NHLBI-1

DEPARTMENT OF HEALTH AND HUMAN SERVICES

NATIONAL INSTITUTES OF HEALTH

National Heart, Lung, and Blood Institute (NHLBI)

FY 2021 Budget Page No.

Organization Chart...........................................................................................................................2

Appropriation Language ..................................................................................................................3

Amounts Available for Obligation...................................................................................................4

Budget Mechanism Table ................................................................................................................5

Major Changes in Budget Request ..................................................................................................6

Summary of Changes.......................................................................................................................7

Budget Graphs .................................................................................................................................8

Budget Authority by Activity ..........................................................................................................9

Authorizing Legislation .................................................................................................................10

Appropriations History ..................................................................................................................11

Justification of Budget Request .....................................................................................................12

Budget Authority by Object Class.................................................................................................26

Salaries and Expenses....................................................................................................................27

Detail of Full-Time Equivalent Employment (FTE) .....................................................................28

Detail of Positions..........................................................................................................................29
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NHLBI-3

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, [$3,624,258,000]$3,298,004,000.
NHLBI-4

Source of Funding FY 2019 Final FY 2020 Enacted FY 2021 President's 

Budget

Appropriation $3,488,335 $3,624,258 $3,298,004

Mandatory Appropriation: (non-add)

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

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

Rescission 0 0 0

Sequestration 0 0 0

Secretary's Transfer -11,982 0 0

Subtotal, adjusted appropriation $3,476,353 $3,624,258 $3,298,004

OAR HIV/AIDS Transfers 6,024 1,000 0

HEAL Transfer from NINDS 0 0 0

Subtotal, adjusted budget authority $3,482,377 $3,625,258 $3,298,004

Unobligated balance, start of year 0 0 0

Unobligated balance, end of year 0 0 0

Subtotal, adjusted budget authority $3,482,377 $3,625,258 $3,298,004

Unobligated balance lapsing -140 0 0

Total obligations $3,482,237 $3,625,258 $3,298,004

NATIONAL INSTITUTES OF HEALTH

National Heart, Lung, and Blood Institute

Amounts Available for Obligation1

(Dollars in Thousands)

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

 FY 2019 - $13,267 FY 2020 - $14,100 FY 2021 - $15,306 
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No. Amount No. Amount No. Amount No. Amount

2,779 $1,705,468 2,788 $1,769,513 2,792 $1,658,171 4 -$111,342

(113) 27,882 (98) 24,267 (20) 3,177 (-78) -21,090

144 102,920 154 110,008 139 99,007 -15 -11,001

820 493,446 851 512,248 758 455,901 -93 -56,347

0 0 0 0 0 0 0 0

964 $596,366 1,005 $622,256 897 $554,908 -108 -$67,348

3,743 $2,329,716 3,793 $2,416,036 3,689 $2,216,256 -104 -$199,779

203 106,113 212 110,627 197 102,883 -15 -7,744

3,946 $2,435,829 4,005 $2,526,663 3,886 $2,319,139 -119 -$207,523

8 $15,899 7 $14,839 6 $13,059 -1 -$1,781

0 0 0 0 0 0 0 0

0 1,017 0 806 0 749 0 -56

0 455 0 455 0 455 0 0

0 0 0 0 0 0 0 0

8 $17,371 7 $16,100 6 $14,263 -1 -$1,837

768 $138,068 784 $144,540 692 $127,542 -92 -$16,999

0 0 0 0 0 0 0 0

39 12,531 39 12,847 35 11,562 -4 -1,285

0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0

154 94,157 158 98,158 139 85,397 -19 -12,761

961 $244,756 981 $255,545 866 $224,501 -115 -$31,044

4,915 $2,697,955 4,993 $2,798,308 4,758 $2,557,903 -235 -$240,405

FTTPs FTTPs FTTPs FTTPs

473 $22,194 527 $25,296 464 $22,261 -63 -$3,036

2,021 95,097 2,064 99,055 1,816 87,168 -248 -11,887

2,494 $117,291 2,591 $124,351 2,280 $109,429 -311 -$14,922

743 $307,931 794 $329,031 722 $289,548 -72 -$39,484

(0) (7,927) (0) (7,900) (0) (6,900) (0) (-1,000)

406 220,596 467 229,420 467 204,184 0 -25,236

434 138,604 495 144,148 495 136,941 0 -7,207

(0) (1,710) (0) (1,800) (0) (900) (0) (-900)

0 0 0 0

0 0 0 0

840 $3,482,377 962 $3,625,258 962 $3,298,004 0 -$327,254

1

NATIONAL INSTITUTES OF HEALTH

National Heart, Lung, and Blood Institute

Budget Mechanism - Total1

(Dollars in Thousands)

MECHANISM FY 2019 Final FY 2020 Enacted FY 2021 President's Budget

FY 2021

+/-

FY 2020 Enacted

Research Projects:

Noncompeting

Administrative Supplements 

Competing:

Renewal

New

Supplements

Subtotal, Competing

Subtotal, RPGs

SBIR/STTR

Research Project Grants

Research Centers:

Specialized/Comprehensive

Clinical Research

Biotechnology

Comparative Medicine

Research Centers in Minority Institutions

Research Centers

Other Research:

Research Careers

Cancer Education

Cooperative Clinical Research

Biomedical Research Support

Minority Biomedical Research Support

Other

Other Research

Total Research Grants

Ruth L Kirchstein Training Awards:

Individual Awards

Institutional Awards

Total Research Training

Research & Develop. Contracts

(SBIR/STTR) (non-add)

Intramural Research

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

Res. Management & Support

Res. Management & Support (SBIR Admin) (non-add)

Construction 

Buildings and Facilities

Total, NHLBI
NHLBI-6

Major Changes in the Fiscal Year 2021 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 mechansims and activity detail; and these 

highlights may not sum to the total change for the FY 2021 budget request for the NHLBI, which 

is $3,298.0 million, a decrease of $327.3 million from the FY 2020 Enacted level. In FY 2021,

the overall reductions of 9.0 percent are distributed across multiple programmatic areas including 

basic, translational, and clinical research. NHLBI is committed to the continuous support for key 

strategic priorities along with other scientific areas of the Institute’s research portfolio. Within 

the framework of the Administration’s fiscal policy goals for the Federal Government, NHLBI 

will pursue its highest research priorities through strategic investments and careful stewardship 

of the appropriated funds.

Research Project Grants (RPGs) (-$207.5 million; total $2,319.1 million):

NHLBI will make dollar adjustments to both competing and non-competing RPGs which result 

in a 8.2 percent reduction to fund 897 competing RPGs and approximately 2,792 noncompeting 

RPG awards in FY 2021. Adjustments for special circumstances will be accommodated.

Research Centers (-$1.8 million; total $14.3 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 (-$31.0 million; total $224.5 million):

NHLBI will reduce funding for Other Research by 12.1 percent, which is a $31.0 million 

decrease compared to the FY 2020 Enacted level of $255.5 million. The number of competing 

grant awards will also decrease. The reductions are distributed across all programmatic areas 

and basic, translational or clinical research.

