$54,506 

1,969,197 

793,724 

473,855 

$3,291,282 

FTE Amount 

$84,163 

2,043,930 

834,667 

498,298 

$3,461,057 

FTE Amount 

$29,657 

74,733 

40,943 

24,443 

$169,775 

Intramural Research 409 $226,275 467 $230,503 482 $237,418 15 $6,915 

Research Management & Support 408 $141,740 495 $142,918 480 $147,206 -15 $4,288 

TOTAL 817 $3,625,258 962 $3,664,703 962 $3,845,681 0 $180,978 

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

NHLBI-18 
 

 

 

 

 

 

 

 

 

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 FY 2022 FY 2022 +/-

FY 2020 Final Enacted President's Budget FY 2021 

BA $3,625,258,000 $3,664,703,000 $3,845,681,000 $180,978,000 

FTE 817 962 962 0 

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

Contracts; Direct Federal/Intramural and Other. 

Program Descriptions and Accomplishments 

Cardiovascular Diseases: The cardiovascular disease (CVD) program provides leadership and 

supports basic, clinical, population, and health services research on the causes, prevention, and 

treatment of cardiovascular diseases, including heart attack and heart failure, high blood 

pressure, stroke, arrhythmias, adult and pediatric congenital heart disease, cardiovascular 

complications of diabetes and obesity, and other CVDs. It also offers research training and 

career development opportunities and supports the development of innovative technologies. 

This program is committed to promoting heart health across the lifespan and reducing the burden 

of CVD, which is the number one cause of death for men and women in the United States— 

about one of every three deaths in 2017. As part of this commitment, the program supports 

clinical trial networks that test interventions, devices, and procedures to improve treatment of 

heart and vascular diseases. As one example, for decades, there has been uncertainty about how 

to treat the most deadly and common type of heart disease—ischemic (or coronary) heart 

disease—in which the arteries become blocked and cannot pump enough blood to the heart. The 

NHLBI’s International Study of Comparative Health Effectiveness with Medical and Invasive 

Approaches (ISCHEMIA) was designed to compare two common approaches for managing 

ischemic heart disease. In this study of over 5,000 patients, about half were treated with an 

invasive approach that included stenting, bypass surgery, and medications, while the other half 

were treated with lifestyle changes and medications but not surgery. The study found that both 

approaches produced similar outcomes after three years of follow-up. However, the invasive 

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approach offered better symptom relief and quality of life for patients with chest pain.16,17 These 

results will help inform decisions about the best treatment optionsfor each patient. 

In 2019, NHLBI renewed its commitment to the Cardiothoracic Surgical Trials Network 

(CTSN), which brings together scientists and surgeons at medical sites across the country to 

move research from the proof-of-concept stage into clinical trials. A new phase 3 trial will 

examine how to manage patients after coronary artery bypass surgery, in which blood vessels 

from elsewhere in the body are rerouted or transplanted to substitute for blocked coronary 

arteries. After this surgery, many patients develop atrial fibrillation (AFib)—an abnormal heart 

rhythm that can lead to heart attack and stroke—which is treated with antiplatelet therapies such 

as aspirin. The PACeS trial is evaluating whether adding oral anticoagulants (blood thinners) to 

antiplatelet therapy can further reduce the risk of heart attack and stroke for such patients.18 

NHLBI is also robustly addressing how to prevent or improve outcomes for the 6.2 million 

adults living with heart failure (HF), in which the heart fails to pump enough blood to meet the 

body’s needs. In HF with preserved ejection fraction (HFpEF), the heart contracts normally, but 

fills with blood too slowly. It accounts for about 50 percent of all HF and has limited treatment 

options. In 2020, NHLBI announced HeartShare, a new funding opportunity to conduct largescale analysis of clinical, laboratory, and imaging data from patients with HFpEF to characterize 

mechanisms of disease and identify therapeutic targets.19 NHLBI also initiated a Big Data 

challenge competition calling upon researchers to mine data from past and ongoing HF studies to 

define subtypes of adult HF and new subtype-specific approaches to managing the disease.

20 

The five winners were announced in November 2020. 

New state-of-the-art cardiac imaging tools are enabling clinicians to more rapidly diagnose and 

treat patients with a number of heart disorders, including cardiac arrhythmia (irregular heartbeat). 

Locating the origin of an arrhythmia within the heart is often important for treatment. An 

NHLBI-funded team recently developed a technique that uses ultrasound to see electrical waves 

moving through the heart with each beat, called electromechanical wave imaging (EWI). In a 

study of 55 patients, they found that EWI successfully located 96 percent of arrythmias, while 

standard electrocardiography (ECG), which uses electrodes to record heartbeats, had a success 

rate of 71 percent.21 Other new artificial intelligence (AI) technologies are able to analyze 

conventional ultrasound images of the heart (echocardiogram) and identify subtle signs of heart 

disease that are missed by standard techniques.22 

Another technology with the potential to transform CVD treatment is 3D-bioprinting, which can 

be used to generate heart and vascular (blood vessel) tissue. In one recent study, researchers 

designed a bioprinting device that uses fractal geometry to build simple organic resins into 

