National Heart, 

Lung, And Blood 

Institute

CONGRESSIONAL JUSTIFICATION

FY 2024 

Department of Health and Human Services

National Institutes of Health
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DEPARTMENT OF HEALTH AND HUMAN SERVICES

NATIONAL INSTITUTES OF HEALTH

National Heart, Lung, and Blood Institute (NHLBI) 

FY 2024 Budget Table of Contents 

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

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

Major Changes ........................................................................................................................... 9

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

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

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

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

Organization 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

General Notes

1. FY 2023 Enacted levels cited in this document include the effects of the FY 2023

HIV/AIDS transfer, as shown in the Amounts Available for Obligation table.

2. Detail in this document may not sum to the subtotals and totals due to rounding.

Cover page: Under specific laboratory culture conditions, adult mouse cells begin exhibiting 

characteristics of haematopoietic stem cells, as demonstrated by the appearance of CD45 (shown 

in green)—a protein known to be present in haematopoietic stem cells; nuclei are shown in red. 

Source: NHLBI 
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DIRECTOR’S OVERVIEW

Director’s Overview

The National Heart, Lung, and Blood Institute (NHLBI) supports research to prevent and treat 

heart, lung, blood, and sleep disorders. NHLBI’s portfolio includes basic science, 

epidemiological (population) studies, clinical trials, implementation science, health education 

and dissemination efforts, and initiatives in emergent fields such as artificial 

intelligence/machine learning, precision medicine, data science, and new and curative therapies 

for common and rare diseases and conditions. The Institute’s research programs have helped 

improve longevity and quality of life for people in the United States and around the world. 

NHLBI is also focused on reaching communities disproportionately burdened by diseases of the

heart, lung, and blood, as well as sleep disorders. Despite research advances, these disorders 

continue to be among the leading causes of death and disability in the United States.1 In FY

2024, NHLBI will continue to support a robust spectrum of basic and applied research that aims 

to yield effective approaches for the prevention and early diagnosis, and treatment of diseases 

and disorders within our research portfolio, including the largest contributors to death and 

suffering in America.

Capitalizing on Community-Engaged Research to Advance Public Health

In the wake of the coronavirus disease 2019 (COVID-19) pandemic, the scientific community has 

learned a great deal about how to approach critical public health issues that impact vulnerable 

communities and populations. Clinical research is now acknowledging the need to address a 

complex network of influences on health and disease. Many of the diseases in NHLBI’s portfolio 

have an inequitable effect upon people of color, people living in rural communities, and other 

underserved and vulnerable populations, and the road to discovery depends upon the trusting 

participation of these communities in the research enterprise.

In July 2020, NHLBI, along with the National Institute on Minority Health and Health Disparities 

(NIMHD), launched the National Institutes of Health (NIH) Community Engagement Alliance 

(CEAL) Against COVID-19 Disparities.

2 CEAL is an empowering driver of research using 

strategies that address the obstacles limiting participation in, and benefits from, biomedical 

research. The initiative brings together diverse teams that include researchers and trusted 

community partners including community-based organizations, minority professional societies, 

faith-based organizations, and others in communities affected by COVID-19. CEAL has since

evolved into a robust, comprehensive research platform that can be used by other researchers to 

address misinformation, foster trust in science and research, and ensure inclusive participation in 

NIH research.

NHLBI is now leveraging the CEAL community engagement platform for other initiatives,

including the NHLBI Maternal Morbidity and Mortality Community Implementation 

1 nhlbi.nih.gov/heart-lung-blood-sleep-data 2 covid19community.nih.gov/
NHLBI-4

Program, the NIH Implementing a Maternal health and PRegnancy Outcomes Vision for 

Everyone (IMPROVE) Initiative, and the NIH Climate Change and Health Initiative. 

3,4,5

The World Health Organization describes climate change as the biggest threat to human health 

and well-being moving into the future. Both short- and long-term effects will lead to increases in 

the incidence and worsening of chronic diseases within NHLBI’s portfolio, including 

cardiovascular disease, respiratory conditions, and sleep disorders. Social determinants of health

play a significant role in the effect of climate change, as low-income communities and 

communities of color will be disproportionately affected. NHLBI understands the important role 

it has to play in this massive challenge, and recognizes the value of leveraging communityengaged research platforms that evolved during the pandemic for other public issues. For this 

reason, NHLBI has provided significant funding to NIH’s Alliance for Community 

Engagement-Climate and Health (ACE-CH) initiative. The Institute will also leverage CEAL 

as a research platform to strengthen community-based interventions. These interventions can 

raise awareness about climate stressors on health, and working to understand and build resilience 

in communities at highest risk.

Supporting Diversity, Equity, Inclusion, and Access Across the Research Enterprise

Studies show that teams that embrace diversity at every level of the research endeavor produce 

more, and more significant, scientific breakthroughs.6 NHLBI believes that diversity isn’t limited 

to researchers; it includes everyone who participates at every level of the research enterprise. 

Inclusive collaboration and co-creation posits members of communities and affected populations 

as partners from the formulation of the research questions, through the planning, design, and 

implementation of research protocols, and to the interpretation and dissemination of findings.

Results from several NHLBI community-embedded initiatives launched in 2020 in response to the 

COVID-19 pandemic have illuminated the importance of implementation science strategies to 

improve community health and increase resilience in populations most vulnerable to the unequal 

burdens of diseases. This fundamentally changes the meaning of a multidisciplinary research team; 

it now includes not only a diversity of scientific expertise and skills, but, equally as important, the 

viewpoints and inputs of people in and across diverse communities, whose differing life 

experiences add crucial insights into how to tackle complex health conditions.

For example, since its inception in 2021, the NIH Researching COVID to Enhance Recovery 

(RECOVER) initiative has depended upon the input and support of those most affected by Long

COVID: the people living with the condition. The initiative has evolved a robust patient and 

community engagement approach unprecedented for NIH. Grounded in evidence-based 

approaches to patient engagement, RECOVER puts patients and community representatives from 

all walks of life at the core of its governance structure and across the research enterprise. This 

large-scale, diverse representation ensures that the voices of those disproportionately affected by 

COVID-19 meaningfully contribute their viewpoints to the research endeavor.

3 maternalhealthcip.org/

4 grants.nih.gov/grants/guide/notice-files/NOT-OD-20-104.html 5 nhlbi.nih.gov/sites/default/files/media/docs/ACE_CH_ROA_6_08_2022_FINAL.pdf

6 https://academic.oup.com/jid/article/220/Supplement_2/S33/5552350
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NHLBI continues to further its commitment to increasing diversity in the research workforce. The 

Mentored Career Development Award to Promote Faculty Diversity in Biomedical 

Research provides funding for mentoring opportunities to highly trained investigators from 

groups underrepresented in research areas of interest to NHLBI.

7 Additionally, Programs to 

Increase Diversity among Individuals Engaged in Health-Related Research (PRIDE) offers 

hands-on, mentored research lab experiences, small project awards for pilot research, and grant 

writing courses for junior faculty and transitioning post-doctoral candidates from diverse 

backgrounds.

