The American Heart Association (AHA) recently awarded more than $14 million to teams at four universities to study two important, closely related issues: sudden cardiac arrest and arrhythmias. These are problems worth solving, to put it mildly. Not only are there 350,000 out-of-hospital sudden cardiac arrests each year in the U.S, but about 90 percent of them result in death. And arrhythmias are the most common cause of these catastrophic health events.
The grants pull together different types of scientists and teams, including basic science, clinical and population researchers, to assemble a clearer picture of arrhythmias and sudden cardiac arrest and to develop better ways to study them, said the AHA.
While heart arrhythmias are common, most don't lead to cardiac arrest. But for many victims, there's no warning.
“In a third to maybe half of these patients, the first manifestation of disease is sudden cardiac arrest, which is often fatal,” Mariell Jessup, MD, chief science and medical officer at AHA told Inside Philanthropy. “You miss the opportunity for intervention if someone dies suddenly like that.”
Pushing for Better Answers
Immediate CPR treatment can improve a patient’s chances of survival, but doctors clearly need better ways to understand arrhythmias and take steps to prevent sudden cardiac arrests in the first place. “And as we become more and more successful at keeping people alive after heart attacks or other forms of heart failure, we find that often, the enduring problem is arrhythmia,” said Jessup.
(A note on terminology: cardiac arrest occurs when the heart’s electrical system goes awry, causing the heart to beat too quickly, too slowly or erratically, as in arrhythmias. Heart attacks occur when blood flow to the heart is interrupted due to a clog or narrowing in an artery supplying the heart.)
The AHA has directed the $14 million to create a collaborative research network linking teams at Northwestern University, University of Michigan, University of Washington and Vanderbilt University Medical Center. Each will receive more than $3.7 million. They'll study causes, risk factors and disease processes in an effort to generate knowledge that may lead to prevention and treatment of arrhythmia and sudden cardiac arrest.
A Shifting Strategy
From the perspective of developing key understanding and potentially saving lives, this investment is an important step. But the awards are also examples of a substantial shift in the AHA’s funding approach that started during the last few years, signaling the organization’s evolution from a more typical philanthropic funder of early-career researchers and clear public health threats such as high blood pressure, to an outfit that sets broad scientific goals for the country’s researchers.
Approximately 100 years old, the AHA has for decades been the best-known funder in cardiovascular disease and stroke. In fact, the majority of established investigators currently working in the field probably got their first important grants from the AHA, said Jessup.
But in the last decade, the organization reassessed its progress fighting heart disease, stroke and many cardiac-related health issues.
“We had been doing traditional funding, mostly for early career investigators and some established investigators, but we weren’t entirely happy with how well we were doing," said Jessup. The organization held a research summit involving an array of health experts and scientists. "In addition to our initial goal to fund early-career investigators and help launch their careers, we wanted to develop different models of funding to ultimately have an important impact on the health of Americans with respect to cardiac health.”
Among the AHA's new funding approaches were the Strategically Focused Research Programs, which launched around 2014. Under that program, the similarly named Strategically Focused Research Networks makes big grants—such as the one for sudden cardiac arrest and arrhythmia—to enable three to five institutions to create a new research network to address a health research area, such as hypertension.
"We asked where we were going, and how we could do better," said Jessup. "Coming up with these new funding models was a big step for the organization."
The AHA’s strategic network programs don't abandon support for early-career researchers and their concern with maintaining a pipeline of top researchers for the future, Jessup said. The grants require funded institutions to provide mentoring for early-career investigators and even trainees.
The Bigger Picture
The evolution at the AHA reflects similar trends in research funding. In recognition of the difficulty of solving humankind’s most serious health problems, the National Institutes of Health has also increased support for team science, cross-discipline research, and multi-institutional approaches.
Of course, many individual givers and foundations have invested in the study of heart and vascular health, but the AHA has long remained the largest funder of cardiac and neurovascular research after the federal government. The broad support from other funders may have helped the AHA to take on the more strategic role that reasonably falls to one of the field's biggest operators.