16 pubmed.ncbi.nlm.nih.gov/32227755/ 17 pubmed.ncbi.nlm.nih.gov/32227753/ 18 clinicaltrials.gov/ct2/show/NCT04045665 19 grants.nih.gov/grants/guide/rfa-files/RFA-HL-21-015.html 20 nhlbi.nih.gov/grants-and-training/funding-opportunities-and-contacts/NHLBI-heart-failure-data-challenge 21 pubmed.ncbi.nlm.nih.gov/32213631/ 22 pubmed.ncbi.nlm.nih.gov/32269341/ 

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RAPID RESEARCH TO ADDRESS THE 

HEALTH EFFECTS OF VAPING 

Electronic (e-)cigarettes, which became available to 

U.S. consumers in 2007, work by heating liquids that 

typically contain nicotine and other additives to 

produce a smokeless aerosol. E-cigarette use, or 

vaping, was steadily embraced as a healthy alternative 

to conventional cigarettes,1 especially among young 

people, and by 2019, one in four 12th graders reported 

having vaped in the past 30 days.2 In spring 2019, the 

health risks of vaping came into tragic focus when 

reports began to emerge of e-cigarette, or vaping, 

product use-associated lung injury (EVALI). NHLBI 

has a legacy of supporting high-impact research on 

tobacco, including studies that linked conventional 

smoking to chronic diseases. Thanks to these 

continuing investments, the Institute prepared to 

address EVALI. For example, by November 2019,

data from the Centers for Disease Control and 

Prevention had linked many EVALI cases to use of 

vaping liquids containing tetrahydrocannabinol 

(THC)—the active ingredient in marijuana—as well as 

vitamin E acetate—an agent used to dilute THC.3 

NHLBI-funded researchers quickly pursued these 

leads, and in February 2020, reported that e-cigarette 

vapor containing vitamin E acetate causes lung injury 

in mice similar to that seen in EVALI patients.4 These 

strong links between vitamin E acetate and EVALI led 

the Food and Drug Administration (FDA) to advise that 

vitamin E acetate should not be used in vaping 

products. Although EVALI cases subsided in late 

2019, the long-term health risks from vaping remain 

largely unknown, and NHLBI continues to provide 

robust support for research on this topic. Researchers 

and federal officials convened by NHLBI have 

proposed resources to help speed progress, including 

patient questionnaires to better characterize vaping 

behaviors, and systems to share data and specimens.5 

1 pubmed.ncbi.nlm.nih.gov/27890516/ 

2 pubmed.ncbi.nlm.nih.gov/31532955/ 

3 cdc.gov/mmwr/volumes/68/wr/mm6845e2.htm 

4 pubmed.ncbi.nlm.nih.gov/32101656/ 5 pubmed.ncbi.nlm.nih.gov/32243764/ 

complex tubular networks that mimic human 

vascular networks,such as an artificial 

network of lung alveoli (air sacs) surrounded 

by vasculature.

23 Others have developed an 

approach to print 3D collagen, the main 

protein in the body’s fibrous tissues, and then 

embed cells within it to produce several 

complex heart tissues including capillaries, 

valves, and ventricles.24 Such techniques 

could one day be used to repair damaged heart 

or vascular tissue, or to engineer bioartificial 

hearts. 

Budget Policy: 

The FY 2022 President’s Budget request is 

$2,043.9 million, an increase of $74.7 million 

or 3.8 percent compared with the FY 2021 

Enacted level. 

Lung Diseases: Since its inception in 1969, 

the NHLBI’s Division of Lung Diseases has 

focused on translating basic scientific 

research into more effective treatments and 

patient care. The lung program supports 

research on the causes, diagnosis, prevention, 

and treatment of lung diseases and sleep 

disorders, while also supporting the 

researchers of the future. Some areas covered 

include asthma, chronic obstructive 

pulmonary disease (COPD), cystic fibrosis, 

sleep-disordered breathing, acute lung injury, 

pulmonary complications of HIV/AIDS, 

pediatric lung diseases, pulmonary fibrosis 

and other rare lung disorders, including 

lymphangioleiomyomatosis. 

Asthma is the most prevalent chronic respiratory disease worldwide. It can profoundly affect 

quality of life and is a major contributing factor to missed time from school and work. Decades 

ago, NHLBI helped bring inhaled corticosteroids into the clinician’s toolbox for asthma, and the 

Institute now supports research to more precisely tailor interventions based on growing 

knowledge about the variable symptoms, severity, and underlying mechanisms of asthma. The 

PrecISE clinical trial network, with 30 locations across the country, will evaluate several novel 

and approved treatments for asthma by targeting them to defined groups of patients who share 

23 pubmed.ncbi.nlm.nih.gov/31048486/ 24 pubmed.ncbi.nlm.nih.gov/31371612/ 

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similar characteristics, such as genetic factors or biomarkers. The need for more personalized 

treatments is especially important in light of new findings showing that a variety of patient 

characteristics—such as ethnicity, overweight/obesity, and sensitivity to household allergens— 

can influence susceptibility to asthma as well as its severity.25, 26 In 2020, NHLBI also led an 

update of the 2007 national asthma guidelines, which help health care providers and patients 

make treatment decisions. The updated recommendations include guidance on the use of a new 

inhaled medication, immunotherapy or “allergy shots” (injections of an allergen to desensitize 

the body), and reducing indoor allergens. 