8 NHLBI is committed to sustaining a pipeline for biomedical research 

professionals. As these programs make critical strides in recruiting and nurturing the next 

generation of scientists from backgrounds historically underrepresented in biomedical research, 

NHLBI is also garnering additional pathways toward scientific careers as the communityengaged research initiatives harness the excitement of younger scientific minds in a quest to 

tackle health disparities.

Fostering Key Partnerships and Leveraging Platforms to Address Complex Diseases

The future of biomedical research is collaborative and dependent upon multidisciplinary teams 

with the expertise to answer complex questions about common and rare diseases. For example, 

more than 6.2 million adults in the United States have heart failure. Roughly half of them have 

heart failure with preserved ejection fraction (HFpEF). In HFpEF, the heart muscle contracts 

normally, but the walls of the heart’s chambers (ventricles) are thicker and stiffer than usual and 

can’t relax enough between heart beats to adequately fill with blood. Death rates are higher for 

this type of heart failure because of the reduction in the amount of blood available to pump 

through the body. Years of NHLBI research has confirmed that HFpEF is the result of the 

interplay of impairments in cardiac, pulmonary, renal, musculoskeletal, and vascular function. 

This makes HFpEF a complicated disease to address.

Given its complex nature, HFpEF required a strategic, multidisciplinary approach to accelerate 

the development of treatments. In 2020, NHLBI launched HeartShare, an initiative that set up 

clinical centers across the country to collect a wide range of clinical, laboratory, and imaging 

data from people with and without HFpEF.

9,10 It has established collaborative networks of 

researchers and given them a collection and analysis hub that provides access to advanced data 

science tools and strategies that will help identify biological targets that could be used to develop 

therapeutic drugs or other interventions.

Building on this collaborative research platform, in September 2022, NHLBI and the Foundation 

for the National Institutes of Health (FNIH) tapped into the Accelerating Medicines 

Partnership® (AMP®). AMP is a public-private partnership between NIH, the U.S. Food and 

Drug Administration (FDA), and biopharmaceutical and life science companies that integrates 

their distinct resources and expertise about drug discovery and development into established 

NHLBI programs and initiatives. This new program, known as AMP Heart Failure, is forming

working groups to systematically analyze data from HeartShare, Trans-Omics for Precision 

7 grants.nih.gov/grants/guide/rfa-files/RFA-HL-22-010.html 8 nhlbi.nih.gov/grants-and-training/training-and-career-development/diversity/pride 9 grants.nih.gov/grants/guide/rfa-files/rfa-hl-21-015.html 10 grants.nih.gov/grants/guide/rfa-files/RFA-HL-21-016.html
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Medicine (TOPMed), and other NHLBI resources to turn discovery of novel therapeutic targets 

into safe and effective treatments.

Developing Targeted Preventions and Cures

While heart health is important at every stage of life, it is especially crucial immediately before, 

during, and after pregnancy. Recent research shows that approximately half of all American 

women have at least one risk factor for heart disease (such as high blood pressure, diabetes, or 

overweight/obesity) before pregnancy. Members of certain racial and ethnic groups have 

disproportionately high rates of these risk factors. NHLBI’s Chronic Hypertension and 

Pregnancy (CHAP) trial seeks to prevent adverse pregnancy and fetal growth outcomes due to 

mild chronic hypertension by focusing on interventions to safely control the condition during 

pregnancy. Recent results from this study have shown that treatment for mild chronic 

hypertension leads to better pregnancy outcomes and has no negative effect on fetal growth, a 

concern that had previously constrained interventions.11 This discovery has been so significant 

that it led to immediate changes in the American College of Obstetricians and Gynecologists’ 

clinical practice guidelines for treatment of mild chronic hypertension during pregnancy.12

NHLBI has always supported research to improve the lives of people with sickle cell disease 

(SCD), an inherited blood disorder that often leads to chronic pain, organ failure, and premature 

death. SCD affects 100,000 people in the United States and millions worldwide, with most cases 

in people of African descent (including African Americans). Scientific progress to date situates 

the research enterprise in a position to support the development of genetic-based curative 

strategies through interactions with scientific and patient communities. The NHLBI Cure Sickle 

Cell Initiative focuses on curative gene therapies while further examining SCD in a 

comprehensive manner by considering the total effect on a patient in areas such as mental health 

and the cost of living with the disease. As part of the Initiative, NHLBI is conducting clinical 

trials for potential curative therapies. NHLBI researchers are now using the ReFRAME Drug 

Repurposing Library, which looks at already FDA-approved drugs with the potential to treat 

SCD pain, to find more cost-effective options for relief.13

Additionally, researchers are using cutting-edge technology to create molecular and cellular 

maps of the human body. This year, the NHLBI-funded LungMAP Consortium, a group of 

researchers and experts in the pulmonary biology community, synthesized current data into a 

comprehensive and practical cellular census of the lung.

14 This flagship program will lead to 

novel therapeutic targets for lung diseases.

These scientific approaches leverage the latest technologies to redefine biomedical research for 

the 21st century. By actively engaging communities, supporting diversity at all levels of the 

research enterprise, and fostering new and diverse types of partnerships—all while continuing to 

invest in critical research—the Institute is leaning in to wield scientific findings to accelerate 

discoveries for the enhancement of public health.

11 .nejm.org/doi/full/10.1056/NEJMoa2201295 12 acog.org/clinical/clinical-guidance/practice-advisory/articles/2022/04/clinical-guidance-for-the-integration-of-thefindings-of-the-chronic-hypertension-and-pregnancy-chap-study 13 pnas.org/doi/10.1073/pnas.2210779119?cookieSet=1#core-collateral-metrics 14 sciencedirect.com/science/article/pii/S1534580721008923?via%3Dihub
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FY 2023 CONGRESSIONAL JUSTIFICATION FACT SHEET
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MAJOR CHANGES

Major Changes in the 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 2024 budget request for the NHLBI, which 

is $3,985.2 million, which is the same as the FY 2023 Enacted level. 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) (-$6.0 million; total $2,750.8 million):

NHLBI will slightly decrease funding for RPGs in FY 2024, supporting 1,059 competing RPGs 

and 2,880 noncompeting RPG awards, and 199 awards to small businesses to stimulate research 

technology in key strategic areas.

Research Centers (-$6.9 million; total $9.6 million):

NHLBI will decrease funding for Centers by 42.0 percent, which is a $6.9 million decrease 

compared to the FY 2023 Enacted level. The total funding will support the continuation of major 

initiatives for all programmatic areas and basic, translational and clinical research.

Research Training ($1.2 million; total $123.0 million):

NHLBI will increase funding for Research Training by 1.0 percent, a $1.2 million increase 

compared to the FY 2023 Enacted Level of $121.8 million. These increases are to support 

general annual adjustments for trainees, and to continue stimulating research training focused on 

strategic priorities and programmatic goals.

Intramural Research (IR) ($5.7 million; total $258.8 million):

NHLBI will increase funding for Intramural Research by 2.2 percent, which is a $5.7 million 

increase compared to the FY 2023 Enacted Level of $253.2 million. These increases 

accommodate proposed pay increases for IR staff, changes in NIH-wide assessments on the IR 

program, and other inflationary costs.