Research and Development (R&D) Contracts (-$39.5 million; total $289.5 million):

NHLBI will reduce funding for Research and Development Contracts by 12.0 percent, which is a 

$39.5 million decrease compared to the FY 2020 Enacted level of $329.0 million. These 

reductions are distributed across all programmatic areas and basic, translational or clinical 

research.

Intramural Research (IR) (-$25.2 million; total $204.2 million):

NHLBI will reduce funding for Intramural Research by 11.0 percent, which is a $25.2 million 

decrease compared to the FY 2020 Enacted level of $229.4 million. These reductions are 

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

Research Management and Support (RMS) (-$7.2 million; total $136.9 million):

NHLBI will reduce funding for Intramural Research by 5.0 percent, which is a $7.2 million 

decrease compared to the FY 2020 Enacted level of $144.1 million. These reductions are 

distributed across all programmatic areas of RMS.
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FY 2020 Enacted

FY 2021 President's Budget

Net change

FTEs Budget Authority FTEs Budget Authority

$87,135 $565

87,135 837

87,135 -325

87,135 0

28,555 -1,503

88,494 1,415

$989

$73,227 $470

73,227 722

73,227 -273

73,227 0

3,314 -174

60,416 842

$1,585

$2,574

No. Amount No. Amount

2,792 $1,661,348 4 -$132,431

897 554,908 -108 -67,348

197 102,883 -15 -7,744

3,886 $2,319,139 -119 -$207,523

6 $14,263 -1 -$1,837

866 224,501 -115 -31,044

2,280 109,429 -311 -14,922

722 289,548 -72 -39,484

$2,956,879 -$294,810

FTEs FTEs

467 $204,184 0 -$26,225

495 136,941 0 -8,793

0 0

0 0

962 $3,298,004 0 -$329,828

-$327,254

Subtotal, Program

Total changes

7. Research Management and Support

8. Construction

9. Buildings and Facilities

4. Research Training

5. Research and development contracts

Subtotal, Extramural

6. Intramural Research

Subtotal, RPGs

2. Research Centers

3. Other Research

CHANGES

B. Program:

1. Research Project Grants:

a. Noncompeting

b. Competing

c. SBIR/STTR

Subtotal

Subtotal, Built-in

FY 2021 President's Budget Change from FY 2020 Enacted

a. Annualization of January 2020 pay increase & benefits

b. January FY 2021 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

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

Subtotal

2. Research Management and Support:

CHANGES

A. Built-in:

1. Intramural Research:

a. Annualization of January 2020 pay increase & benefits

b. January FY 2021 pay increase & benefits

c. Paid days adjustment

NATIONAL INSTITUTES OF HEALTH

National Heart, Lung, and Blood Institute

Summary of Changes

(Dollars in Thousands)

$3,625,258

$3,298,004

-$327,254

FY 2021 President's Budget Change from FY 2020 Enacted
NHLBI-8

Fiscal Year 2021 Budget Graphs

History of Budget Authority and FTEs:

Distribution by Mechanism:

Change by Selected Mechanism:
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FTE Amount FTE Amount FTE Amount FTE Amount

$27,369 $28,496 $25,913 -$2,584

1,865,252 1,941,945 1,765,881 -176,064

740,036 770,521 700,663 -69,858

490,520 510,727 464,423 -46,304

$3,123,177 $3,251,690 $2,956,879 -$294,810

406 $220,596 467 $229,420 467 $204,184 0 -$25,236

434 $138,604 495 $144,148 495 $136,941 0 -$7,207

840 $3,482,377 962 $3,625,258 962 $3,298,004 0 -$327,254

1

Subtotal, Extramural

Intramural Research

Research Management & Support

TOTAL

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

Extramural Research

Detail

Center for Translation, Implementation Sciences

Heart and Vascular Diseases

Lung Diseases

Blood Diseases and Resources

NATIONAL INSTITUTES OF HEALTH

National Heart, Lung, and Blood Institute

Budget Authority by Activity1

(Dollars in Thousands)

FY 2019 Final FY 2020 Enacted FY 2021 President's 

Budget

FY 2021

+/-

FY2020
NHLBI

-10

PHS Act/

Other Citation

U.S. Code

Citation

FY 2020 Enacted FY 2021 President's Budget

Section 301

Section 401(a) 42§281 Indefinite

Total, Budget Authority $3,625,258,000 $3,298,004,000

NATIONAL INSTITUTES OF HEALTH

National Heart, Lung, and Blood Institute

Authorizing Legislation

2020 Amount

Authorized

2021 Amount

Authorized

Research and Investigation 42§241 Indefinite IndefiniteNational Heart, Lung, and Blood Institute

$3,298,004,000 $3,625,258,000

Indefinite
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Budget Estimate to 

Congress House Allowance Senate Allowance Appropriation

$3,147,992,000 $3,147,992,000 $3,036,189,000 $3,084,851,000

$5,830,368

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

$6,158,041

($154,545,663)

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

$0

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

$0

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

$0

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

$0

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

$0

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

$0

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

$0

$3,298,004,000

1

2021

Budget Estimate to Congress includes mandatory financing.

2019

Rescission

2020

Rescission

20171

Rescission

2018

Rescission

2015

Rescission

2016

Rescission

Rescission

Sequestration

2014

Rescission

NATIONAL INSTITUTES OF HEALTH

National Heart, Lung, and Blood Institute

Appropriations History

Fiscal Year

2012

Rescission

2013
NHLBI-12

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 2019

Final

FY 2020

Enacted

FY 2021 President’s

Budget

FY 2021 +/-

FY 2020

BA $3,482,377,000 $3,625,258,000 $3,298,004,000 -$327,254,000

FTE 840 962 962 0

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

Contracts; Direct Federal/Intramural and Other.

Director’s Overview

The National Heart, Lung, and Blood Institute (NHLBI) is committed to fueling the scientific 

discoveries needed to improve the health of the nation. Over the past seven decades, by forming 

partnerships with communities, patients, and researchers, NHLBI’s research programs have 

helped improve longevity and quality of life for people across the globe. Among adults in the 

United States, deaths from cardiovascular disease (CVD) decreased by nearly 19 percent 

between 2006-2016 and from coronary heart disease by almost 32 percent.1 While congenital 

heart disease and sickle cell disease (SCD) once meant a death sentence in childhood, children 

with these diseases are now living and thriving into adulthood; young people with SCD have 

even been cured through state-of-the-art cell- and gene-based therapies. 

To continue these encouraging trends, in FY 2021, NHLBI will pursue the priorities set forward 

in its Strategic Vision,2 with an emphasis on advancing fundamental discovery research, 

expanding the biomedical use of artificial intelligence (AI), reducing heart disease deaths for 

women of all races and ethnicities, improving the health of rural and underserved populations, 

and nurturing a diverse, talented biomedical workforce. 