The lung program also supports vigorous research to address chronic obstructive pulmonary 

disease (COPD), the fourth leading cause of death and third leading cause of disability in the 

U.S. NHLBI partnered with federal partners, voluntary health organizations, and communities 

across the country to develop and release the COPD National Action Plan in 2017 and continues 

to move ahead with its implementation. In 2021, NHLBI will launch an online tracking system 

to enable all partners to track and share progress. A major priority is to reduce the burden of 

COPD in rural and underserved communities, in part by improving the use of pulmonary 

rehabilitation. Although pulmonary rehab has been associated with lower mortality from COPD, 

less than four percent of eligible patients use it.27 NHLBI-funded researchers are studying 

approaches to increase access and adherence to pulmonary rehab, for example, through homebased visits, coaching, and telehealth. NHLBI also continues to make progress unraveling the 

complex causes of COPD. For example, while smoking is the biggest known risk factor, one in 

four people with the disease have never smoked.28 Recently, NHLBI-funded researchers 

addressed this mystery by analyzing lung scans from 6,529 smoking and non-smoking adults 

with COPD. They found that people with small airways relative to lung size were more likely to 

have the disease—even if they did notsmoke or have other risk factors.29 This growing 

knowledge about early risk factors and signs of COPD will enable earlier treatment and better 

outcomes. 

Recognizing that lung transplantation could be a cure for millions of patients with COPD and 

other advanced lung diseases, the lung division is committed to advancing this approach. While 

organ transplant outcomes have steadily improved in recent years, the mortality rate for lung 

transplants remains nearly twice as high as for heart, liver, and kidney transplants. To accelerate 

advances in lung transplantation, NHLBI is establishing a multi-site Lung Transplant 

Consortium that will harmonize clinical studies across lung transplant centers. 30 An NHLBIfunded study is also following more than 3,000 patients who have undergone a lung transplant to 

understand chronic lung allograft dysfunction (CLAD), where the transplanted lung does not 

function properly.31 Others are conducting a trial to determine if a biologic approved for use in 

kidney transplants will help reduce CLAD and improve outcomes for lung transplants. 32 

25 pubmed.ncbi.nlm.nih.gov/32369487/ 26 pubmed.ncbi.nlm.nih.gov/32479111/ 27 pubmed.ncbi.nlm.nih.gov/32396181/ 28 cdc.gov/mmwr/volumes/68/wr/mm6824a1.htm?s_cid=mm6824a1_w 29 pubmed.ncbi.nlm.nih.gov/32515814/ 30 grants.nih.gov/grants/guide/notice-files/NOT-HL-20-752.html 31 projectreporter.nih.gov/project_info_description.cfm?aid=9952409&icde=50515953 32 reporter.nih.gov/search/vKC8eTko8USDsoXGSB7Veg/projects 

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The lung program has played a significant role in developing effective therapies for cystic 

fibrosis (CF). The program has supported decades of basic research to understand the structure 

and function of the CFTR (cystic fibrosis transmembrane conductance regulator), a lung protein 

that is genetically altered in CF. This work paved the way for industry development of ivacaftor, 

the first drug to treat the underlying cause of CF, approved by the U.S. Food and Drug 

Administration (FDA) in 2012. 33 More recently, NHLBI supported clinical trials that led to 

approval of a triple drug combination that improves lung function in about 90 percent of people 

with CF.34, 35 

Sleep is another important component of the lung division’s portfolio. Insufficient sleep is one 

of the most common health complaints in the United States and is a risk factor for diabetes, 

hypertension, obesity, and other life-threatening conditions. An NHLBI-funded study of nearly 

2,000 middle-aged adults showed that compared to people with regular bedtimes and sleep 

duration, people with the most irregular sleep patterns had more than twice the risk of CVD after 

five years of follow-up.36 As new sleep findings emerge from NHLBI-funded studies, they are 

uploaded to NHLBI’s BioData Catalyst platform, so that researchers can share and analyze the 

data collaboratively to speed advances in sleep research. 

Budget Policy: 

The FY 2022 President’s Budget request is $834.7 million, an increase of $40.9 million or 5.2 

percent compared with the FY 2021 Enacted level. 

Blood Diseases: NHLBI’s blood program is a leader in research on the causes, prevention, and 

treatment of congenital and acquired blood diseases, including anemias, venous 

thromboembolism, hemophilia, malaria, and other bleeding disorders. The program also helps 

ensure the safety of the world’s blood supply and supports stem cell biology and new gene and 

cell-based therapies to repair and regenerate human tissues. 