Research Management and Support (RMS) ($4.9 million; total $161.5 million):

NHLBI will increase funding for Research Management Support by 3.1 percent, which is a $4.9 

million increase compared to the FY 2023 Enacted level of $156.6 million. These increases 

accommodate proposed pay increases for RMS staff, changes in NIH-wide assessments on the 

RMS program, and other inflationary costs.
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BUDGET MECHANISM TABLE

NATIONAL INSTITUTES OF HEALTH

National Heart, Lungs, and Blood Institute

Budget Mechanism*

(Dollars in Thousands)

Mechanism

FY 2022 Final FY 2023 Enacted FY 2024 President's 

Budget FY 2024 +/- FY 2023

Number Amount Number Amount Number Amount Number Amount

Research Projects: - - - - - - - -

Noncompeting 2,853 $1,876,959 2,894 $1,936,585 2,880 $1,935,713 -14 -$872

Administrative Supplements (191) $16,018 (175) $14,663 (90) $7,500 -(85) -$7,163

Competing: - - - - - - - -

Renewal 140 $96,724 145 $101,173 143 $101,679 -2 $506

New 844 $520,508 927 $577,595 916 $578,483 -11 $888

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

Subtotal, Competing 984 $617,233 1,072 $678,768 1,059 $680,162 -13 $1,394

Subtotal, RPGs 3,837 $2,510,210 3,966 $2,630,017 3,939 $2,623,376 -27 -$6,641

SBIR/STTR 192 $121,936 199 $126,813 199 $127,447 0 $634

Research Project Grants 4,029 $2,632,146 4,165 $2,756,830 4,138 $2,750,823 -27 -$6,007

Research Centers - - - - - - - -

Specialized/Comprehensive 6 $15,761 6 $16,486 3 $9,564 -3 -$6,922

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

Biotechnology 0 $0 0 $0 0 $0 0 $0

Comparative Medicine 0 $455 0 $0 0 $0 0 $0

Research Centers in Minority 

Institutions 0 $0 0 $0 0 $0 0 $0

Research Centers 6 $16,216 6 $16,486 3 $9,564 -3 -$6,922

Other Research: - - - - - - - -

Research Careers 804 $133,827 816 $135,983 816 $136,662 0 $680

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

Cooperative Clinical Research 39 $10,268 42 $11,389 42 $11,446 0 $57

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

Minority Biomedical 

Research Support 0 $1,484 0 $1,484 0 $1,484 0 $0

Other 155 $153,040 160 $158,755 158 $158,549 -2 -$206

Other Research 998 $298,618 1,018 $307,611 1,016 $308,141 -2 $531

Total Research Grants 5,033 $2,946,980 5,189 $3,080,927 5,157 $3,068,528 -32 -$12,398

Ruth L Kirschstein Training 

Awards: FTTPs - FTTPs - FTTPs - FTTPs -

Individual Awards 511 $24,693 531 $26,194 526 $26,456 -5 $262

Institutional Awards 1,370 $91,063 1,410 $95,612 1,396 $96,569 -14 $956

Total Research Training 1,881 $115,756 1,941 $121,807 1,922 $123,025 -19 $1,218

Research & Develop. 

Contracts 898 $356,216 912 $372,660 891 $373,312 -21 $652

SBIR/STTR (non-add) (3) ($2,663) (3) ($2,786) (3) ($2,800) (0) ($14)

Intramural Research 500 $241,213 502 $253,168 502 $258,826 0 $5,658

Res. Management & Support 399 $150,206 464 $156,596 464 $161,467 0 $4,871

SBIR Admin. (non-add) - ($261) - ($375) - ($383) - ($8)

Construction - $0 - $0 - $0 - $0

Buildings and Facilities - $0 - $0 - $0 - $0

Total, NHLBI 899 $3,810,371 966 $3,985,158 966 $3,985,158 0 $0

*All items in italics and brackets are non-add entries
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APPROPRIATIONS LANGUAGE

NATIONAL INSTITUTES OF HEALTH

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, [$3,982,345,000]$3,985,158,000.
NHLBI-12

SUMMARY OF CHANGES

NATIONAL INSTITUTES OF HEALTH

National Heart, Lungs, and Blood Institute

Summary of Changes

(Dollars in Thousands)

FY 2023 Enacted $3,985,158

FY 2024 President’s Budget $3,985,158

Net change $0

CHANGES

FY 2023 Enacted FY 2024 President’s 

Budget

Built-In Change 

from FY 2023 

Enacted

FTEs Budget 

Authority FTEs Budget Authority FTEs Budget Authority

A. Built-in: - - - - - -

1. Intramural Research: - - - - - -

. Annualization of FY 2023 pay and benefits increase - $104,882 - $110,068 - $1,165

. FY 2024 pay and benefits increase - $104,882 - $110,068 - $4,022

. Paid days adjustment - $104,882 - $110,068 - $404

d. Differences attributable to change in FTE - $104,882 - $110,068 - $0

. Payment for centrally furnished services - $39,238 - $39,238 - $0

. Cost of laboratory supplies, materials, other expenses, 

and non-recurring costs - $109,048 - $109,519 - $2,650

Subtotal - - - - - $8,240

2. Research Management and Support: - - - - - -

a. Annualization of FY 2023 pay and benefits increase - $79,859 - $84,122 - $883

b. FY 2024 pay and benefits increase - $79,859 - $84,122 - $3,057

c. Paid days adjustment - $79,859 - $84,122 - $307

d. Differences attributable to change in FTE - $79,859 - $84,122 - $0

e. Payment for centrally furnished services - $2,083 - $2,116 - $33

. Cost of laboratory supplies, materials, other expenses, 

and non-recurring costs - $74,655 - $75,229 - $1,791

Subtotal - - - - - $6,072

Subtotal, Built-in - - - - - $14,312

CHANGES No. Amount No. Amount No. Amount

B. Program: - - - - - -

1. Research Project Grants: - - - - - -

a. Noncompeting 2,894 $1,951,248 2,880 $1,943,213 -14 -$8,035

b. Competing 1,072 $678,768 1,059 $680,162 -13 $1,394

c. SBIR/STTR 199 $126,813 199 $127,447 0 $634

Subtotal, RPGs 4,165 $2,756,830 4,138 $2,750,823 -27 -$6,007

2. Research Centers 6 $16,486 3 $9,564 -3 -$6,922

3. Other Research 1,018 $307,611 1,016 $308,141 -2 $531

4. Research Training 1,941 $121,807 1,922 $123,025 -19 $1,218

5. Research and development contracts 912 $372,660 891 $373,312 -21 $652

Subtotal, Extramural - $3,575,394 - $3,564,865 - -$10,529

6. Intramural Research 502 $253,168 502 $258,826 0 -$2,582

7. Research Management and Support 464 $156,596 464 $161,467 0 -$1,202

8. Construction - $0 - $0 - $0

9. Buildings and Facilities - $0 - $0 - $0

Subtotal, Program 966 $3,985,158 966 $3,985,158 0 -$14,312

Total built-in and program changes - - - - - $0
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BUDGET GRAPHS

Fiscal Year 2024 Budget Graphs 

History of Budget Authority and FTEs:

 

Distribution by Mechanism:

Change by Selected Mechanisms:
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ORGANIZATION 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

Vacant

Director, Division of Lung 

Diseases

James P. Kiley, Ph.D.

