Despite decades of scientific advancements in the field of resuscitation science, cardiac arrest (CA) remains a leading cause of death and disability. 1 Developing and supporting a pipeline of junior investigators focused on resuscitation science is a critical step toward advancing knowledge to improve outcomes. However, the pipeline of investigators studying resuscitation science and their contributions to the field after attaining research independence are largely unknown.
To address this knowledge gap, we sought to (1) identify the number of National Institutes of Health (NIH) career development K awards focused on CA; (2) evaluate the success rates of K awardees in transitioning to R01 funding; and (3) determine whether K awardees who become independent scientists continue to study CA at the R01 level. Additionally, we aimed to compare these metrics with those of stroke research, which represents another time‐sensitive disease category reliant upon a multidisciplinary system of care.
Using established methodology to identify CA grants, 2 we queried NIH RePORTER 3 from 2008 to 2018. Results were individually reviewed and categorized using published criteria. 2 This included publicly available grant information and did not require institutional review board approval. The data to support these findings are available from the corresponding author upon reasonable request.
All CA grants were filtered by activity code to identify mentored individual K awards (defined as K01, K08, K23, or K99). 4 Subsequently, NIH RePORTER was again queried (through February 16, 2024) using principal investigators (PIs) for each K award and the results were filtered to identify all R01 grants with the former K award recipients listed as the contact PI/program director or other PI/project lead.
For comparison, stroke grants from the same epoch were exported from the NIH categorical spending reports, 5 where stroke research is a distinct line item. The process for identifying individual K awards and subsequent R01 funding for each investigator was repeated as described.
Three outcome measures were calculated for each investigator: (1) R01 funding as either contact PI/program director or other PI/project lead at any point, (2) R01 funding within 5 years of receiving a K award, and (3) R01 funding within 7 years of receiving a K award. The 5‐ and 7‐year benchmarks were chosen based on the methods of Conte et al. 5 Grant abstracts for funded R01 awards were reviewed to determine the proportion of K awardees who remained focused on CA or stroke research. Stroke R01s were identified through categorical spending reports 5 or manually reviewed to ascertain the continued research focus. Data were presented as counts, proportions, and median/interquartile ranges. Proportions were compared using the chi‐square test or Fisher's exact test for cell counts <5. P values <0.05 were considered statistically significant.
A total of 857 CA grants were identified including 272 individual awards, compared to 8520 stroke grants with 2788 individual awards (Table). K awards comprised 11.4% of CA grants versus 6.6% for stroke grants (P = 0.003). The R01 conversion rate was 51.6% for CA and 57.3% for stroke (P = 0.555). The median transition time from K to R01 was 5.5 years (interquartile range 4–6) for CA and 5 years (interquartile range 4–7) for stroke. CA K awardees secured 27 funded R01s, and stroke counterparts received 163. Additionally, 48.1% of CA K awardees continued CA research at the R01 level versus 63.8% for stroke (P = 0.121).
Table 1.
TableNIH Research Funding of Cardiac Arrest and Stroke Grants FY2008–2018
| Cardiac arrest grants awarded 2008–2018 | Stroke grants awarded 2008–2018 | P value | |
|---|---|---|---|
| Total grants, n (%) | 857 | 8520 | |
| Career development K award | 122 (14.2) | 611 (7.2) | <0.001 |
| R01 | 396 (46.2) | 3971 (46.6) | 0.825 |
| Other | 339 (39.6) | 3938 (46.2) | <0.001 |
| Individual grants, n (%) | 272 | 2788 | |
| Career development K award | 31 (11.4) | 185 (6.6) | 0.003 |
| K01* | 2 (6.5) | 40 (21.6) | 0.051 |
| K08* | 12 (38.7) | 48 (25.9) | 0.142 |
| K23* | 16 (51.6) | 75 (40.5) | 0.248 |
| K99* | 1 (3.2) | 22 (11.9) | 0.212 |
| R01 | 107 (39.3) | 1100 (39.5) | 0.970 |
| Other | 134 (49.3) | 1503 (53.9) | 0.143 |
| K award conversion to R01 funding, n (%) | |||
| R01 at any time following K receipt | 16 (51.6) | 106 (57.3) | 0.555 |
| R01 within 5 years of K receipt | 8 (25.8) | 58 (31.4) | 0.535 |
| R01 within 7 years of K receipt† | 11 (44.0) | 71 (46.7) | 0.801 |
| K awardees with >1 R01 | 8 (25.8) | 32 (17.3) | 0.259 |
| Total R01 grants by K awardees, n (%) | 27 | 163 | |
| R01 remaining in K award content area (ie, CA or stroke) | 13 (48.1) | 104 (63.8) | 0.121 |
Proportions calculated with number of individual K awards as denominator.