For decades, the blood program has been the leading supporter of research on sickle cell disease 

(SCD), which is caused by gene mutations that affect the oxygen-carrying protein hemoglobin 

(Hb) in red blood cells. The cells take on a sickle shape and can clog blood vessels, which can 

lead to severe pain (called crisis), infections, organ damage, and stroke. While transplantation of 

healthy bone marrow (where red blood cells are made) can cure SCD, this treatment is not an 

option for most patients, since it requires an immune-matched bone marrow donor. NHLBI 

launched the Cure Sickle Cell Initiative in 2018 to support the development of gene-based 

cures for SCD that will work for everyone. The initiative includes an analysis to ensure that new 

therapies will be beneficial to patients in ways that matter to them, including affordability and 

accessibility. Researchers involved in the Cure initiative helped develop an accurate, affordable, 

easy-to-use device for point-of-care diagnosis of SCD in low-resource areas.37 NHLBI is also 

33 ncbi.nlm.nih.gov/pmc/articles/PMC6909826/ 34 pubmed.ncbi.nlm.nih.gov/31697873/ 35 pubmed.ncbi.nlm.nih.gov/31679946/ 36 pubmed.ncbi.nlm.nih.gov/32138974/ 37 pubmed.ncbi.nlm.nih.gov/32123889/ 

NHLBI-23 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

an integral part of a collaboration between NIH and the Bill & Melinda Gates Foundation to 

develop accessible, safe, and effective gene-based cures for SCD in sub-Saharan Africa. 

Researchers also continue to unravel the mechanisms of SCD to inform new therapies. Using a 

mouse model, one team recently found that SCD causes abnormal twists and turns in the blood 

vessels that supply bone marrow, where red blood cells are made. These disorganized blood 

vessels deprive the bone marrow of oxygen and could complicate efforts to restore normal red 

blood cells to patients, such as through bone marrow transplantation or gene therapy. However, 

the researchers also found that six weeks of blood transfusion restored normal blood vessel 

architecture in the mice’s bone marrow, suggesting a similar protocol could be used as part of 

cell-and gene-based therapies in patients to improve outcomes.38 

In addition to gene- and cell-based therapies for SCD, NHLBI supports research into new drug 

treatments. Since 2017, the FDA has approved two new drugs to treat SCD. Through its small 

business program and later through the SUSTAIN clinical trial, NHLBI supported development 

of crizanlizumab-tmca, which helps prevent red blood cells from sticking to the blood vessel 

wall. 39 NHLBI and NIH basic research funding on Hb structure and function also contributed to 

the development of voxelotor, which improves the ability of Hb to carry oxygen. 

Finally, the blood program supports research to improve care for patients who are struggling 

with SCD now. Many patients with SCD do not receive interventions proven to reduce pain and 

the risk of stroke, and some have difficulty or concern regarding side effects. To move proven 

interventions into broader practice, NHLBI established eight geographically diverse centers that 

comprise the Sickle Cell Implementation Consortium. A recent Consortium survey of 440 

adolescents and adults with SCD found that most were pleased with their primary care, but had 

negative experiences with emergency care for sickle cell crisis.40 A new Consortium study is 

testing an approach to help patients receive faster treatment for crisis by embedding each 

patient’s individualized pain treatment plan in their electronic health record so that it can be 

pulled up quickly on a cell phone or tablet during emergency care. In another study, researchers 

have worked closely with patients to develop a smartphone app to improve adherence to 

hydroxyurea, a drug proven to reduce crises; the app is now being tested in a clinical trial.41 

The blood program also supports research to protect the Nation’s blood supply, and to improve 

the safety and efficacy of blood transfusions, through the Recipient Epidemiology and Donor 

Evaluation Study (REDS). For example, REDS recently found that iron supplements can help 

correct iron deficiencies in people who donate whole blood frequently,42 and that a donor’s 

health-related habits (such as smoking, or drinking caffeine or alcohol) can impact the quality of 

stored donated blood and transfusions. 43 The REDS program also has been leveraged to help 

determine how many people in the U.S. have developed antibodies to SARS-CoV-2. These 

antibodies are an important indicator not only of past SARS-CoV-2 infection, but also the body’s 

38 ncbi.nlm.nih.gov/pmc/articles/PMC7273832/ 39 pubmed.ncbi.nlm.nih.gov/27959701/ 40 pubmed.ncbi.nlm.nih.gov/32469413/ 41 pubmed.ncbi.nlm.nih.gov/32383683/ 42 pubmed.ncbi.nlm.nih.gov/32243609/ 43 pubmed.ncbi.nlm.nih.gov/32385854/ 

NHLBI-24 
 

 

 

 

 

 

 

 

 

 

immune response to it, with implications for vaccine development. REDS has analyzed the 

prevalence of antibodies (seroprevalence) in six cities where COVID-19 was most prevalent 

from March-August 2020, which helped establish a framework for a nationwide COVID19 seroprevalence survey led by the Centers for Disease Control and Prevention. 44 

Budget Policy: 

The FY 2022 President’s Budget request is $498.3 million, an increase of $24.4 million or 5.2 

percent compared with the FY 2021 Enacted level. 

Implementation Science: NHLBI’s Center for Translation Research and Implementation 

Science was established in 2014 to serve as a focal point within the Institute for coordinating and 

advancing research to improve the adoption of evidence-based approaches to treat and prevent 

disease and promote health. The Center supports research that addresses both domestic and 

global health disparities and inequities, and training and career development in this research. 