Director, Division of Blood 

Diseases and Resources

Julie Panepinto, M.D.

Director, Division of

Extramural Research 

Activities

Laura K. Moen, Ph.D.

Director, Division of 

Intramural 

Research

Vacant

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
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BUDGET AUTHORITY BY ACTIVITY TABLE

NATIONAL INSTITUTES OF HEALTH

National Heart, Lungs, and Blood Institute

Budget Authority by Activity*

(Dollars in Thousands)

Activity FY 2022 Final FY 2023 Enacted

FY 2024 

President's 

Budget

FY 2024 +/- FY 

2023 Enacted

Extramural Research FTE Amount FTE Amount FTE Amount FTE Amount

Detail NA NA NA NA NA NA NA NA

Center for Translation, Implementation Sciences NA $59,478 NA $103,469 NA $103,469 NA $0

Heart and Vascular Diseases NA $2,037,346 NA $2,105,542 NA $2,106,418 NA $877

Lung and Sleep Health NA $807,642 NA $834,676 NA $829,050 NA -$5,627

Blood Diseases and Resources NA $514,486 NA $531,707 NA $525,928 NA -$5,779

Subtotal, Extramural NA $3,418,953 NA $3,575,394 NA $3,564,865 NA -$10,529

Intramural Research 500 $241,213 502 $253,168 502 $258,826 0 $5,658

Research Management & Support 399 $150,206 464 $156,596 464 $161,467 0 $4,871

TOTAL 899 $3,810,371 966 $3,985,158 966 $3,985,158 0 $0

*Includes FTEs whose payroll obligations are supported by the NIH Common Fund.
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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 2022 Final

FY 2023

Enacted

FY 2024 

President's 

Budget

FY 2024

+/- FY 

2023

BA $3,810,371,000 $3,985,158,000 $3,985,158,000 $0

FTE 899 966 966 0

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

Contracts; Direct Federal/Intramural and Other.

Overall Budget Policy: The FY 2024 President’s Budget request is $3,985.2 million, the same as

the FY 2023 Enacted level. Included in this amount is funding to sustain the FY 2023 Enacted 

increase of $30.0 million for continued support of the NIH Community Engagement Alliance 

(CEAL) Against COVID-19 Disparities program so that it can operationalize a community 

engagement plan to reduce research participation hesitancy, address misinformation and mistrust 

of science, and promote diverse inclusion in NIH clinical trials and research in COVID-19 

treatments, vaccination uptake, and other community mitigation and preventive strategies. The 

Alliance for Community Engagement- Climate and Health’s goal is to reduce health threats 

across the lifespan and build health resilience in individuals, communities, and nations around 

the world, especially among those at highest risk. NHLBI will work with climate scientists, 

citizen scientists, and decision-makers to develop, monitor, and evaluate programs to control 

sensitivity (e.g., age, access to green space), control exposure (e.g., wildfires, outdoor activities 

in extreme heat), and create adaptive environments (e.g., cooling centers, heat warnings). NHLBI 

is also targeting sleep research to improve the negative health impacts of climate change on 

heart, lung, and blood health.
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Program Descriptions

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.

Additionally, NHLBI and FNIH recently launched the 

Accelerated Medicines Partnership® for Heart Failure 

(AMP HF).

15 The program will focus on heart failure 

with preserved ejection fraction (HFpEF), a condition in 

which the heart cannot meet the body’s oxygen and 

nutrient needs. AMP HF is a public-private partnership 

between NIH, FDA, multiple biopharmaceutical and life 

sciences companies, and non-profit organizations. The 

program will use cutting-edge technologies, including 

digital measurements and artificial intelligence analytic 

methods, to find novel proteins or genes that could 

alleviate this disease. Further, the program will use 

imaging, multi-omics in blood and other tissues, and 

deep clinical phenotyping to identify disease subtypes 

and novel biologic pathways and mechanisms 

underlying development and progression of HFpEF, 

with the goal of advancing effective targeted 

therapeutics.

Hypertension has major impacts on health including 

morbidity, mortality, and consumption of health care 

resources. Approximately 50 percent of American adults 

have high blood pressure, and this rate is rising. Even 

with drugs and lifestyle modifications widely available, 

blood pressure is inadequately controlled in about one of 

five hypertensive individuals. NHLBI is examining alternative causes of hypertension, including 

what is known as the gut-brain axis, which is the biochemical system of communication between 

the gastrointestinal tract and the central nervous system. Previous studies demonstrated that the 

gut microbiome is connected to inflammation, but new research showed that it may also affect 

blood pressure.16 Gut-brain axis dysfunction results in brain inflammation and irregular activity 

in the autonomic nervous system, leading to elevated blood pressure. That high blood pressure 

15 nih.gov/research-training/accelerating-medicines-partnership-amp/heart-failure 16 ahajournals.org/doi/10.1161/CIRCRESAHA.121.319816?cookieSet=1

CHAP: Treating Chronic Hypertension during 

Pregnancy 

Hypertension, or elevated blood pressure, 

accounts for approximately 20 percent of deaths 

in American women. Hypertension can be 

particularly dangerous in pregnant women, both 

for themselves and their unborn babies.1 For 

example, elevated blood pressure during 

pregnancy can lead to decreased blood flow to 

the placenta, which means that the fetus 

receives less oxygen and nutrients to grow and 

develop normally. It can also cause placental 

abruption (the separation of the placenta from 

the wall of the uterus before delivery), which can 

be life-threatening to both the woman and her 

fetus.

The NIH Chronic Hypertension and Pregnancy 

(CHAP) Project launched in 2014 to examine the 

effects of mild chronic hypertension on maternal 

and fetal health. The study includes women ages 

12 and older with mild chronic hypertension who 

are less than 23 weeks pregnant with one fetus. 

The purpose of the study is to determine whether 

maternal and fetal outcomes were affected when 

being treated for mild chronic hypertension. The 

findings from this study led the American College 

of Obstetricians and Gynecologists to update 

their clinical guidelines, recommending that 

clinicians utilize blood pressure of 140/90 as the 

threshold for initiation of treatment for chronic 

hypertension in pregnancy, rather than the 

previously recommended threshold of 160/110.2

1. https://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-byweek/in-depth/pregnancy/art20046098#:~:text=High%20blood%20pressure%20during%20pregnan

cy%20poses%20the%20following%20risks%3A,birth%20weight%20or

%20premature%20birth

2. https://www.acog.org/clinical/clinical-guidance/practiceadvisory/articles/2022/04/clinical-guidance-for-the-integration-of-thefindings-of-the-chronic-hypertension-and-pregnancy-chap-study
NHLBI-18

then negatively affects gut function, exacerbating the problem. This discovery provides a better 

understanding of the gut-brain axis and could lead to more successful treatments for high blood 

pressure.

Another issue of great interest to NHLBI is congenital heart disease (CHD), which affects one 

percent of newborns. In recent years, whole-exome sequencing has accelerated understanding of 

CHD. However, despite the growing catalog of human genome variants, the cause of over 50

percent of CHD cases remains unknown. In a recent study, researchers defined the entire 

network of protein interactions between two factors (GATA4 and TBX5) critical for normal heart 

development.