Only grants from 2008 to 2016 eligible.
NIH indicates National Institutes of Health.
To our knowledge, this is the first detailed report on the CA investigator pipeline in the United States, and our findings underscore the tremendous need for further investment in resuscitation science. Although stroke and CA are both leading causes of death and disability, 1 stroke research receives 10‐fold more funded federal grants that include 6‐fold more mentored K awards. Furthermore, both disease entities are archetypical of time‐dependent illness reliant upon systems of care, so the disparity cannot be accounted for in the complexity of stroke care. Potential contributors to this disparity may include a smaller pool of overall applicants, limited institutional presence of resuscitation science mentors, lower quality grant proposals, or constrained federal resource allocation for CA research.
Though pipeline volume is much smaller, outputs for both fields appear similar across reported metrics, including rate and time of K to R01 conversion. Of note, more than half of CA K to R01 awards and 36% from the stroke cohort departed from their original content focus. Although this phenomenon may represent the natural evolution of scientific inquiry in the development of young investigators, exploring these findings across other disease states would inform future efforts to expand young investigator cohorts for specific lines of science.
Finally, transparent and readily accessible tracking of CA research funding is an essential step to shape the future of resuscitation science research. CA is not included in the NIH Categorical Spending Report, which provides funding details for >300 disease categories. Absent its inclusion, CA investigators, advocacy groups, and the public are unable to track and compare the annual federal investment in CA research. Future NIH Categorical Spending Reports should strongly consider inclusion of CA as a distinct funding category.
Sources of Funding
None.
Disclosures
RAC is funded by NHLBI K23H166692. The remaining authors have no disclosures to report.
Acknowledgments
Author contributions: Ryan A. Coute: study designed, data analysis, manuscript writing. Ryan Huebinger, Sarah M. Perman, and Marina Del Rios: content expertise and substantial manuscript contributions. Michael C. Kurz: study design, manuscript writing. All authors have read and approved of the manuscript.
This article was sent to Kori S. Zachrison, MD, MSc, Associate Editor, for review by expert referees, editorial decision, and final disposition.
For Sources of Funding and Disclosures, see page 3.
References
- 1. Coute RA, Nathanson BH, Panchal AR, Kurz MC, Haas NL, McNally B, Neumar RW, Mader TJ. Disability‐adjusted life years following adult out‐of‐hospital cardiac arrest in the United States. Circ Cardiovasc Qual Outcomes. 2019;12:e004677. doi: 10.1161/CIRCOUTCOMES.118.004677 [DOI] [PubMed] [Google Scholar]
- 2. Coute RA, Panchal AR, Mader TJ, Neumar RW. National Institutes of Health‐funded cardiac arrest research: a 10‐year trend analysis. J Am Heart Assoc. 2017;6:6. doi: 10.1161/JAHA.116.005239 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3. NIH Reporter Database. Bethesda: National Institutes of Health; 2024. Accessed February 16, 2024. https://reporter.nih.gov [Google Scholar]
- 4. Conte ML, Omary MB. NIH career development awards: conversion to research grants and regional distribution. J Clin Invest. 2018;128:5187–5190. doi: 10.1172/JCI123875 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5. Estimates of Funding for Various Research, Condition, or Disease Category. Bethesda: National Institutes of Health; 2024. Accessed February 16, 2024. https://report.nih.gov/funding/categorical‐spending#/ [Google Scholar]