To date, there have been very few studies focused on the implementation, scale-up, and 

maintenance of delivering new interventions to communities where they are needed, and even 

fewer studies focused on high need, underserved communities. To address this gap, NHLBI 

recently launched the DECIPHeR program, and awarded the first projects in September 2020. 

Seven grantees in different areas of the country will begin working with local communities to 

evaluate a variety of proven interventionsfor conditions such as asthma,CVD, and hypertension. 

In Louisiana, community health workers will partner with local churches to reduce CVD risk in 

African Americans by promoting lifestyle interventions in line with current CVD guidelines 

(e.g., healthy diet, physical activity, smoking cessation, weight loss). 45 In rural Colorado, 

researchers will work with school-based asthma navigators and nurses to test a team approach to 

asthma control in school children.46 In Los Angeles, 51 adult primary care clinics will 

implement culturally tailored multi-level evidence-based strategies to improve blood pressure 

control in this very large, diverse city. 47 

Another implementation research effort is focused on improving diagnosis of a common genetic 

disorder, familial hypercholesterolemia (FH). FH can cause lifelong high levels of LDL (bad) 

cholesterol and lead to premature heart disease. It is estimated that less than 10 percent of people 

with FH have been diagnosed, and among those, only half are on life-saving therapies. Screening 

family members of people with an FH diagnosis (called cascade screening) has proven effective 

at identifying undiagnosed patients, but is often limited in reach given patient privacy laws and 

44 cdc.gov/coronavirus/2019-ncov/cases-updates/blood-bank-serosurvey.html 45 projectreporter.nih.gov/project_info_description.cfm?aid=9931807&icde=51724393 46 projectreporter.nih.gov/project_info_description.cfm?aid=9931020&icde=51724371 47 projectreporter.nih.gov/project_info_description.cfm?aid=10064593&icde=51724340 

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low availability of FH genetic testing in 

some areas. In 2019, NHLBI released a 

new funding opportunity to develop 

solutions to these barriers.48 

The implementation science program also 

supports research to address global health 

disparities, including an effort to address 

HIV/AIDS and associated chronic 

diseases. The emergence of effective 

antiretroviral therapy (ART) for HIV has 

led to a decline in deaths from AIDS 

worldwide, but as people with HIV age, 

they are at higher risk than their peers for 

chronic heart, lung, blood, and sleep 

disorders. A new NHLBI initiative is 

supporting the development of model 

programs to deliver proven prevention and 

treatments for chronic diseases 

associated with HIV among patients in 

low resource settings in Africa; the 

program is funding projects in five African 

countries and a coordinating center in the 

United States. 49 

Budget Policy: 

The FY 2022 President’s Budget request is 

$84.2 million, an increase of $29.7 million 

or 54.4 percent compared with the FY 

2021 Enacted level. This increase will 

support major health initiatives across the 

nation, including significant contributions 

to CEAL and DECIPHeR, which focus on 

health disparities and community 

engagement to ensure treatments and 

interventions that improve population 

health in high-burden communities. 

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, blood and sleep systems. The research portfolio is broad, 

MOBILIZING TO REDUCE SEVERE ILLNESS AND 

DEATH FROM COVID-19 

By late January 2020, with the emergence of the first peerreviewed reports of COVID-19 outcomes in Chinese 

patients, it was clear that the disease attacks multiple 

organs, including the heart and lungs, with potentially fatal 

effects. By February, NHLBI had formed a COVID-19 

response team and developed a strategy to act quickly by 

leveraging existing assets, including clinical trial networks, 

population-based studies, and our talented cadre of 

investigators across the country. The following are early 

milestones. 

• March: NHLBI issued its first funding opportunity to 

address the disease’s impact on the heart, lungs, blood, 

and blood vessels. The COVID-19 Observational 

(CORAL) study was also started to examine 

pathobiology and outcomes among adults hospitalized 

with COVID-19. 

• April: NHLBI launched a clinical trial of 

hydroxychloroquine for hospitalized COVID-19 patients; 

by June, the trial was halted because the drug provided 

no benefit.1 NHLBI also launched a trial to evaluate 

convalescent plasma for mild COVID-19.2 

• July: NHLBI established a “network of networks” 

(CONNECTS) bringing together nearly 30 existing 

clinical trial networks to identify and test potential 

therapies for COVID-19.3 

• September: NIH announced that CONNECTS will 

conduct the ACTIV-4 Antithrombotic clinical trials to test 

blood-clotting regimens against different stages of 

COVID-19.4 To address the disparate burden of COVID19 in communities of color and ensure their inclusion in 

research, NHLBI and NIMHD launched the trans-NIH 

CEAL initiative.5 

• October: The Collaborative Cohort of Cohorts for 

COVID-19 Research (C4R) was formed to leverage 

NHLBI’s ongoing population-based studies to examine 

long-term outcomes of SARS-CoV-2 infection, as well as 

factors that affect risk and resilience to severe illness. 