Advancing Fundamental Discovery Science for Public Health Impact. Decades of 

fundamental research into life’s dependence on oxygen shows how long-term investments in 

basic research can have unexpected payoffs.3 In work recognized with the 2019 Nobel Prize in 

Medicine, NHLBI grantee Gregg Semenza explored how the body responds to oxygen 

deprivation. It was known that low oxygen leads to increased production of red blood cells, but 

how the body senses low oxygen was unknown. More than 20 years ago, Semenza’s research 

established that a protein called hypoxia-inducible factor-1 (HIF-1) plays a key role in oxygen 

1 www.ahajournals.org/doi/full/10.1161/CIR.0000000000000659

2 www.nhlbi.nih.gov/about/strategic-vision 3 www.nobelprize.org/prizes/medicine/2019/press-release/
NHLBI-13

sensing. His later work in models of heart disease showed that when arteries to the heart are 

clogged, HIF-1 can stimulate the growth of blood vessels around the blockage.4 This knowledge 

about blood cell production and blood vessel remodeling may lead to new therapies for anemia, 

heart disease, and even cancers, which all depend on a robust blood supply to thrive.

Other Nobelists honored in 2017 helped to define the genetic and molecular pathways underlying 

the circadian rhythm—the body’s internal clock—opening new doors to understanding sleep and 

sleep disorders.5 Years of basic research have established that the brain regulates sleep and 

wakefulness in part by releasing a hormone called hypocretin. In 2019, a study in mice found 

that undisturbed sleep maintains the brain’s proper release of hypocretin, which in turn helps 

quiet inflammatory signals that can contribute to atherosclerosis.

6

 Sleep-deprived mice had 

lower levels of circulating hypocretin and higher rates of atherosclerosis, which could be 

prevented by giving them infusions of hypocretin—suggesting that this pathway could be 

leveraged to develop new therapies for atherosclerosis. 

Using Big Data and AI to Predict, Prevent, and Preempt Disease. As new data emerges on 

complex biological pathways, there are growing opportunities for researchers to connect insights 

from one field, or one disease, to another. To enhance data sharing and deep analyses that will 

help make precision medicine a reality, NHLBI is launching a new data science platform.7

 As 

part of the NIH STRIDES Initiative,

8 this cloud-based platform will enable researchers to 

securely find, access, share, store, cross-link, and analyze large-scale datasets, with appropriate 

privacy protections. Among the rich data available from NHLBI-funded research will be more 

than 20,000 chest images from the COPDGene Study9 and more than 150,000 whole genome 

sequences collected through NHLBI’s Trans-Omics for Precision Medicine (TOPMed)10

program from participants in more than 80 diverse studies, including the Framingham Heart 

Study, Jackson Heart Study, and Women’s Health Initiative. 

To propel further growth in data science, NHLBI also supports research on transformational AI 

tools, which rapidly sift through vast amounts of data to identify patterns that can help 

researchers make new discoveries and aid clinicians in improving care. For example, NHLBI’s 

COPDGene Study used AI principles to predict acute respiratory events in smokers with chronic 

obstructive pulmonary disease (COPD),

11 and another study used AI to distinguish malignant 

and benign lung nodules (swellings).12 An ongoing study is evaluating whether an AI “chat bot” 

can improve adherence to medication for high blood pressure, coronary heart disease, and other 

4 www.ncbi.nlm.nih.gov/pmc/articles/PMC4696033/

5 www.nhlbi.nih.gov/news/2017/wake-call-2017-nobel-prize-medicine-awarded-studies-bodys-internal-clock 6 www.ncbi.nlm.nih.gov/pubmed/30760925

7 www.nhlbidatastage.org/

8 www.datascience.nih.gov/strides

9 www.copdgene.org/

10 www.nhlbiwgs.org/ 11 www.ncbi.nlm.nih.gov/pubmed/28892454 12 www.ncbi.nlm.nih.gov/pubmed/31087332
NHLBI-14

conditions.13 The hope is that in the years ahead, the combination of AI, large accessible 

datasets, and robust analytics will lead to more precise diagnostic tools and therapies. 

Reducing Maternal Mortality and Improving Women’s Heart Health across the Lifespan. 

Maternal mortality and morbidity are rising in the United States even as they decrease globally. 

Each year, about 700 American women die from pregnancy or delivery complications. 

Cardiovascular conditions, including gestational hypertension and preeclampsia (which is 

marked by hypertension and elevated protein in urine), cardiomyopathy (heart muscle 

weakness), and venous thromboembolism (a clot that starts in a vein) are among the leading 

causes.14 Moreover, these conditions disproportionately affect women of color, and Black and 

American Indian/Alaska Native women aged 30 and over are four to five times more likely to die 

during childbirth than White women.15

With rising rates of obesity, diabetes, and high blood pressure among young people, many 

women are coming into their pregnancies at higher risk for CVD. Additionally, pregnancy is a 

risk factor for future CVD. There is an urgent need to improve women’s heart health across the 

entire lifespan, and to use implementation science to bring proven interventions into practice to 

reduce racial/ethnic disparities in CVD. NHLBI supports research to understand and reduce 

women’s risk of CVD, including during vulnerable windows of time before, during, and after

pregnancy. For example, an ongoing trial is examining whether pregnant women with mild 

chronic hypertension, the most common medical disorder in pregnancy, will benefit from 

treatment to lower their blood pressure to a target often used for non-pregnant adults (<140/90 

mmHg), without a harmful reduction in blood flow to the womb.16 In collaboration with the 

Eunice Kennedy Shriver National Institute of Child Health and Human Development, NHLBI is 

supporting research to better understand how sleep disturbance affects pregnancy outcomes. A 

recent analysis from the nuMoM2b Sleep-Disordered Breathing Study revealed that sleep apnea 

during pregnancy is associated with an increased risk of gestational hypertension and diabetes.17 

The nuMoM2b Heart Health Study18 is now looking at how sleep apnea and other pregnancy 

complications, such as preeclampsia and hypertension, affect a woman’s long-term health. 

Another NHLBI-funded study focuses on how to best manage blood clots in pregnant women.19

Researchers are also working to determine the most effective ways to improve pregnancy-related 

outcomes in obese and overweight pregnant women. A recent study found that lifestyle 

interventions can help.20

Addressing Disparities to Improve the Health of All Populations. In addition to reducing 

disparities in maternal health, NHLBI will continue its long-standing commitment to address the 

13 https://projectreporter.nih.gov/project_info_description.cfm?aid=9750927&icde=46475566 14 www.cdc.gov/reproductivehealth/maternal-mortality/pregnancy-mortality-surveillance-system.htm 15 www.cdc.gov/mmwr/volumes/68/wr/mm6835a3.htm?s_cid=mm6835a3_w 16 www.nhlbi.nih.gov/news/2019/chronic-hypertension-pregnancy-treat-or-not-treat 17 www.ncbi.nlm.nih.gov/pubmed/27926645 18 www.clinicaltrials.gov/ct2/show/NCT02231398 19 https://projectreporter.nih.gov/project_info_description.cfm?aid=9676403&icde=46918786 20 www.ncbi.nlm.nih.gov/pubmed/31292531
NHLBI-15

disparate burden of CVD and chronic lung disease in underserved minority, low-income, and 

rural communities. Recognizing that unique communities can face unique barriers and 

challenges to health over the lifespan, NHLBI will expand its cohort studies to better understand 

and address chronic disease risk factors and outcomes across diverse populations.

For COPD, which disproportionately affects people living in rural areas, NHLBI is working with 

Federal agencies and non-governmental partners to implement the COPD National Action Plan, 

released in 2017.21 For example, funding opportunities driven by the Action Plan are supporting 

researchers to develop innovative ways to deliver pulmonary rehabilitation to patients in hard-toreach settings, which can help them breathe better and may even slow disease progression. 