17 Using genome sequences from more than 3,000 children with CHD and their 

parents, they identified the genes that interact with this array of proteins. Computational analyses 

further refined the list of gene variants, which included GYR1—a gene that they showed plays a 

key role in heart development. This novel method of integrating protein interaction analyses, 

DNA sequence data, and computational approaches could greatly improve the ability of 

scientists to discover elusive genes contributing to many diseases.

Embryonic stem (ES) cells can initially become any type of cell in the body. This property can 

be beneficial in scientific explorations. By growing ES cells in particular laboratory conditions, 

scientists can push these cells to mature into specific cell types (e.g., liver cells or bone cells). 

Once cells are programmed to become a particular cell type, scientists had previously thought 

that they could not change their identity to a completely different one without first reverting to an 

immature state and then following a new developmental path. In a recent study, researchers 

found that mouse ES cells coaxed to become heart cells could completely transform to a brain 

cell fate, simply by experimentally deleting a gene called Brm.

18 While it remains unclear 

whether ES cells in the body can undergo the dramatic reprogramming observed in a culture 

dish, these findings have important implications not only for the pathology of heart disease, but 

more broadly for the general rules governing the influence of developmental genes in normal cell 

fate determination, as well as disease progression.

Budget Policy: The FY 2024 President’s Budget request for NHLBI heart and vascular disease 

research is $2,106.4 million, an increase of $0.9 million or 0.04 percent compared with the FY 

2023 Enacted Level.

17 sciencedirect.com/science/article/pii/S0092867422000794?via%3Dihub 18 nature.com/articles/s41586-021-04336-y
NHLBI-19 

Lung and Sleep Health

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.

The mapping of the human genome in 2003 was a 

significant step forward for biology and medicine. Since 

then, a number of genetic tests have become widely 

available in the United States. Genetic testing allows 

people to better understand their genetic risks for certain 

diseases and health conditions. However, calculating 

these risks across racial and ethnic groups limits the 

accuracy of the tests. Researchers used data from 

NHLBI’s Trans-Omics for Precision Medicine 

(TOPMed) program to determine that, compared to 

using the standard “polygenic risk scores,” a novel 

framework called a “polygenic transcriptome risk score” 

improved the accuracy of predictions regarding risk of 

COPD.

19

Idiopathic pulmonary fibrosis (IPF) is a serious chronic 

disease that affects the tissue surrounding the air sacs, or 

alveoli, in the lungs.20 This condition develops when that 

lung tissue becomes thick and stiff for unknown reasons. 

Over time, these changes can cause permanent scarring 

in the lungs, called fibrosis, that makes it progressively 

more difficult to breathe. Life expectancy after diagnosis 

is approximately three years and most patients die from 

respiratory failure. Currently, there are two FDAapproved drugs to slow the rate of decline in lung 

function, but they do not cure the condition and side 

effects are common. Researchers discovered that 

saracatinib, a drug initially developed to treat cancer, 

shows promise as an IPF therapeutic and is currently 

being tested in a clinical trial.

21 Repurposing drugs to 

treat conditions other than the one for which they were developed and/or approved can make 

effective, more affordable treatments available to patients sooner.

19 cell.com/ajhg/fulltext/S0002-9297(22)00103-3 20 nhlbi.nih.gov/health/idiopathic-pulmonary-fibrosis 21 biorxiv.org/content/10.1101/2022.01.04.474955v1.abstract

NIH Sleep Research Plan

Sleep and circadian rhythms profoundly influence 

the crucial functions of nearly every cell and 

organ in the body. Unfortunately, some groups 

are disproportionately affected by poor sleep, 

such as racial and ethnic minorities and those of 

lower socioeconomic status.1 Suboptimal sleep 

environments, including those burdened by 

climate change, also influence how and how well 

people sleep. Studies have shown that elevated 

nighttime temperature lowers sleep quality, with 

the largest effects being felt by older adults and 

low-income participants.2 There are also 

biological differences in sleep quality and its 

health impacts. For example, women report 

poorer sleep quality and have higher risk for 

insomnia than do men and may be affected by 

changes in sleep related to menstruation, 

pregnancy, post-childbirth, and menopause.

The 2021 NIH Sleep Research Plan incorporates 

crosscutting NIH priorities that address topics 

such as minority health and health disparities, 

sex/gender, sleep across the lifespan, the impact 

of opioid addiction, and how poor sleep may 

exacerbate the risk and outcome of infectious 

diseases such as COVID-19. The plan also 

covers the development of personalized 

treatments for sleep and circadian disorders. The 

plan is based on a set of research needs and 

opportunities identified with input from 

researchers, public representatives, NIH 

workshop participants, and NHLBI programmatic 

staff. The scientific recommendations are based 

on discussions with the Sleep Disorders 

Research Advisory Board (SDRAB), members of 

the public attending SDRAB meetings, and 

representatives of NIH extramural programs 

participating in the NIH Sleep Research 

Coordinating Committee (SRCC). The plan 

identifies timely and actionable research goals 

with the potential to significantly impact sleep, 

circadian, and biomedical sciences.

1.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3884220/

2.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5446217/
NHLBI-20

Human lungs are a unique organ in the body and have specific cell types found only in the lungs. 

Other cell types, while having counterparts in the rest of the body, have evolved to meet the 

specific needs of the respiratory system. The NHLBI-funded LungMAP Consortium is a group 

of researchers and experts in the pulmonary biology community. This year, the Consortium 

synthesized current data into a comprehensive and practical cellular census of the lung.

22 These 

results are publicly available and will be a foundational resource for lung research moving 

forward.

23

Appropriate sleep is key to the proper function of the human body. Sleep dysfunction and 

insufficient sleep are associated with Alzheimer's Disease and Alzheimer's Disease Related 

Dementias (AD/ADRD). Unfortunately, African American people are disproportionately 

affected by higher rates and earlier onset of ADRDs relative to White Americans. In a study 

sample of predominantly African American older adults, both the amount of time spent awake

while in bed (known as low sleep efficiency) and frequently waking up while sleeping (known as 

wakefulness after sleep onset, or WASO) were associated with poorer cognitive function.

24

Improving sleep health may help prevent ADRD and reduce health disparities.

Budget Policy: The FY 2024 President’s Budget request for NHLBI lung disease research is 

$829.1 million, a decrease of $5.6 million or -0.7 percent compared with the FY 2023 Enacted 

Level.

Blood Diseases and Resources

The blood program is a leader in research on the causes, prevention, and treatment of noncancerous 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.

NHLBI supports 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. This condition affects approximately 100,000 people in the United States and millions 

more around the world, a large percentage of whom are of African descent (including African 

Americans). Unfortunately, the cost of treating SCD is a significant burden for many patients.

The NHLBI Cure Sickle Cell Initiative (CureSC) was developed to facilitate the development of 

genetic-based curative strategies to build upon the success of stem cell transplants.