NHLBI also co-funded a five-year study to understand a 

pediatric disease associated with COVID-19, 

multisystem inflammatory syndrome in children (MIS-C) 

As our knowledge about COVID-19 evolves, NHLBI will 

continue to pursue the most promising scientific leads and 

potential therapies, and shed light on the long-term health 

impacts of SARS-CoV-2. 

1 clinicaltrials.gov/ct2/show/NCT04332991 

2 clinicaltrials.gov/ct2/show/NCT04355767 3 https://nhlbi-connects.org/ 4 go.usa.gov/x7rtU 

5 go.usa.gov/x7rtM 

48 grants.nih.gov/grants/guide/rfa-files/RFA-HL-22-006.html 49 grants.nih.gov/grants/guide/rfa-files/rfa-hl-20-025.html 

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ranging from basic research on molecules and cells to clarifying disease mechanisms, to 

establishing new therapies for human diseases through population studies and clinical trials. It 

also has a strong training program. 

For the second time in a decade, NHLBI intramural staff have been on the frontlines responding 

to deadly viruses. In 2014, they made vital contributions to understand and control a deadly 

outbreak of Ebola virus in West Africa. Now DIR investigators have been working tirelessly to 

address the global COVID-19 pandemic. In February 2020, the NHLBI clinical director led an 

international team charged with safely evacuating Americans from a cruise ship off the coast of 

Japan with more than 700 passengers testing positive for COVID-19. This team also provided 

the antiviral drug remdesivir to severely affected patients on a compassionate use basis, helping 

to set the stage for larger randomized clinical trials of the drug.50 In the fall, DIR scientists 

began working with the NIH Clinical Center and industry in a trial to examine how patients with 

severe COVID-19 respond to fostamatinib, a small molecule that can inhibit inflammation and is 

FDA-approved to treat a rare autoimmune blood clotting disorder.51 

Other DIR labs are conducting basic research on COVID-19. For example, one group has been 

working to determine how SARS-CoV-2 exits infected cells and spreads to other cells. Most 

viruses are released from cells by secretory vesicles, small packets that are used to send 

hormones and other signals. However, by studying a stripped down, non-infectious SARS virus, 

DIR researchers found these viruses are instead released from lysosomes52, which are acid-filled 

compartments that degrade waste and toxins, like a garbage disposal. The fact that lysosomes do 

not destroy SARS-CoV-2 suggests the virus might also interfere with their essential cell clean-up 

functions, which may explain some of the disease’s complex symptoms. 

DIR continues to make advances in non-COVID related research, too. For example, DIR 

investigators developed a new type of magnetic resonance imaging (MRI), called quantitative 

myocardial perfusion mapping, that improves identification of patients with heart disease who 

have two or more blocked coronary arteries.53 DIR researchers have also developed new 

biological imaging approaches to visualize the dynamic behavior of mitochondria—the power 

houses within our cells—which may lead to new therapies for mitochondrial disorders, heart 

disease, and muscular dystrophy.54 

Budget Policy: 

The FY 2022 President’s Budget request is $237.4 million, an increase of $6.9 million or 3.0 

percent compared with the FY 2021 Enacted level. 

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

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

50 www.nejm.org/doi/full/10.1056/NEJMoa2007016?query=featured_coronavirus 51 rigel.com/news-events/press-releases/detail/296/rigel-announces-nihnhlbi-sponsored-trial-of-fostamatinib 

52 https://www.nih.gov/news-events/news-releases/nih-scientists-discover-key-pathway-lysosomes-coronavirusesuse-exit-cells. 

53 pubmed.ncbi.nlm.nih.gov/33011115/ 54 pubmed.ncbi.nlm.nih.gov/31706841/ 

NHLBI-27 
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 2022 President’s Budget request is $147.2 million, an increase of $4.3 million or 3.0 

percent compared with the FY 2021 Enacted level. 

NHLBI-28 
NATIONAL INSTITUTES OF HEALTH 

National Heart, Lung, and Blood Institute 

Appropriations History 

Fiscal Year Budget Estimate to 

Congress House Allowance Senate Allowance Appropriation 

2013 $3,076,067,000 $3,085,390,000 $3,079,020,632 

Rescission $6,158,041 

Sequestration ($154,545,663) 

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 

20171 $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 

1 Budget Estimate to Congress includes mandatory financing. 

NHLBI-29 
NHLBI

-30 

NATIONAL INSTITUTES OF HEALTH 

National Heart, Lung, and Blood Institute 

Authorizing Legislation 

PHS Act/ U.S. Code 2021 Amount FY 2021 Enacted 2022 Amount FY 2022 President's Budget 

Other Citation Citation Authorized Authorized 

Research and Investigation Section 301 42§241 Indefinite 

$3,664,703,000 $3,845,681,000

National Heart, Lung, and Blood Institute Section 401(a) 42§281 Indefinite 

Indefinite 

Indefinite 

Total, Budget Authority $3,664,703,000 $3,845,681,000 
NATIONAL INSTITUTES OF HEALTH 

National Heart, Lung, and Blood Institute 

Amounts Available for Obligation1 

(Dollars in Thousands) 