To address the high burden of chronic disease in America’s heartland, NHLBI established a new 

study in 2019, the Risk Underlying Rural Areas Longitudinal (RURAL) cohort study,22 that will 

include 4,000 people in 10 low-income counties in the South. NHLBI also continues to advance 

research to improve the health of American Indian communities. In 2019, NHLBI renewed its 

commitment to the Strong Heart Study, the largest study of CVD and its risk factors in American 

Indians. The study involves a partnership with 12 Tribal Nations, and since its inception in 

1988, has followed more than 8,000 participants, many of whom live in low-income, rural areas 

of Arizona, Oklahoma, and the Dakotas. This new study phase includes more funding for 

community-driven pilot projects, and continued emphasis on training and development.

Sustaining a Diverse and Inclusive Scientific Workforce. Investigator-initiated research 

remains the cornerstone of the biomedical research enterprise. NHLBI has prioritized

investigator-initiated science and support for early-stage investigators (ESI); over the past five 

years, the success rate for NHLBI ESIs improved by 78 percent. The Institute also has invested 

in programs to sustain a workforce that reflects the diversity of the Nation. Examples include the 

availability of NHLBI supplemental awards to grantees who diversify their research team, and 

NHLBI’s Programs to Increase Diversity Among Individuals Engaged in Health-Related 

Research (PRIDE), which prepares junior faculty from underrepresented backgrounds for 

successful research careers. An analysis of the PRIDE program found that from 2006 to 2018, 

the success rate for NIH grant applications submitted by PRIDE graduates was 63 percent, 

compared to 19 percent for NIH applications overall—evidence that the program has been 

successful in strengthening the skills of underrepresented investigators and helping to diversify 

the NIH-funded workforce.23

Ensuring the long-term stability of an inclusive workforce is also a priority. NHLBI leadership 

and program staff make every effort to identify and retain tomorrow’s scientific leaders; to 

support them on a path to independence; and to prepare them to train the next generation. One 

researcher with early support from an NHLBI training award is now helping cultivate a new 

21 www.nhlbi.nih.gov/health-topics/education-and-awareness/COPD-national-action-plan 22 www.theruralstudy.org/ 23 www.ncbi.nlm.nih.gov/pubmed/30975303
NHLBI-16

cadre of physician-scientists through a medical residency program,24 and recently discovered a 

new lung cell type that could lead to new treatment strategies for cystic fibrosis.25 A Native 

American researcher who did her graduate work with the Strong Heart Study under a training 

grant is now the principal investigator leading the study’s field center in North and South 

Dakota, and is working with research trainees from the affiliated American Indian 

communities.26 Yet another former NHLBI-funded trainee in hematology went on to transform 

the understanding of how blood-clotting cells regenerate and to lead a program for early medical 

students to gain research experience.27 NHLBI will continue this commitment to support 

talented scientists throughout their careers, helping them succeed not only as investigators, but as 

teachers and mentors for a future globally competitive workforce.

Overall Budget Policy:

The FY 2021 President’s Budget request is $3,298.0 million, a decrease of $327.3 million or 9.0

percent compared with the FY 2020 Enacted level. Reductions are distributed across all 

programmatic, basic, epidemiologic, translation, and clinical research areas. 

Program Descriptions and Accomplishments

Cardiovascular Diseases: The cardiovascular disease (CVD) program supports research aimed 

at diagnosing, preventing and treating pediatric and adult cardiovascular diseases, including heart 

attack, heart failure, vascular dementia, stroke, and congenital heart disease. The program also 

supports the development of innovative technologies to diagnose, prevent, and treat CVD and 

offers research training and career development opportunities. In FY 2021, NHLBI will continue 

24 www.ncbi.nlm.nih.gov/pubmed/29878132 25 www.ncbi.nlm.nih.gov/pubmed/30069044 26 www.nhlbi.nih.gov/nhlbi-celebrates-women-scientists/amanda-fretts-phd-mph 27 www.projectreporter.nih.gov/project_info_description.cfm?aid=9672557

Program Portrait: Supporting Native American Students to Lead in Native Health Research 

A racially and ethnically diverse biomedical workforce is essential for addressing racial and ethnic health 

disparities, such as those that affect American Indian and Alaska Native (AI/AN) populations. Rates of heart 

disease and asthma are higher in AI/AN people than in whites, yet AI/AN researchers represent less than one 

percent of the biomedical work force.1 To address this issue, NHLBI and other Institutes established the 

Native American Research Internship (NARI) nearly one decade ago to provide culturally relevant research 

training and experience for AI/AN students.2 NARI supports undergraduate AI/AN students from across the 

country in paid summer research internships at the University of Utah. Students also receive cultural and 

professional mentorship from community members and renowned biomedical scientists working in many areas 

including heart, lung, blood, and sleep disorders. Through program development in partnership with AI/AN 

elders, faculty, students, and community organizations, NARI has been highly successful. Since 2010, NHLBI 

funding for the program has supported 65 students from 36 tribal nations. Of those, 47 have received a healthrelated bachelor’s degree, 14 have gone to graduate school, and 10 have gone to medical school. 

1 www.ncbi.nlm.nih.gov/pubmed/25588950

2 https://medicine.utah.edu/pediatrics/research/education/nari.php
NHLBI-17

supporting innovative and novel research ideas submitted by new investigators.

The CVD program’s portfolio supports research to understand and improve heart and vascular 

health across the lifespan. Since 1948, NHLBI’s Framingham Heart Study (FHS) has continued 

to amass knowledge about CVD risk factors, and to guide prevention and treatment strategies. 

Many studies modeled after FHS are exploring chronic disease risk in diverse populations, 

including the Jackson Heart Study of African Americans in Mississippi, and the Atherosclerosis 

Risk in Communities Study (ARIC) study of Black and White middle-aged adults.

FHS investigators were also among the first to recognize that a high burden of CVD might 

contribute to the increasing burden of dementia in older Americans. The FHS and NHLBI’s 

diverse cohort studies have thus expanded over the years to include cognitive testing, and to 

examine how cardiovascular risk factors affect cognitive outcomes. For example, new findings 

from ARIC add to the growing evidence base that physical activity is not only good for the heart, 

but also for the brain. The researchers found that after 17 years of follow-up, participants who 

engaged in persistent moderate-to-high physical activity in midlife had about a 40 percent 

reduced incidence of dementia than their sedentary peers.28

NHLBI is also working with the National Institute on Aging and other Institutes to refine this 

emerging knowledge about vascular causes of dementia. In FY 2019 and 2020, NHLBI made 

nearly 30 supplemental awards to existing projects with potential relevance to dementia. For 

example, one group of researchers has been examining reductive stress—a harmful process that 

can occur with excess exposure to antioxidants—and its potential role in some types of heart 

failure. With their supplemental award, these researchers are now also studying whether 

reductive stress contributes to dementia in people with heart failure.29 

The CVD program continues to support innovative research toward new treatments for the full 

spectrum of cardiovascular disease in people of all ages. For example, many Americans have a 

cardiac arrhythmia (an abnormal heart rate); the most common type—atrial fibrillation (AFib)—

affects 3 to 7 million adults and is a risk factor for strokes. One NHLBI-funded team is working 