25 While stem 

cell transplants can cure sickle cell disease, many patients do not have a suitable donor for the 

procedure. Gene therapy allows a patient’s own stem cells to be collected, genetically modified, 

and given back to the patient. The corrected stem cells then produce red blood cells without the 

sickle mutation. Another genetic-based strategy is to treat the patient’s stem cells to increase 

fetal hemoglobin, preventing the sickled hemoglobin from being dominant, and thus lessening 

symptoms of the disease. CureSC is funding two clinical trials in conjunction with the California 

Institute of Regenerative Medicine (CIRM) as well as funding data collection to allow for a 

22 sciencedirect.com/science/article/pii/S1534580721008923?via%3Dihub 23 lungmap.net/ 24 content.iospress.com/articles/journal-of-alzheimers-disease/jad215530 25 curesickle.org/
NHLBI-21

comparative, contemporaneous cohort of patients who have not received curative therapies.

26

This will provide comparator data to the investigators as well as to the FDA to demonstrate the 

effects of these genetically based curative therapies.

Hemoglobin, a protein in the blood that transports oxygen throughout the body, is essential to 

human life. SCD and another disorder called beta-thalassemia (a condition in which when the 

body does not produce enough hemoglobin) are caused by certain mutations in a gene that 

creates hemoglobin. The gene, called beta-globin, is turned on in red blood cells (RBCs) around 

the time of birth as the fetal version, called gamma-globin, is turned off. However, under the 

stress condition of hypoxia (low oxygen), gamma-globin genes are turned on in adults, and adult 

expression of gamma-globin can alleviate symptoms in people with SCD and beta-thalassaemia. 

A recent NHLBI-supported study identified a new molecular pathway, which is sensitive to 

oxygen levels, that turns on the gamma-globin gene in adult RBCs.

27 Hypoxia stabilizes a 

protein called Hypoxia-inducible factor 1 (HIF1), which turns on the gamma-globin gene in adult 

RBCs. Researchers then tested whether prolyl hydroxylase inhibitors (PHIs), which can stabilize 

the HIF1 protein, could induce fetal hemoglobin. Using young red blood cells from individuals 

with SCD and testing in vitro, they found that PHIs can stabilize HIF1, leading to increased fetal 

hemoglobin and significantly less sickling of cells. This important finding could lead to new 

therapeutic approaches for reversing disease progression in people with these conditions.

It is imperative to better understand the origins of adult blood to best treat a myriad of blood 

disorders and cancers. This year, researchers supported by NHLBI made great strides in this 

area. It has long been believed that blood cells created in the developing fetus (known as 

embryonic blood progenitors) decrease as a person reaches adulthood. However, researchers 

used an enzyme called transposase to insert unique genetic sequences into mice embryos; these 

“barcodes” were then present in any cell that descended from the original, allowing the 

researchers to trace their lineages. The results showed that adult blood cells derived not just from 

blood stem cells (hematopoietic stem cells) as previously believed, but also from long-lived 

embryonic blood progenitors. These findings could spark new strategies for developing 

treatments for blood disorders and cancers, as well as improve outcomes of bone marrow 

transplants.

Budget Policy: The FY 2024 President’s Budget request for this research program is $525.9

million, an decrease of $5.8 million or 1.1 percent compared with the FY 2023 Enacted 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.

26 curesickle.org/phase-2 27 pubmed.ncbi.nlm.nih.gov/36224385/
NHLBI-22

The COVID-19 pandemic provided a stark reminder 

of how social determinants of health and existing 

health disparities can contribute to unequal burden of 

disease. The NIH Community Engagement Alliance 

Against COVID-19 Disparities (CEAL) is an NIHwide initiative that leverages existing communityengaged research efforts to address misinformation, 

foster trust in science, and ensure inclusive 

participation of ethnic and racial minority 

communities disproportionately affected by the 

COVID-19 pandemic, in important life-saving 

research efforts focused on the mitigation, prevention, 

and treatment of COVID-19.28 NHLBI is continuing 

this community-engaged approach in 21 states and 

territories with approximately 1,000 community 

partners to address the lingering effects of COVID-19 

and recruiting participants for the NIH Researching 

COVID to Enhance Recovery’s (RECOVER) clinical 

trials for therapeutics to treat post-acute sequelae of 

COVID-19 (PASC), commonly known as Long

COVID.

29 Enrollment in clinical trials is expected to 

begin in early 2023.

Additionally, the Network for Community-Engaged 

Primary Care Research (NCPCR) supports the CEAL 

mission by leveraging community-engaged research in 

primary care settings to address health inequities.

30

Primary care providers use their role as a trusted 

professional to address misinformation and 

disinformation related to prevention and treatment of 

COVID-19 and its lingering effects and symptoms.

NHLBI is also using lessons learned from CEAL to 

work with communities on other health issues. For 

example, the United States currently has the highest 

rates of maternal mortality and morbidity in the 

developed world, more than half of which are 

preventable. Despite relative national wealth, 

significant racial, ethnic, and geographic disparities 

contribute substantially to overall poor maternal health 

outcomes in the United States. One of the ways 

NHLBI is addressing this important issue is by 

funding the Maternal Health Community 

28 covid19community.nih.gov/ 29 recovercovid.org/ 30 covid19community.nih.gov/Network-for-Community-Engaged-Primary-Care-Research

CEAL and RECOVER: Community 

Engagement in Response to COVID-19 

Disparities and Long COVID

More than a million people in the United States 

have died from infection with the virus that 

causes COVID-19. Soon after the pandemic 

began, it became clear that the hardest hit 

communities were those of people of color, who 

were more likely to be hospitalized, and whose 

mortality rates were much higher than others. In 

July 2020, NHLBI and the National Institute on 

Minority Health and Health Disparities launched 

the NIH Community Engaged Alliance (CEAL) 

Against COVID-19 Disparities. CEAL was 

charged with developing community-based 

initiatives to counter COVID-19 misinformation, 

foster trust in science and research, and 

encourage the participation of under-represented 

populations in NIH research. Since then, CEAL 

has evolved into a robust, comprehensive 

research platform compromised of research 

teams in 21 locations across the country.

NHLBI is also participating in another 

community-based initiative — RECOVER 

(Researching COVID to Enhance Recovery), 

launched in 2021 to better understand why some 

people develop what has come to be called Long 

COVID, a constellation of symptoms (such as 

fatigue, loss of taste and smell, and “brain fog”) 

that persists after the initial infection resolves. At 

the center of RECOVER is a longitudinal 

observational study currently recruiting adults 

and children from other ongoing studies of 

COVID-19, CEAL sites, Long COVID clinics, and 

other places that have a history of including 

people from communities disproportionately 

burdened by disease. RECOVER will 

significantly expand knowledge about the full 

clinical spectrum of symptoms, long-term 

outcomes, and underlying biology of Long 

COVID, as well as accelerate the ability to 

develop safe and effective therapeutic 

interventions. As of March 2023, more than 

16,000- people have been enrolled, which far 

exceeds RECOVER’s initial target recruitment of 

6,000. A significant percent of enrollees live in 

federally designated medically underserved 

areas.
NHLBI-23

Implementation Project (MH-CIP).

31 This program supports the development and testing of 

promising community-based strategies to increase adoption, uptake, and scale-up of evidencebased interventions to improve pre-pregnancy, pregnancy, perinatal, and postpartum care. This 

can advance maternal health and maternal health equity in disproportionately affected 

communities. MH-CIP supports four community coalitions, comprised of research organizations 

and community partners, to engage communities and pilot test the implementation of proven 

interventions in vulnerable populations.