Source of Funding FY 2020 Final FY 2021 Enacted FY 2022 President's 

Budget 

Appropriation 

Secretary's Transfer 

OAR HIV/AIDS Transfers 

$3,624,258 

0 

1,000 

$3,664,811 

0 

-108 

$3,845,681 

0 

0 

Subtotal, adjusted budget authority 

Unobligated balance, start of year 

Unobligated balance, end of year 

$3,625,258 

0 

0 

$3,664,703 

0 

0 

$3,845,681 

0 

0 

Subtotal, adjusted budget authority 

Unobligated balance lapsing 

$3,625,258 

-395 

$3,664,703 

0 

$3,845,681 

0 

Total obligations $3,624,863 $3,664,703 $3,845,681 

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

 FY 2020 - $15,313 FY 2021 - $15,000 FY 2022 - $15,000 

NHLBI-31 
NATIONAL INSTITUTES OF HEALTH 

National Heart, Lung, and Blood Institute 

Budget Authority by Object Class1 

(Dollars in Thousands) 

FY 2021 Enacted FY 2022 President's 

Budget 

FY 2022 

+/-

FY 2021 Enacted 

Total compensable workyears: 

Full-time equivalent 

Full-time equivalent of overtime and holiday hours 

Average ES salary 

Average GM/GS grade 

Average GM/GS salary 

Average salary, Commissioned Corps (42 U.S.C. 

207) 

Average salary of ungraded positions 

962 

1 

$195 

12.8 

$124 

$115 

$132 

962 

1 

$199 

12.8 

$127 

$118 

$135 

0 

0 

$4 

0.0 

$3 

$3 

$3 

OBJECT CLASSES FY 2021 Enacted FY 2022 President's 

Budget 

FY 2022 

+/-

FY 2021 

Personnel Compensation 

11.1 Full-Time Permanent 

11.3 Other Than Full-Time Permanent 

11.5 Other Personnel Compensation 

11.7 Military Personnel 

11.8 Special Personnel Services Payments 

66,754 

35,612 

4,677 

2,264 

11,472 

68,273 

36,423 

4,783 

2,327 

11,733 

1,519 

810 

106 

63 

261 

11.9 Subtotal Personnel Compensation $120,780 $123,539 $2,759 

12.1 Civilian Personnel Benefits 

12.2 Military Personnel Benefits 

13.0 Benefits to Former Personnel 

38,545 

1,778 

0 

40,592 

1,828 

0 

2,047 

49 

0 

Subtotal Pay Costs $161,103 $165,958 $4,855 

21.0 Travel & Transportation of Persons 

22.0 Transportation of Things 

23.1 Rental Payments to GSA 

23.2 Rental Payments to Others 

23.3 Communications, Utilities & Misc. Charges 

24.0 Printing & Reproduction 

25.1 Consulting Services 

25.2 Other Services 

Purchase of goods and services from government 25.3 

accounts 

25.4 Operation & Maintenance of Facilities 

25.5 R&D Contracts 

25.6 Medical Care 

25.7 Operation & Maintenance of Equipment 

25.8 Subsistence & Support of Persons 

1,699 

350 

0 

2 

569 

0 

112,091 

100,478 

205,304 

667 

123,400 

2,355 

15,964 

0 

1,730 

356 

0 

2 

579 

0 

107,940 

102,510 

206,085 

667 

124,516 

2,442 

16,307 

0 

31 

6 

0 

0 

10 

0 

-4,151 

2,031 

781 

0 

1,116 

87 

343 

0 

25.0 Subtotal Other Contractual Services $560,260 $560,467 $208 

26.0 Supplies & Materials 

31.0 Equipment 

32.0 Land and Structures 

33.0 Investments & Loans 

41.0 Grants, Subsidies & Contributions 

42.0 Insurance Claims & Indemnities 

43.0 Interest & Dividends 

44.0 Refunds 

15,009 

5,187 

6,035 

0 

2,914,487 

0 

2 

0 

15,280 

5,281 

6,143 

0 

3,089,882 

0 

2 

0 

271 

94 

109 

0 

175,395 

0 

0 

0 

Subtotal Non-Pay Costs $3,503,600 $3,679,723 $176,123 

Total Budget Authority by Object Class $3,664,703 $3,845,681 $180,978 

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

NHLBI-32 
NATIONAL INSTITUTES OF HEALTH 

National Heart, Lung, and Blood Institute 

Salaries and Expenses 

(Dollars in Thousands) 

OBJECT CLASSES FY 2021 Enacted FY 2022 President's 

Budget 

FY 2022 

+/-

FY 2021 

Personnel Compensation 

Full-Time Permanent (11.1) $66,754 $68,273 $1,519 

Other Than Full-Time Permanent (11.3) 35,612 36,423 810 

Other Personnel Compensation (11.5) 4,677 4,783 106 

Military Personnel (11.7) 2,264 2,327 63 

Special Personnel Services Payments (11.8) 11,472 11,733 261 

Subtotal Personnel Compensation (11.9) $120,780 $123,539 $2,759 

Civilian Personnel Benefits (12.1) 