with patients, their caregivers, health care providers and computer programmers to develop, 

validate and test a new smartphone application that can monitor and detect AFib in people at risk 

for a first-time or recurrent stroke.30 In a study of ventricular tachycardia (a fast rhythm), 

researchers are developing a noninvasive catheter-free method for mapping and treating the area 

of the heart where the abnormal rhythm originates. The procedure combines cardiac imaging 

and electrocardiography (EKG) with stereotactic body radiation therapy—originally developed 

to deliver precise, high-dose radiation to tumors.31 Others are working to improve cardiac 

interventions for pediatric patients. In one study, magnetic resonance imaging (MRI) images 

were overlaid with standard live X-ray images to help guide cardiac catheterization for children 

with congenital heart disease. The combined procedure was faster and reduced the children’s 

exposure to X-rays.32

28 www.ncbi.nlm.nih.gov/pubmed/30321503 29 www.projectreporter.nih.gov/project_info_description.cfm?aid=9596809&icde=45602328 30 www.clinicaltrials.gov/ct2/show/NCT03761394 31 www.ncbi.nlm.nih.gov/pubmed/29236642 32 www.ncbi.nlm.nih.gov/pubmed/31062506
NHLBI-18

Since it began in 2001, NHLBI’s Pediatric Heart Network (PHN) has been working to improve 

evidence-based treatment for congenital heart disease. The PHN includes more than 30 

children’s hospitals with specialized heart disease teams that collaborate to support both state-ofthe-art care and research. For example, through a collaborative review of surgeries for two 

common heart defects—tetralogy of Fallot (TOF) and coarctation (narrowing) of the aorta—

network researchers developed new postsurgical guidelines that cut the amount of time infants 

spent on a breathing tube by 80 percent.33 These new guidelines also reduced the cost of TOF 

surgery by 27 percent.34

NHLBI is leveraging the PHN and other resources, including its Pediatric Cardiac Genomics 

Consortium (PGCC), as part of the trans-NIH project, Investigation of Co-occurring Conditions 

Across the Lifespan to Understand Down syndrome (INCLUDE). Through INCLUDE, NHLBIfunded researchers are increasing the number of individuals with both Down syndrome and 

congenital heart disease in the PGCC to investigate the genetic factors that could link Down 

syndrome with congenital heart disease. The PHN is also supporting career development awards 

for four emerging clinician-scientists to help them gain expertise in treating patients with 

congenital heart disease and Down syndrome.

Budget Policy:

The FY 2021 President’s Budget request is $1,765.9 million, a decrease of $176.1 million or 9.0

percent compared with the FY 2020 Enacted level. 

Lung Diseases: Since its inception in 1969, 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, 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 (LAM). 

NHLBI’s lung program is committed to reducing the burden of COPD, which is among the 

leading causes of death in the United States and has a disproportionate impact on rural 

communities. As part of the COPD National Action Plan, NHLBI has been working with other 

Federal health agencies and non-governmental partners to intensify research and outreach efforts 

to address this disparity. One high priority area for NHLBI is finding new ways to increase the 

use of pulmonary rehabilitation (PR) for COPD patients, especially in rural areas. Despite 

proven benefits, a very small proportion of COPD patients receive PR during hospitalization, and 

of those, only about four percent adhere to it after discharge, perhaps due to the challenge of 

regular travel to distant PR facilities. Researchers are thus testing the effectiveness of a home33 www.ncbi.nlm.nih.gov/pubmed/27513600 34 www.ncbi.nlm.nih.gov/pubmed/30458158
NHLBI-19

based PR program that includes a health coach.35 Another group is analyzing the records of 

Medicare beneficiaries to identify factors and strategies that enable some hospitals to achieve 

higher rates of PR participation than others.36 

In 2019, NHLBI funded two new population studies that will also help address the burden of 

COPD and other lung diseases nationwide and in rural communities. The American Lung 

Association (ALA) Lung Health Cohort is the first national adult cohort focused on respiratory

health and will follow 4,000 healthy millennials (aged 25-35) to identify early risk factors and 

signs of lung disease, to allow for earlier and more effective intervention. This cohort may help 

researchers better understand the long-term impact of potentially harmful exposures such as 

nicotine products and e-cigarettes or vaping on adult lungs. The RURAL Cohort Study will 

investigate what causes the high rates of COPD and other chronic diseases in southern rural 

communities. The study will use a mobile clinic to collect health data from about 4,000 residents 

aged 35-64 in 10 rural counties in Alabama, Kentucky, Louisiana, and Mississippi. 

The lung program is also committed to reducing the burden of asthma, the most prevalent 

chronic respiratory disease worldwide. Poorly controlled or uncontrolled asthma is associated 

with reduced quality of life, increased hospitalizations and healthcare costs, and high rates of 

missed school and work. There is a need for timely clinical practice guidelines that can be used 

by frontline practitioners to diagnose, treat, and manage asthma. NHLBI is taking a leadership 

role in updating the 2007 national asthma guidelines for adults and children. The new guidelines 

are expected to be released for public comment in early 2020 and completed by fall 2020. 

As part of its commitment to translational research and precision medicine, NHLBI’s lung 

program is beginning to enroll patients with severe asthma at 30 locations nationwide as part of 

its PrecISE clinical trial network.37 PrecISE will evaluate novel and approved treatments for 

asthma by targeting them to defined groups of patients, for example, patients who share certain 

genetic factors or biomarkers. Recent NHLBI-funded research illustrates the benefits of tailoring 

asthma interventions based on patient characteristics. For example, one study found that patients 

with high levels of eosinophils—a cell type that can contribute to airway inflammation—are 

more likely to respond to inhaled corticosteroid medications, a standard treatment for asthma,

than are patients with low eosinophils.

38 Another recent study examined how African Americans 

with poorly controlled asthma respond to more intensive treatment options—either a higher 

corticosteroid dose or addition of a bronchodilator (a drug to open the airway). While the latter 

option tends to work best for most African Americans over age 12 and for White children, in this 

study, the two options were about equally likely to work for African American children under 

12.

39 

NHLBI’s leadership in precision medicine for lung disease can also be seen in its Pulmonary 

Vascular Disease Phenomics (PVDOMICS) program, which focuses on pulmonary hypertension 

35 https://projectreporter.nih.gov/project_info_details.cfm?aid=9786816&icde=46788170 36 www.ncbi.nlm.nih.gov/pubmed/30417670 37 www.preciseasthma.org/preciseweb/ 38 www.ncbi.nlm.nih.gov/pubmed/31112384 39 www.ncbi.nlm.nih.gov/pubmed/31553835
NHLBI-20

(PH)—a type of high blood pressure in the lungs and heart. There are clinically defined subtypes 

of PH that can help refine diagnosis and treatment—but many patients have a mix of subtypes 

and face poor outcomes. Via deep analysis of disease mechanisms and biomarkers, PVDOMICS 

is achieving new molecularly defined subtypes of PH that will inform more precise treatments.

