NIH Investment in Cardiac-Arrest Research Sinking

Patrice Wendling

July 13, 2017

ANN ARBOR, MI — National Institutes of Health (NIH) research funding in cardiac arrest (CA), the third leading cause of death in the US, fell nearly $7 million over the past decade, according to a new analysis[1].

The NIH investment in 2015 per annual death was just $91 for CA, compared with $13,000 for diabetes, $9000 for cancer, and $2200 for stroke. Based on 2016 data, researchers estimate NIH funding for CA research will further drop to $63 per annual death.

"There haven't been significant new discoveries that change the way we care for cardiac arrest based on the scientific pipeline for a long time," senior author Dr Robert W Neumar (University of Michigan, Ann Arbor) told | Medscape Cardiology.

Indeed, the funding pipeline is so dry that a recent review[2] found fewer than five CA randomized controlled trials, "a marker of research and innovation in the field," published per year for the past two decades, according to the paper, published July 12, 2017 in the Journal of the American Heart Association.

Part of the lack of monies is due to tepid support from drug companies and cardiovascular device makers. On the other hand, Neumar said, the lack of randomized trials may be because there aren't enough scientists interested in CA research.

He noted that despite advances such as public access to defibrillation, dispatched CPR, and the change to hands-only CPR, the average CA survival rate has remained largely unchanged in the US at 24% for in-hospital CA and 11% for EMS-treated, out-of-hospital CA. However, in up to half of cases where 911 is called, "EMS doesn't even initiate resuscitation because there are signs of irreversible death."

Neumar suggests, "The key to moving the field forward and improving outcomes from cardiac arrest is going to be more basic and clinical research."

Commenting on the findings, AHA president Dr John Warner (UT Southwestern Medical Center, Dallas TX) said in an email, "With thousands of Americans dying every year from cardiac arrest, more NIH-funded research into this condition is clearly needed."

He said CA survival is on the rise but that the AHA's 2015 guidelines identified some "steep gaps" in this area of research. For instance, "are mechanical chest compression devices better than chest compressions in a moving ambulance? What is the maximum shock energy for defibrillation, and what are the most effective methods for increasing bystander CPR?"

He added, "There are many more unanswered questions, and we encourage investigators to delve into these issues. More research can help save many more lives."


For the present study, the researchers analyzed CA research funding from 2007 to 2016 using the NIH research Portfolio Online Reporting Tools Expenditures and Results (REPORTER) database. Of the 2763 NIH-funded grants identified, 745 (27%) were classified as CA research by three independent reviewers (Fleiss κ=0.86 for interrater reliability; 95% CI 0.80–0.93).

Total CA funding was $30.5 million in 2007, peaked at $69.7 million in 2010, and fell to $28.5 million in 2016. After adjustment for inflation, funding was down nearly $7 million from $35.4 million in 2007 to $28.5 million in 2016.

Roughly 80% of this decline was because a 5-year NIH funding grant ended for the Resuscitation Outcomes Consortium (ROC), recently replaced by the broader-in-scope Strategies to Innovate Emergency Care Clinical Trials Network (SIREN).

"I don't know if I'd call it a golden era, but when the ROC was funded it was the highest level of NIH funding for cardiac arrest we'd seen, but most of that was for clinical research," Neumar said. "That consortium could have been even more successful if it had a more robust pipeline of laboratory, translational, and phase 1 studies to feed into that infrastructure."

The study did identify a bright spot in NIH research funding—a nearly 10-fold increase in pediatric CA funding from $1.1 million in inflation-adjusted dollars in 2007 to $9.6 million 2016. Over the same period, pediatric CA grants increased from five to 17 and individual trainee CA grants from five to 15.

Overall, there was little to no growth in the number of funded investigators (from 54 to 60), newly funded grants (12 to 17), and overall grants funded (from 70 to 65), according to the investigators, led by Ryan A Coute (formerly with University of Michigan, now with Kansas City University of Medicine and Biosciences).

Neumar said it's unclear exactly why pediatric CA funding has taken off, but high-profile deaths of young athletes on the playing field may be a contributing factor.

What is clear, however, is that the lack of new research in cardiac arrest means there are very few level 1 recommendations in the guidelines to direct the lay public, EMTs, paramedics, nurses, mid-level providers, and physicians in CPR and emergency CV care.

"There are case studies, observational studies, and a lot of expert opinion, but providers need recommendations in order to take care of these patients in a very timely manner," said Neumar, who's been involved in the guideline process for more than a decade as member of the AHA's emergency cardiovascular care committee.

"We feel strongly that those guidelines could be significantly improved with much more robust clinical research, and that needs to be fed by investing in basic and translational science."

Neumar reports modest funding from the National Institutes of Health. Lead author Ryan Coute was supported by the Sarnoff Cardiovascular Research Foundation during the study. Other coauthor disclosures are listed in the paper.

Follow Patrice Wendling on Twitter: @pwendl. For more from | Medscape Cardiology, follow us on Twitter and Facebook.


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