Military Personnel Benefits (12.2) 

Benefits to Former Personnel (13.0) 

$38,545 

1,778 

0 

$40,592 

1,828 

0 

$2,047 

49 

0 

Subtotal Pay Costs $161,103 $165,958 $4,855 

Travel & Transportation of Persons (21.0) $1,699 $1,730 $31 

Transportation of Things (22.0) 350 356 6 

Rental Payments to Others (23.2) 2 2 0 

Communications, Utilities & Misc. Charges (23.3) 569 579 10 

Printing & Reproduction (24.0) 

Other Contractual Services: 

0 0 0 

Consultant Services (25.1) 112,091 107,940 -4,151 

Other Services (25.2) 100,478 102,510 2,031 

Purchases from government accounts (25.3) 113,226 117,919 4,693 

Operation & Maintenance of Facilities (25.4) 667 667 0 

Operation & Maintenance of Equipment (25.7) 15,964 16,307 343 

Subsistence & Support of Persons (25.8) 0 0 0 

Subtotal Other Contractual Services $342,426 $345,343 $2,917 

Supplies & Materials (26.0) $15,009 $15,280 $271 

Subtotal Non-Pay Costs 

Total Administrative Costs 

$360,055 

$521,159 

$363,290 

$529,248 

$3,235 

$8,090 

NHLBI-33 
NATIONAL INSTITUTES OF HEALTH 

National Heart, Lung, and Blood Institute 

Detail of Full-Time Equivalent Employment (FTE) 

OFFICE/DIVISION 

FY 2020 Final FY 2021 Enacted FY 2022 President's Budget 

Civilian Military Total Civilian Military Total Civilian Military Total 

Center for Translation Research and Implementation Science 

Direct: 

Reimbursable: 

Total: 

Division of Blood and Resources 

Direct: 

Reimbursable: 

Total: 

Division of Cardiovascular Sciences 

Direct: 

Reimbursable: 

Total: 

Division of Extramural Research Activities 

Direct: 

Reimbursable: 

Total: 

Division of Intramural Research 

Direct: 

Reimbursable: 

Total: 

Division of Lung Diseases 

Direct: 

Reimbursable: 

Total: 

Office of the Director 

Direct: 

Reimbursable: 

Total: 

11 

-

11 

24 

-

24 

110 

-

110 

92 

-

92 

382 

14 

396 

33 

-

33 

133 

-

133 

1 

-

1 

1 

-

1 

1 

-

1 

-

-

-

13 

-

13 

-

-

-

2 

-

2 

12 

-

12 

25 

-

25 

111 

-

111 

92 

-

92 

395 

14 

409 

33 

-

33 

135 

-

135 

13 

-

13 

29 

-

29 

129 

-

129 

109 

-

109 

436 

17 

453 

39 

-

39 

171 

-

171 

1 

-

1 

1 

-

1 

1 

-

1 

-

-

-

14 

-

14 

-

-

-

2 

-

2 

14 

-

14 

30 

-

30 

130 

-

130 

109 

-

109 

450 

17 

467 

39 

-

39 

173 

-

173 

13 

-

13 

29 

-

29 

128 

-

128 

109 

-

109 

451 

17 

468 

39 

-

39 

157 

-

157 

1 

-

1 

1 

-

1 

1 

-

1 

-

-

-

14 

-

14 

-

-

-

2 

-

2 

14 

-

14 

30 

-

30 

129 

-

129 

109 

-

109 

465 

17 

482 

39 

-

39 

159 

-

159 

Total 799 18 817 943 19 962 943 19 962 

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 

2018 12.7 

2019 12.7 

2020 12.7 

2021 12.8 

2022 12.8 

NHLBI-34 
NATIONAL INSTITUTES OF HEALTH 

National Heart, Lung, and Blood Institute 

Detail of Positions1 

GRADE FY 2020 Final FY 2021 Enacted FY 2022 President's 

Budget 

Total, ES Positions 

Total, ES Salary 

2 

384,849 

2 

389,236 

2 

398,091 

General Schedule 

GM/GS-15 80 97 97 

GM/GS-14 148 178 178 

GM/GS-13 172 204 204 

GS-12 59 69 69 

GS-11 38 45 45 

GS-10 0 0 0 

GS-9 33 37 37 

GS-8 3 3 3 

GS-7 6 7 7 

GS-6 2 2 2 

GS-5 0 0 0 

GS-4 5 5 5 

GS-3 4 4 4 

GS-2 2 2 2 

GS-1 1 1 1 

Subtotal 553 654 654 

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 6 6 6 

Senior Assistant Grade 1 1 1 

Assistant Grade 0 0 0 

Subtotal 19 19 19 

Ungraded 243 287 287 

Total permanent positions 574 675 675 

Total positions, end of year 817 962 962 

Total full-time equivalent (FTE) employment, end of year 817 962 962 

Average ES salary 

Average GM/GS grade 

Average GM/GS salary 

192,424 

12.7 

121,806 

194,618 

12.8 

124,352 

199,046 

12.8 

127,182 

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

NHLBI-35