The Institute is also committed to stimulating precision medicine approaches for pulmonary 

fibrosis (PF), a progressive disease that scars the lungs. For example, new projects in calendar 

year 2020 will focus on developing better model systems to understand the disease and conduct 

preclinical studies of potential new therapies. In addition, based on an earlier retrospective 

analysis suggesting that the TOLLIP gene influences patients’ responses to the antioxidant Nacetylcysteine (NAC), the new PRECISIONS trial will enroll only those patients who carry a 

certain TOLLIP gene variation to determine if they benefit from NAC.40

The lung program also administers NIH’s National Center on Sleep Disorders Research, 

established by Congress in 1993.41 In its early years, the Center facilitated programs to raise 

public awareness about sleep and health, including a collaboration with the Department of 

Transportation to call attention to the perils of drowsy driving. In its second decade, the Center 

commissioned an Institute of Medicine review concluding that sleep deprivation and disorders 

remain an unmet challenge to public health, and in follow-up, NHLBI established novel training 

programs in sleep research and public health education. Today, the Center supports state-of-theart science in the biology of sleep, circadian rhythms, and sleep disorders, and their contributions 

to heart, lung, and blood health, and the risk of chronic disease.

Budget Policy:

The FY 2021 President’s Budget request is $700.7 million, a decrease of $69.9 million or 9.0

percent compared with the FY 2020 Enacted level. 

Blood Diseases: Blood diseases affect millions of people worldwide each year. 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. 

The blood program has a long history of supporting research on sickle cell disease (SCD), a 

genetic blood disorder that afflicts about 100,000 African Americans with disabling pain and 

life-threatening complications. A legacy of research support on SCD provided a scientific 

foundation for the Cure Sickle Cell Initiative42, a public-private partnership of patients, 

researchers, Federal health agencies, biotechnology firms, and other private sector partners. 

40 www.projectreporter.nih.gov/project_info_description.cfm?aid=9822535&icde=46909809 41 www.ncbi.nlm.nih.gov/pubmed/31125417 42 www.nhlbi.nih.gov/science/cure-sickle-cell-initiative
NHLBI-21

Launched in 2018, the initiative aims to bring state-of-the-art gene- and cell-based therapies for 

SCD into first-in-human trials within the next several years. Recent progress includes funding of 

several preclinical studies of emerging therapies. For example, one project awarded in 2019 

focuses on clustered regularly interspaced short palindromic repeats (CRISPR) gene-editing 

technology, which can precisely cut out and insert small pieces of DNA to repair a defective 

gene. The researchers have devised an approach that uses CRISPR to repair the sickle cell 

mutation in blood-forming stem cells, and are performing the studies needed to prepare for an 

early phase clinical trial in adults with severe SCD.43

Also, as part of The Cure Initiative, a funding opportunity released in May 2019 will support the 

development of new assays to evaluate SCD gene therapy and gene editing approaches in clinical 

trials, as well as new technology and methods to support manufacture of validated therapeutics. 

An analysis is also being conducted to better understand both the clinical and economic benefits 

and risks of new intervention strategies compared to more established treatment strategies. 

Since data show that many patients with SCD do not receive interventions proven to reduce pain 

and the risk of stroke, the blood program also supports research to identify barriers to care for 

SCD. The SCD Implementation Consortium consists of eight geographically diverse centers that 

are testing new approaches to enhance delivery of evidence-based care for SCD and improve 

health outcomes. The first three protocols have begun, including one that focuses on improving 

emergency department (ED) care of patients in severe acute pain, or sickle cell crisis. NHLBI 

supports global research efforts in SCD that are expected to benefit patients in the United States 

and in other parts of the world. For example, sub-Saharan Africa is home to more than 75 

percent of SCD births worldwide, and more than half of infants born with SCD die before age 5. 

NHLBI supports major programs in the region, including the Sickle Pan-African Research 

Consortium, that are working to build research capacity and develop an infrastructure to enhance 

disease surveillance and delivery of care. NHLBI is also part of a new NIH collaboration with 

the Bill & Melinda Gates Foundation to develop affordable, gene-based cures for SCD that will 

be made available in low-resource communities globally. 

43 www.projectreporter.nih.gov/project_info_description.cfm?aid=9935897&icde=45533387
NHLBI-22

In addition to SCD, NHLBI supports research on many other blood disorders, including 

hemophilia, a rare genetic disorder that can cause severe bleeding from a minor cut. People with 

hemophilia A are deficient for blood-clotting protein called Factor VIII (FVIII); those with 

hemophilia B are deficient for Factor IX. NHLBI-funded research helped lead to the 

development of factor replacement therapy—the infusion of these proteins into the blood—

which can prevent dangerous bleeding. However, approximately 30 percent of individuals with 

hemophilia A develop antibodies against FVIII that can render the therapy ineffective. In 2018, 

NHLBI launched a five-year multi-center program to understand how anti-FVIII antibodies arise, 

and to guide development of new therapies that avoid triggering them. Researchers are also 

working to develop gene therapy approaches with the potential to avoid the antibody response to 

FVIII. 44

Ensuring the safety of the blood supply is a public health priority, particularly when the Nation is 

threatened by new infectious diseases with the potential for blood transmission. NHLBI’s

Recipient Epidemiology and Donor Study (REDS) program was established in 1989 during the 

AIDS epidemic to reduce the transmission of HIV/AIDS through blood. REDS investigators 

began monitoring the blood supply and developed a screening method, nucleic acid testing 

(NAT), that can rapidly detect HIV in donated blood and is still being used today. 

44 https://projectreporter.nih.gov/project_info_description.cfm?aid=9738975&icde=47058833

Program Portrait: Leveraging Genetic Discoveries and Technologies to Improve Health

The NHLBI has been a leader in defining the genetic causes of rare, inheritable diseases, and in developing 

gene-based therapies. For example, in 1993, NHLBI intramural scientists discovered the gene that causes Xlinked severe combined immunodeficiency (XSCID), in which the body fails to develop essential immune 

cells, causing a high risk of recurrent and potentially fatal infections.1

 This discovery paved the way for a 

recent NIH-funded gene therapy trial that successfully reconstituted the immune systems of eight infants with 

XSCID.2

 Today, NHLBI supports a robust portfolio of projects focused on gene-based therapies, including 

gene editing, a technology that works like molecular scissors to repair a defective gene. An NHLBI-sponsored 

workshop held in 2018, “Advancing Gene Editing Technologies for the Treatment of Cystic Fibrosis Lung 

Disease,” is helping inform strategic research in this area.3

 NHLBI also support the development of gene 

editing tools that are highly precise yet versatile enough to target a wide range of mutations, such as those that 

can cause Duchenne muscular dystrophy (DMD). In one recent study, researchers used a gene editing tool 

called CRISPR-Cas9 to “cut out” a variety of DMD mutations—including large deletions and single-letter 

changes in the DNA code— in heart muscle cells derived from patients.4

 Every advance for each disease is 

helping set the stage for new treatments, and ultimately cures, for a vast array of diseases. Indeed, NHLBI’s 

Cure Sickle Cell Initiative, launched in 2018, is building on these kinds of advances to bring gene-based 

therapies for sickle cell disease into clinical trials in the next several years.