NIH understands that climate change is one of the greatest existential threats to the health of the 

planet and to human health. Similarly, a collaborative, cross-disciplinary approach is needed to 

address this urgent issue. For example, extreme weather, rising sea levels, rising temperatures, 

and increases in carbon dioxide levels disproportionately affect the most vulnerable 

communities. Some of these adverse health outcomes may be short-lived, but others lead to 

chronic cardiovascular or respiratory illnesses. NHLBI is working closely with the National 

Institute of Environmental Health Sciences (NIEHS) to fund climate change-related research, 

including community outreach efforts. The Alliance for Community Engagement-Climate and 

Health’s (ACE-CH) goal is to reduce health threats across the lifespan and build health resilience 

in individuals, communities, and nations around the world, especially among those at highest 

risk.

32 NHLBI will work with climate scientists, citizen scientists, and decision-makers to 

develop, monitor, and evaluate programs to control sensitivity (e.g., age, access to green space), 

control exposure (e.g., wildfires, outdoor activities in extreme heat), and create adaptive 

environments (e.g., cooling centers, heat warnings). NHLBI is also targeting sleep research to 

improve the negative health impacts of climate change on heart, lung, and blood health.

Budget Policy: The FY 2024 President’s Budget request for CTRIS is $103.5 million, equal to

the FY 2023 Enacted level.

Intramural Research

The NHLBI Division of Intramural Research (DIR) 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 play a significant role in federal research efforts to address COVID-19. One 

DIR group discovered that certain antibodies found in some COVID-19 patients drive 

endotheliopathy.

33 Endotheliopathy occurs when endothelial cells (the primary cell type inside 

the linings of blood vessels, lymph nodes, and the heart) do not function properly, potentially 

leading to blood clots. These findings have potential clinical implications. For example, the 

authors suggest consideration for patients with severe COVID-19 to be screened to evaluate their 

risk for endotheliopathy, and that patients at high risk may benefit from treatments used in 

31 maternalhealthcip.org/ 32 nhlbi.nih.gov/sites/default/files/media/docs/ACE_CH_ROA_6_08_2022_FINAL.pdf 33 onlinelibrary.wiley.com/doi/10.1002/art.42094
NHLBI-24

traditional cases of severe antiphospholipid syndrome, a disorder of the immune system that 

causes an increased risk of blood clots.

NHLBI is dedicated to developing and improving treatments for severe pain episodes, also 

known as pain crises for those with SCD. These pain crises may happen without warning when 

sickle cells block blood flow. People describe this pain as sharp, intense, stabbing, or 

throbbing.

34 This year, a proof-of-concept clinical study by NHLBI scientists showed that the 

pyruvate kinase activator mitapivat (AG-348) improved molecular hallmarks of SCD, increased 

blood oxygen levels, and reduced sickling in patients with sickle cell anemia.

35 Similar to the 

use of saracatinib, a drug initially developed to treat cancer or pulmonary fibrosis, another SCD 

study identified 20 compounds in existing, FDA-approved drugs that may be repurposed to treat 

SCD pain.

36 Should some of these therapies become available, millions around the world will 

have improved access to safe, affordable treatments.

Budget Policy: The FY 2024 President’s Budget request for NHLBI intramural research is 

$258.8 million, an increase of $5.7 million or 2.2 percent compared with the FY 2023 Enacted 

level. These increases accommodate proposed pay increases for IR staff, changes in NIH-wide 

assessments on the IR program, and other inflationary costs.

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, trans-NHLBI 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 2024 President’s Budget request for RMS at NHLBI is $161.5 million, 

an increase of $4.9 million or 3.1 percent compared with the FY 2023 Enacted level.

34 nhlbi.nih.gov/health/sickle-cell-disease/health-effects 35 ashpublications.org/blood/article-abstract/doi/10.1182/blood.2022015403/485276/A-Phase-1-Dose-EscalationStudy-of-the-Pyruvate?redirectedFrom=fulltext 36 pnas.org/doi/10.1073/pnas.2210779119#core-collateral-metrics
NHLBI-25

APPROPRIATIONS HISTORY

NATIONAL INSTITUTES OF HEALTH

National Heart, Lungs, and Blood Institute

Appropriations History

Fiscal Year

Budget 

Estimate to 

Congress

House 

Allowance

Senate 

Allowance Appropriation

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 $3,808,494,000

Rescission - - - $0

2023 $3,822,961,000 $3,943,702,000 $3,946,557,000 $3,982,345,000

Rescission - - - $0

2024 $3,985,158,000 - - - 1 Budget Estimate to Congress includes mandatory financing.
NHLBI-26

AUTHORIZING LEGISLATION

NATIONAL INSTITUTES OF HEALTH

National Heart, Lungs, and Blood Institute

Authorizing Legislation

PHS Act/ 

Other 

Citation

U.S. Code 

Citation

2023 Amount 

Authorized FY 2023 Enacted

2024 Amount 

Authorized

FY 2024 President’s 

Budget

Research 

and 

Investigation

Section 

301 42§241 Indefinite

} $3,985,158,000

Indefinite

} $3,985,158,000

National 

Heart, Lung, 

and Blood 

Institute

Section 

401(a) 42§281 Indefinite Indefinite

Total, 

Budget 

Authority $3,985,158,000 $3,985,158,000
NHLBI-27

AMOUNTS AVAILABLE FOR OBLIGATION

NATIONAL INSTITUTES OF HEALTH

National Heart, Lungs, and Blood Institute

Amounts Available for Obligation1

(Dollars in Thousands)

Source of Funding FY 2022 Final FY 2023 

Enacted

FY 2024 

President's 

Budget

Appropriation $3,808,494 $3,982,345 $3,985,158

OAR HIV/AIDS Transfers $1,877 $2,813 $0

Subtotal, adjusted budget authority $3,810,371 $3,985,158 $3,985,158

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

Unobligated balance, end of year 

(carryover) $0 $0 $0

Subtotal, adjusted budget authority $3,810,371 $3,985,158 $3,985,158

Unobligated balance lapsing -$65 $0 $0

Total obligations $3,810,306 $3,985,158 $3,985,158 1 Excludes the following amounts (in thousands) for reimbursable activities carried out by this account:

FY 2022 - $23,323 FY 2023 - $23,323 FY 2024 - $23,323
NHLBI-28

BUDGET AUTHORITY BY OBJECT CLASS

NATIONAL INSTITUTES OF HEALTH

National Heart, Lungs, and Blood Institute

Budget Authority by Object Class1

(Dollars in Thousands)

OBJECT CLASSES FY 2023 Enacted FY 2024 

President's Budget

FY 2024 +/- FY 

2023

Total compensable workyears:

