It is critical that applicants follow the Research (R) Instructions in the SF424 (R&R) Application Guide, except where instructed to do otherwise (in this FOA or in a Notice from the NIH Guide for Grants and Contracts). Conformance to all requirements (both in the Application Guide and the FOA) is required and strictly enforced. Applicants must read and follow all application instructions in the Application Guide as well as any program-specific instructions noted in Section IV. When the program-specific instructions deviate from those in the Application Guide, follow the program-specific instructions. Applications that do not comply with these instructions may be delayed or not accepted for review.

Part 1. Overview Information
Part 2. Full Text of the Announcement

Section I. Funding Opportunity Description
Section II. Award Information
Section III. Eligibility Information
Section IV. Application and Submission Information
Section V. Application Review Information
Section VI. Award Administration Information
Section VII. Agency Contacts
Section VIII. Other Information

Each year, nearly 2 million Americans have an acute coronary event or revascularization procedure, and millions more have a chronic cardiac condition, such as heart failure, for which cardiac rehabilitation (CR) is recommended by clinical care guidelines (Class 1A). Traditional CR consists of an individualized treatment plan of 36 one-hour sessions of physician-prescribed exercise, cardiovascular (CV) risk factor modification via education, counseling and behavioral intervention, and psychosocial assessment, typically delivered at a hospital-based outpatient facility over 12 weeks. Cardiac rehabilitation is recommended after acute myocardial infarction, percutaneous coronary intervention, coronary artery bypass surgery, valvular heart surgery, chronic stable angina, and chronic stable heart failure. There is a substantial body of evidence showing cardiovascular (CV) and other benefits of CR, including a reduction in CV morbidity/mortality and improved quality of life (QOL) and functional status. Recent studies have shown that CR participation resulted in a 25-30% reduction in hospital readmissions and a 26% decrease in CV deaths.

Despite these clear benefits to clinical and patient-centered outcomes, CR remains severely underutilized. Fewer than 20% of all eligible patients participate in a CR program. Participation in CR is especially low in the groups that are at highest risk for morbidity and mortality, including the elderly, sicker patients, women, minorities, and persons of lower socioeconomic status (SES). There are multiple contributors to low CR participation rates in the general population. These include lack of referral or strong recommendation from a physician; inadequate follow-up or facilitation of enrollment after referral; limited or no health insurance coverage; conflicting work and home responsibilities; distance and transportation problems; lack of gender and racial diversity among CR staff; language and cultural barriers; and lack of program availability and access. Newer delivery models for health care such as telemedicine and delivery of treatment in non-healthcare settings (e.g., home, community center) offer opportunities to address some of these patient and provider barriers, and the lower costs to patients afforded by these newer models may facilitate participation in CR. Although these barriers and potential solutions to CR utilization have been known for some time, CR participation rates remain very low.

As the population ages and the incidence and prevalence of cardiovascular events and disease escalates, the number of older adults (those over 70 years old) who could benefit from CR is rapidly expanding, highlighting several important issues and challenges facing seniors in traditional CR programs. Less than 12% of potential CR candidates enroll in and complete CR programs despite the increase in older potential CR patients, similar beneficial effects of CR in this population, and Medicare reimbursement for CR those 65 years of age and older with an eligible CV event or diagnoses. While some barriers to CR participation may be more common in younger patients, such as less insurance coverage and needed early return to work, barriers particular to complex and vulnerable, older patients may point to unique opportunities to enhance the suitability and use of existing CR programs for these patients. Traditional CR programs initially focused on a fairly rigorous exercise-based regimen, but their expansion to a more comprehensive lifestyle program integrating health, dietary and lifestyle education suggests opportunities to develop transdisciplinary, multifaceted interventions that are adapted to specific age-related changes and the associated clinical complexity that more vulnerable and older CV patients manifest.

The overall goal of this funding announcement is to seek applications for novel strategies to enhance referral, participation, and adherence in cardiac rehabilitation of older and more vulnerable patients who are eligible for CR under current Medicare eligibility criteria. Specifically, NIA seeks clinical trials that address one or more of the following specific age-related aspects:

Patient-related issues: When considering older adults for CR, clinicians must be convinced of the individualized balance of risk versus benefit, especially in more vulnerable older adults. The following non-exhaustive list highlights some significant factors as examples of age-related alterations and common age-associated conditions and syndromes that should be considered in tailoring and/or enhancing a CR program for seniors and more vulnerable patients:

• Age-related physiologic alterations in baseline
• Optimal goals and response to exercise
• Sarcopenia/generalized weakness/frailty
• Functional decline
• Nutritional deficiencies
• Blood pressure lability
• Balance/instability and fall risk
• Polypharmacy and multiple chronic conditions
• Cognitive decline
• Ability to live independently.

Tools that help to identify low- and high-risk CR participants based on some of these factors may help to optimize novel implementation strategies discussed below.

Program goals and components: Given the unique complexities of each potential CR patient, especially older adults with complex conditions, identification of patient-centered goals that embrace the generalized function, disability, health-related QOL, and independence of the patient may supplant traditional cardiorespiratory measures of endurance. Baseline measures of frailty, physical and cognitive function, ability to self-manage health, QOL, and independence have been shown to correlate with trajectories of morbidity, mortality and hospital readmission and should be considered as metrics, and possibly goals, of CR, including evaluation of these global measures versus traditional CV outcomes. This is supported by evidence that readmission after CV events is more commonly due to non-cardiac diagnoses than to recurrence or worsening of the initial cardiac diagnosis. A transdisciplinary approach may reduce these vulnerabilities through enhanced methods and components of traditional CR programs including fall prevention, muscle strengthening, use of assistive devices when needed, nutritional guidance, and self-management strategies for polypharmacy and multiple chronic conditions. Thus, goals and components of CR programs, as well as session and overall duration should be reexamined for more vulnerable patients, with consideration of patient-prioritized goals of therapy.