1 www.ncbi.nlm.nih.gov/pubmed/8462096

2 www.ncbi.nlm.nih.gov/pubmed/30995372

3 https://www.nhlbi.nih.gov/events/2018/nhlbicff-workshop-advancing-gene-editing-technologies-treatmentcystic-fibrosis-lung 4 www.ncbi.nlm.nih.gov/pubmed/29404407
NHLBI-23

When the mosquito-borne Zika virus emerged as a public health threat in 2016, the Recipient 

Epidemiology and Donor Evaluation Study (REDS)

45 program began surveillance of the virus in 

blood donations, and established a biorepository of blood samples from consenting Zika-positive 

donors in the United States from 2016-2018. Although the Zika outbreak has fortunately waned, 

these blood samples have been shared broadly with researchers who are studying the virus and 

developing better tests to detect it. In 2019, the REDS program expanded its scope to address 

transfusion safety in infants and children—a group that is understudied in transfusion research 

and highly vulnerable to adverse outcomes. REDS is also working with the Department of 

Defense and academic centers to establish guidelines for use of blood-clotting products in 

injured soldiers. 

Budget Policy:

The FY 2021 President’s Budget request is $464.4 million, a decrease of $46.3 million or 9.0

percent compared with the FY 2020 Enacted level.

Implementation Science: The Center for Translation Research and Implementation Science46

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

advancing late-stage translational research implementation science—which describes research to 

improve the adoption of evidence-based approaches to treat and prevent disease and promote 

health. As an important part of this focus, the Center supports research on health disparities and 

inequities, and on global health, as well as research training and career development in 

implementation science.

The program is at the leading edge of using implementation science and predictive analytics to 

translate discovery into real-world health impact. For example, the program is supporting a new 

field of study called Modeling and Systems Science (SMSS), in which researchers simulate how 

a specific intervention might work in different populations and settings, with the ability to adjust 

and refine the intervention prior to actually implementing it in the real world. A current project

is using SMSS to project the 10- and 30-year impact of 6 evidence-based obesity interventions at 

the national level and in 6 socioeconomically diverse states—Alaska, Hawaii, Mississippi, New 

York, West Virginia, and Washington.47

To better address the high burden of chronic disease faced by many communities in the United 

States, the Center is working in collaboration with the National Institute on Minority Health and 

Health Disparities to analyze health data at the county level, stratified by race/ethnicity, 

socioeconomic status, sex, and age. These data are expected to help identify what drives high 

rates of disease in some communities, and to reveal potential targets for intervention.

In collaboration with NIH’s Fogarty International Center, the program is working to address the 

increasing global burden of chronic diseases that affect people living with HIV.48 Even with 

45 https://www.nhlbi.nih.gov/science/recipient-epidemiology-and-donor-evaluation-study-reds-program 46 https://www.nhlbi.nih.gov/about/divisions/center-translation-research-and-implementation-science 47 https://projectreporter.nih.gov/project_info_description.cfm?aid=9714056&icde=46850057 48 www.grants.nih.gov/grants/guide/rfa-files/RFA-HL-20-026.html
NHLBI-24

effective drug therapy to suppress HIV, people with HIV have a high risk of developing chronic 

heart, lung, blood, and sleep disorders, compared to people who are HIV-negative. The Heart, 

Lung, and Blood Co-morbidities Implementation Models in People Living with HIV (HLBSIMPLe) initiative supports implementation science research to understand and reduce these 

HIV-related comorbidities in low- and middle-income countries. The goal is to achieve earlier 

detection and prevention of these comorbidities, and the strategies and findings are expected to 

benefit Americans with HIV living in low-and middle-income regions of the United States.

Budget Policy:

The FY 2021 President’s Budget request is $25.9 million, a decrease of $2.6 million or 9.1

percent compared with the FY 2020 Enacted level.

Intramural Research: The NHLBI intramural program, located on the NIH Campus in 

Bethesda, Maryland, conducts innovative basic and clinical research and has a strong training 

program. The research portfolio is broad, 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. 

Intramural researchers studying psoriasis, a chronic inflammatory skin disease, recently made a 

discovery with potential implications not only for treating psoriasis but for heart disease. Based 

on prior research showing that people with psoriasis have a higher risk of coronary artery 

disease, the researchers wondered if newer therapies for psoriasis would also reduce heart 

disease risk in these patients. In a study of 134 patients, they used a novel imaging technique to 

determine that patients who received biologic therapy had a significant reduction in coronary 

artery plaque after one year, compared to patients who elected to receive only topical skin 

treatments.49 This work highlights the potential significance of inflammation—and efforts to 

treat it— in all patients with coronary artery disease. 

Other researchers continue to work toward curative strategies for SCD. For more than a decade, 

an intramural team has been working to improve genetic therapy approaches for the disease, with 

a focus on higher efficiency methods to insert therapeutic genes into bone marrow stem cells that 

could then be delivered to patients. These researchers recently developed an improved vector, or 

virus-based delivery system, that is 10 times more efficient at incorporating corrective genes into 

bone marrow stem cells than the most common vectors used in this research.50 The new vector 

will soon be tested in human trials. 

Intramural scientists continue to be innovative leaders in biological imaging, which has earned 

them recognition from major scientific professional organizations. One scientist set out to 

achieve better views of the lung using MRI, which has been problematic because the images are 

distorted by air. Her solution was to combine older, lower magnetic-field MRI technology with 

49 www.ncbi.nlm.nih.gov/pubmed/31365032 50 www.ncbi.nlm.nih.gov/pubmed/31578323
NHLBI-25

contemporary high-performance hardware. This approach enabled high-quality lung images, and 

earned a BEAR Cage (Building Education to Advance Research) prize at the 2019 American 

Thoracic Society conference.51 Another intramural scientist was recently inducted into the 

National Academy of Sciences52 for her pioneering work in understanding the movement of 

cells. She invented an advanced microscopic imaging method that has increased the field’s 

knowledge of the molecular and biophysical basis of cell movement, a critical aspect of many 

processes including growth, development, wound healing, and regeneration.

Budget Policy:

The FY 2021 President’s Budget request is $204.2 million, a decrease of $25.2 million or 11.0

percent compared with the FY 2020 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 

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 2021 President’s Budget request is $136.9 million, a decrease of $7.2 million or 5.0

percent compared with the FY 2020 Enacted level.

51 https://www.nhlbi.nih.gov/nhlbi-celebrates-women-scientists/adrienne-campbell-washburn-phd 52 www.nasonline.org/member-directory/members/20044138.html
NHLBI-26