- Full-time equivalent 966 966 0

- Full-time equivalent of overtime and holiday 

hours 1 1 0

- Average ES salary $211 $223 $11

- Average GM/GS grade 12.8 12.8 0.0

- Average GM/GS salary $131 $138 $7

- Average salary, Commissioned Corps (42 

U.S.C. 207) $124 $131 $7

- Average salary of ungraded positions $157 $166 $9

- Personnel Compensation - - -

11.1 Full-Time Permanent $75,858 $79,896 $4,038

11.3 Other Than Full-Time Permanent $41,880 $44,011 $2,131

11.5 Other Personnel Compensation $6,313 $6,646 $333

11.7 Military Personnel $3,075 $3,232 $157

11.8 Special Personnel Services Payments $11,551 $12,134 $583

11.9 Subtotal Personnel Compensation $138,676 $145,918 $7,242

12.1 Civilian Personnel Benefits $45,449 $47,625 $2,176

12.2 Military Personnel Benefits $616 $647 $31

13.0 Benefits to Former Personnel $0 $0 $0

- Subtotal Pay Costs $184,741 $194,190 $9,449

21.0 Travel & Transportation of Persons $2,017 $2,024 $7

22.0 Transportation of Things $378 $378 $0

23.1 Rental Payments to GSA $0 $0 $0

23.2 Rental Payments to Others $0 $0 $0

23.3 Communications, Utilities & Misc. Charges $292 $292 $0

24.0 Printing & Reproduction $2 $2 $0

25.1 Consulting Services $102,780 $104,033 $1,254

25.2 Other Services $70,116 $70,972 $856

25.3 Purchase of Goods and Services from 

Government Accounts $260,882 $261,818 $936

25.4 Operation & Maintenance of Facilities $122 $122 $1

25.5 R&D Contracts $139,859 $143,126 $3,267

25.6 Medical Care $2,075 $2,075 $0

25.7 Operation & Maintenance of Equipment $14,676 $14,691 $15

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

25.0 Subtotal Other Contractual Services $590,509 $596,837 $6,328

26.0 Supplies & Materials $15,398 $15,394 -$4

31.0 Equipment $8,664 $8,701 $37

32.0 Land and Structures $4,474 $4,488 $14

33.0 Investments & Loans $0 $0 $0

41.0 Grants, Subsidies & Contributions $3,178,661 $3,162,829 -$15,833

42.0 Insurance Claims & Indemnities $0 $0 $0

43.0 Interest & Dividends $22 $22 $0

44.0 Refunds $0 $0 $0

- Subtotal Non-Pay Costs $3,800,417 $3,790,968 -$9,449

- Total Budget Authority by Object Class $3,985,158 $3,985,158 $0

1 Includes FTEs whose payroll obligations are supported by the NIH Common Fund.
NHLBI-29

SALARIES AND EXPENSES

NATIONAL INSTITUTES OF HEALTH

National Heart, Lungs, and Blood Institute

Salaries and Expenses

(Dollars in Thousands)

Object Classes FY 2023 

Enacted

FY 2024 

President's 

Budget

FY 2024 +/- FY 

2023

Personnel Compensation

Full-Time Permanent (11.1) $75,858 $79,896 $4,038

Other Than Full-Time Permanent (11.3) $41,880 $44,011 $2,131

Other Personnel Compensation (11.5) $6,313 $6,646 $333

Military Personnel (11.7) $3,075 $3,232 $157

Special Personnel Services Payments (11.8) $11,551 $12,134 $583

Subtotal, Personnel Compensation (11.9) $138,676 $145,918 $7,242

Civilian Personnel Benefits (12.1) $45,449 $47,625 $2,176

Military Personnel Benefits (12.2) $616 $647 $31

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

Subtotal Pay Costs $184,741 $194,190 $9,449

Travel & Transportation of Persons (21.0) $2,017 $2,024 $7

Transportation of Things (22.0) $378 $378 $0

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

Communications, Utilities & Misc. Charges 

(23.3) $292 $292 $0

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

Other Contractual Services

Consultant Services (25.1) $102,780 $104,033 $1,254

Other Services (25.2) $70,116 $70,972 $856

Purchase of Goods and Services from 

Government Accounts (25.3) $159,760 $160,695 $936

Operation & Maintenance of Facilities (25.4) $122 $122 $1

Operation & Maintenance of Equipment (25.7) $14,676 $14,691 $15

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

Subtotal Other Contractual Services $347,453 $350,514 $3,061

Supplies & Materials (26.0) $15,398 $15,394 -$4

Subtotal Non-Pay Costs $365,540 $368,605 $3,065

Total Administrative Costs $550,280 $562,795 $12,515
NHLBI-30

DETAIL OF FULL-TIME EQUIVALENT EMPLOYMENT (FTE)

NATIONAL INSTITUTES OF HEALTH

National Heart, Lungs, and Blood Institute

Detail of Full-Time Equivalent Employment (FTE)

Office

FY 2022 Final FY2023 Enacted FY 2024 President’s 

Budget

Civilian Military Total Civilian Military Total Civilian Military Total

Division of Intramural Research

Direct: 467 15 482 469 15 484 469 15 484

Reimbursable: 18 - 18 18 - 18 18 - 18

Total: 485 15 500 487 15 502 487 15 502

Office of the Director

Direct: 112 1 113 156 1 157 156 1 157

Reimbursable: - - - - - - - - -

Total: 112 1 113 156 1 157 156 1 157

Division of Blood and Resources

Direct: 25 2 27 27 2 29 27 2 29

Total: 25 2 27 27 2 29 27 2 29

Division of Lung Diseases

Direct: 37 - 37 39 - 39 39 - 39

Total: 37 - 37 39 - 39 39 - 39

Center for Translation Research 

and Implementation Science

Direct: 13 - 13 15 - 15 15 - 15

Total: 13 - 13 15 - 15 15 - 15

Division of Cardiovascular 

Sciences

Direct: 114 - 114 119 - 119 119 - 119

Total: 114 - 114 119 - 119 119 - 119

Division of Extramural Research 

Activities

Direct: 95 - 95 105 - 105 105 - 105

Total: 95 - 95 105 - 105 105 - 105

Total 881 18 899 948 18 966 948 18 966

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

2020 12.7

2021 12.7

2022 12.7

2023 12.8

2024 12.8
NHLBI-31

DETAIL OF POSITIONS

NATIONAL INSTITUTES OF HEALTH

National Heart, Lungs, and Blood Institute

Detail of Positions1

GRADE FY 2022 Final FY 2023 Enacted FY 2024 President's 

Budget

Total, ES Positions 2 2 2

Total, ES Salary $407,400 $422,644 $445,616

General Schedule

GM/GS-15 85 89 89

GM/GS-14 154 167 167

GM/GS-13 195 210 210

GS-12 73 78 78

GS-11 36 38 38

GS-10 0 0 0

GS-9 34 36 36

GS-8 1 2 2

GS-7 2 3 3

GS-6 3 4 4

GS-5 3 4 4

GS-4 5 6 6

GS-3 3 3 3

GS-2 3 3 3

GS-1 0 0 0

Subtotal 597 643 643

Commissioned Corps (42 U.S.C. 207)

Assistant Surgeon General 1 1 1

Director Grade 6 6 6

Senior Grade 4 4 4

Full Grade 7 7 7

Senior Assistant Grade 0 0 0

Assistant Grade 0 0 0

Subtotal 18 18 18

Ungraded 282 303 303

Total permanent positions 617 617 617

Total positions, end of year 899 966 966

Total full-time equivalent (FTE) 

employment, end of year 899 966 966

Average ES salary $203,700 $211,322 $222,808

Average GM/GS grade 12.7 12.8 12.8

Average GM/GS salary $127,592 $130,745 $137,852 1 Includes FTEs whose payroll obligations are supported by the NIH Common Fund.