Medical Professorial Unit,
St Vincent's Hospital,
The University of New South Wales,
Sydney, Australia
To the Editor:
As a student of the circulation, of aging, and of heart failure
in the elderly, I was flabbergasted to read1 that
the NIH "Special Emphasis Panel on Heart Failure Research"
described priorities without mentioning the physical properties of the
circulation and of left ventricular load in the aged.
Priorities were cellular, molecular, genetic, and chemical, yet were
applied to a mechanical system in which arterial stiffening
with age markedly alters wave reflection and distorts the physical
tuning between pulsating heart and compliant arterial tree.
Though recognized as a priority area by the NIH for special
funding (NIH Guide, Vol 24, No 24, June 30, 1995), this area was
completely ignored in the present report, as were clinical trials.
An accompanying commentary from Dr Claude
Lenfant2 as NHLBI Director also concentrated on
subcellular mechanisms and made no mention whatever of
ventricular load in heart failure or the NHLBI's 1995
initiative. Lenfant's pronouncement ran counter to his own 1995 news
article in Circulation3 on "Integrative
Physiology: Remember the Big Picture."
In the Louis P. Bishop lecture delivered at the 1997 American College
of Cardiology annual meeting in Anaheim, Calif, a
previous NIH Director, Bernadine Healy, addressed "The impact of
health care reform on medical schools" and pointed out that community
pressures will force researchers to tackle community problems such as
the escalating problem of heart failure in the elderly. In 2 short
years, the NHLBI appears to be turning from the practical problem of
heart failure to the latest
Health Scientist Administrator,
Heart Research Program,
Division of Heart and Vascular Diseases,
National Heart, Lung, and Blood Institute,
Bethesda, Md
© 1998 American Heart Association, Inc.
Correspondence
Priorities in Heart Failure Research