FY 2020 Enacted FY 2021 President's 

Budget

FY 2021

+/-

FY 2020

Full-time equivalent 962 962 0

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

Average ES salary $194 $197 $3

Average GM/GS grade 12.8 12.8 0.0

Average GM/GS salary $124 $126 $2

Average salary, grade established by act of July 1, 

1944 (42 U.S.C. 207) $107 $110 $3

Average salary of ungraded positions $132 $134 $2

FY 2020 Enacted FY 2021 President's 

Budget

FY 2021

+/-

FY 2020

Personnel Compensation

Full-Time Permanent 65,707 66,463 756

Other Than Full-Time Permanent 35,056 35,459 403

Other Personnel Compensation 4,877 4,933 56

Military Personnel 2,277 2,338 60

Special Personnel Services Payments 11,122 11,250 128

Subtotal Personnel Compensation $119,039 $120,442 $1,403

Civilian Personnel Benefits 36,544 37,969 1,425

Military Personnel Benefits 1,901 1,952 50

Benefits to Former Personnel 0 0 0

Subtotal Pay Costs $157,484 $160,363 $2,879

Travel & Transportation of Persons 3,609 3,681 72

Transportation of Things 193 196 4

Rental Payments to GSA 0 0 0

Rental Payments to Others 0 0 0

Communications, Utilities & Misc. Charges 648 661 13

Printing & Reproduction 6 6 0

Consulting Services 2,967 3,026 59

Other Services 95,320 57,727 -37,593

Purchase of goods and services from government 

accounts 315,322 266,760 -48,562

Operation & Maintenance of Facilities 4,817 4,817 0

R&D Contracts 144,190 105,380 -38,811

Medical Care 1,198 1,245 47

Operation & Maintenance of Equipment 21,515 21,875 360

Subsistence & Support of Persons 0 0 0

Subtotal Other Contractual Services $585,329 $460,829 -$124,500

Supplies & Materials 16,192 16,504 312

Equipment 10,308 10,509 201

Land and Structures 1,663 1,696 33

Investments & Loans 0 0 0

Grants, Subsidies & Contributions 2,849,820 2,643,552 -206,268

Insurance Claims & Indemnities 0 0 0

Interest & Dividends 6 6 0

Refunds 0 0 0

Subtotal Non-Pay Costs $3,467,774 $3,137,641 -$330,133

Total Budget Authority by Object Class $3,625,258 $3,298,004 -$327,254

1

42.0

43.0

44.0

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

25.0

26.0

31.0

32.0

33.0

41.0

25.3

25.4

25.5

25.6

25.7

25.8

23.1

23.2

23.3

24.0

25.1

25.2

12.1

12.2

13.0

21.0

22.0

11.1

11.3

11.5

11.7

11.8

11.9

OBJECT CLASSES

NATIONAL INSTITUTES OF HEALTH

National Heart, Lung, and Blood Institute

Budget Authority by Object Class1

(Dollars in Thousands)

Total compensable workyears:
NHLBI-27

OBJECT CLASSES FY 2020 Enacted FY 2021 President's 

Budget

FY 2021

+/-

FY 2020

Personnel Compensation

Full-Time Permanent (11.1) $65,707 $66,463 $756

Other Than Full-Time Permanent (11.3) 35,056 35,459 403

Other Personnel Compensation (11.5) 4,877 4,933 56

Military Personnel (11.7) 2,277 2,338 60

Special Personnel Services Payments (11.8) 11,122 11,250 128

Subtotal Personnel Compensation (11.9) $119,039 $120,442 $1,403

Civilian Personnel Benefits (12.1) $36,544 $37,969 $1,425

Military Personnel Benefits (12.2) 1,901 1,952 50

Benefits to Former Personnel (13.0) 0 0 0

Subtotal Pay Costs $157,484 $160,363 $2,879

Travel & Transportation of Persons (21.0) $3,609 $3,681 $72

Transportation of Things (22.0) 193 196 4

Rental Payments to Others (23.2) 0 0 0

Communications, Utilities & Misc. Charges (23.3) 648 661 13

Printing & Reproduction (24.0) 6 6 0

Other Contractual Services:

Consultant Services (25.1) 2,967 3,026 59

Other Services (25.2) 95,320 57,727 -37,593

Purchases from government accounts (25.3) 229,388 167,076 -62,312

Operation & Maintenance of Facilities (25.4) 4,817 4,817 0

Operation & Maintenance of Equipment (25.7) 21,515 21,875 360

Subsistence & Support of Persons (25.8) 0 0 0

Subtotal Other Contractual Services $354,007 $254,521 -$99,485

Supplies & Materials (26.0) $16,192 $16,504 $312

Subtotal Non-Pay Costs $374,655 $275,571 -$99,084

Total Administrative Costs $532,139 $435,933 -$96,205

NATIONAL INSTITUTES OF HEALTH

National Heart, Lung, and Blood Institute

Salaries and Expenses

(Dollars in Thousands)
NHLBI-28

Civilian Military Total Civilian Military Total Civilian Military Total

Center for Translation Research and Implementation Science

Direct: 12 1 13 20 2 22 20 2 22

Reimbursable: - - - - - - - - -

Total: 12 1 13 20 2 22 20 2 22

Division of Blood and Resources

Direct: 27 1 28 32 1 33 32 1 33

Reimbursable: - - - - - - - - -

Total: 27 1 28 32 1 33 32 1 33

Division of Cardiovascular Sciences

Direct: 116 1 117 131 2 133 131 2 133

Reimbursable: - - - - - - - - -

Total: 116 1 117 131 2 133 131 2 133

Division of Extramural Research Activities

Direct: 91 - 91 103 1 104 103 1 104

Reimbursable: - - - - - - - - -

Total: 91 - 91 103 1 104 103 1 104

Division of Intramural Research

Direct: 392 15 407 437 15 452 437 15 452

Reimbursable: 12 - 12 15 - 15 15 - 15

Total: 404 15 419 452 15 467 452 15 467

Division of Lung Diseases

Direct: 33 - 33 43 - 43 43 - 43

Reimbursable: - - - - - - - - -

Total: 33 - 33 43 - 43 43 - 43

Office of the Director

Direct: 137 2 139 156 4 160 156 4 160

Reimbursable: - - - - - - - - -

Total: 137 2 139 156 4 160 156 4 160

Total 820 20 840 937 25 962 937 25 962

FTEs supported by funds from Cooperative Research and 

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

FISCAL YEAR

2017

2018

2019

2020

2021 12.8

Average GS Grade

12.6

12.7

12.7

12.8

NATIONAL INSTITUTES OF HEALTH

National Heart, Lung, and Blood Institute

Detail of Full-Time Equivalent Employment (FTE)

OFFICE/DIVISION

FY 2019 Final FY 2020 Enacted FY 2021 President's Budget

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

FY 2019 Final FY 2020 Enacted FY 2021 President's 

Budget

2 2 2

376,126 388,087 393,908

87 102 102

155 180 180

185 214 214

57 67 67

42 47 47

0 0 0

33 36 36

5 5 5

7 8 8

2 2 2

1 1 1

5 5 5

3 3 3

1 1 1

2 2 2

585 673 673

1 1 1

7 7 7

6 6 6

6 6 6

1 1 1

0 0 0

21 21 21

232 266 266

608 696 696

840 962 962

840 962 962

188,063 194,044 196,954

12.7 12.8 12.8

117,684 123,803 125,660

1

Average ES salary

Average GM/GS grade

Average GM/GS salary

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

Total permanent positions

Total positions, end of year

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

Senior Grade

Full Grade

Senior Assistant Grade

Assistant Grade

Subtotal

Ungraded

GS-1

Subtotal

Grades established by Act of July 1, 1944 (42 U.S.C. 207)

Assistant Surgeon General

Director Grade

GS-7

GS-6

GS-5

GS-4

GS-3

GS-2

GM/GS-13

GS-12

GS-11

GS-10

GS-9

GS-8

NATIONAL INSTITUTES OF HEALTH

National Heart, Lung, and Blood Institute

Detail of Positions1

GRADE

Total, ES Positions

Total, ES Salary

GM/GS-15

GM/GS-14