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This report set out to document the sources of innovation to treat cardiovascular disease (CVD), one of America’s most common and deadliest diseases. CVD has historically been an area of considerable innovation, but some industry practitioners, clinicians and policymakers worry the rate of advances is slowing down. We presented 10 examples of CVD innovations to illustrate the sources of these ideas and the factors that shape success and failure. Several conclusions emerged from this work.

First, most successful innovations in CVD have been sparked by a tangible unmet need of patients or providers. Rather than designing “hammers“ and looking for “nails,“ the future of CVD innovation begins with close analysis of the most pressing unmet needs. Although clinicians and patients arguably have the best vantage point to assess unmet needs, in some cases, those with engineering, policy or public health backgrounds might be best positioned to offer solutions. This dynamic implies innovation will be driven by interdisciplinary inquiry into CVD disease. Programs that support innovation must introduce individuals with diverse skill sets to the CVD domain and arm them with the tools to make progress on the most important needs.

These solutions might require different kinds of investors to fund them, because they might not align with the traditional risk-capital model. The medical device industry, which has contributed significantly to the treatment of CVD, is one example of this phenomenon. The development of medical devices was traditionally based on engineering principles but eventually drew from a wider variety of disciplines. The process of discovery and commercialization in medical device companies differs significantly from biotech and other sectors that compete for scarce resources from investors. As a result, funding has ebbed and flowed to this sector over time. Organizations such as the AHA and governments may have a role in supporting the continued development of new technologies that do not fit into the traditional risk-capital model.

Next, these innovations must be evaluated carefully. The rise of AROs and CROs were crucial in previous waves of innovation, but new treatments, notably digital applications, may require new methods of evaluation and different organizing models for the evaluators.

Finally, for the results of these evaluations to have an appreciable impact on the incidence and burden of CVD, they must be accepted by clinicians, payers and patients. The major changes that will happen over the next few years in how we pay for health care in the U.S. will provide an opportunity for a consensus to develop on which kinds of innovations are most likely to be widely adopted, shaping the incentives of innovators to work toward these solutions.

In sum, we hope the future of innovation in CVD will be even brighter than the past. Although the community can build on past successes, accelerating innovation necessitates more dramatic change. It will require new thinking, new ways of organizing and new talent working on the most important problems.

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