devices may also result, if more than one manufacturer exists. The committee therefore recommends that NHLBI consider continuing its support for additional VAD development that is judged by peer review to have sufficient scientific merit, for an interim period ending in 1993 or 1994. At that time, further support could be considered in light of initial results from the Novacor trial.


Additional research is needed in two areas. First, any future R&D commitments to MCSSs should not detract from continuing NHLBI support of research aimed at an increased understanding of the mechanisms of heart failure and at developing new approaches to its treatment and prevention.

Second, as previously stated, relatively little is known about the epidemiological aspects of end-stage heart disease, although one current NHLBI-supported study will provide additional information concerning heart disease in patients aged 65 and over. The committee recommends that more epidemiological studies be performed of the natural course of heart failure in persons under age 65, with particular attention to including women and members of minority groups.


A wide range of persons within and outside the health care community will be able to apply some or all of this report's findings and recommendations. It is both a specific technology assessment that provides detailed guidance to NHLBI and one that can serve as a broader model. The process used in this evaluation and many of its general recommendations should be useful to policymakers at the state and federal levels, third-party payers, and others in the health care system.

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