Program setting considerations: Novel programs that seek to overcome CR barriers of transportation and limited access to traditional programs and aim to increase participation of diverse and underserved populations are embracing technology and alternative CR settings to enhance participation, with beneficial results. Hybrid programs that integrate center- and home-based sessions, as well as those facilitated by telemedicine, mobile applications, and internet-based approaches need further testing in older populations. Risk stratification of more vulnerable patients, together with patient-prioritized goals, may better target optimal settings to improve relevant outcomes.

These three age-related aspects (patient-related issues, program goals and components, and program setting considerations) represent distinct, but potentially interrelated, areas that are impacted by advancing age and are not currently addressed in traditional CR programs. These topics are meant to illustrate potential areas of focus in the development and testing of non-traditional CR programs tailored to older, more vulnerable CR-eligible patients. These topics are not an exhaustive list, but are meant to be a guide to target potential CR components that may reduce the risk of CR-related or future injury, enhance the referral and participation of more vulnerable and complex older CV patients, improve adherence, and enhance patient-centered global outcomes. These outcomes are in addition to benefits already demonstrated including reductions in cardiac events, other risk reduction, and improved quality of life. Determination of the specific aspects of CR programs that may be better suited to medically complex and vulnerable older adults, such as eligibility, patient-centered goals and outcomes, and novel components and delivery systems may ultimately improve referral, enrollment, completion and overall benefit. Inter-institutional collaboration to leverage existing resources and programs is highly encouraged.

Examples of studies that may be considered for this FOA include:

• A study of two or more CR strategies, each comprised of different combinations of assessments, interventions and outcomes, focusing on cardiovascular health and at least one other common geriatric condition (e.g., frailty, gait imbalance, fall risk, impaired functional capacity).
• Studies to evaluate the effectiveness of shared decision-making between physicians and patients on defining goals and identifying specific interventions through a CR program.
• Comparing a CR program consisting of novel components that accommodate frail, complex older adults to traditional programs (structured monitored exercise, risk factor reduction), focusing on patient-centered outcomes such as functional capacity and independence, fall injury and prevention, multimorbidities, polypharmacy, improved health management and QOL.
• A study to determine whether an intervention targeted at improving one or more global parameters (e.g., physical function, balance/fall risk, measures of independence, implementation of self-management strategies) improves measures of clinical outcomes such as cardiovascular events, readmissions, additional morbidities, or mortality.
• Testing the efficacy of a novel strategy which integrates global outcomes (function, independence, self-management) and CV outcomes.
• A trial to test one or more hybrid strategies of CR for high- and low-risk patients including home-based, center-based, or internet-based approaches, involvement of a mobile or fitness application, and/or telemedicine approaches to enhance CR participation, particularly for older or more vulnerable patients who are remote and underserved.
• A trial of a CR intervention that integrates self-management strategies targeted at reducing polypharmacy, prevention of adverse drug events, and managing multiple chronic conditions.
• A trial of function, strength, self-management and/or CV components to achieve patient-preferred outcomes.
• A trial testing an interdisciplinary approach to CR that involves the addition of geriatric-focused pharmacists, nutritionists, nurses, therapists, and/or social workers.
• A trial to optimize outcomes by modifying session duration and/or program length and setting.

The National Heart, Lung, and Blood Institute (NHLBI) and NIA are releasing companion FOAs aimed at enhancing CR referral, participation, and adherence. RFA-HL-18-019 focuses on strategies to overcome identified barriers in CR participation in the general population, whereas this FOA specifically focuses on integrating important aspects of aging and associated complexities to improve CR programs among older and more vulnerable patients who are eligible for CR by current Medicare criteria.

Collaborative meetings to discuss project findings/progress/challenges, share successful strategies, and troubleshoot pitfalls offer a venue to network and foster collaboration. To assist in the overall evaluation of the research program, all awardees will participate in annual meetings arranged by NIA and NHLBI program officers, to be held after award in the Bethesda, Maryland area. The purpose of these meetings is to discuss individual program progress and foster collaborations among the funded investigators. All investigators are expected to attend these meetings, together with additional scientific staff from their research groups when appropriate, and are expected to give oral presentations on current and planned activities and projects. The meetings are planned for years 2 and 5 of the awards. See Section IV of this announcement for instructions on how to include meeting costs in the budget request. The program progress meetings are open to investigators supported under the NIA and NHLBI FOAs and to NIH extramural staff.

See Section VIII. Other Information for award authorities and regulations.

NIH grants policies as described in the NIH Grants Policy Statement will apply to the applications submitted and awards made in response to this FOA.

Higher Education Institutions

• Public/State Controlled Institutions of Higher Education
• Private Institutions of Higher Education

The following types of Higher Education Institutions are always encouraged to apply for NIH support as Public or Private Institutions of Higher Education:

• Hispanic-serving Institutions
• Historically Black Colleges and Universities (HBCUs)
• Tribally Controlled Colleges and Universities (TCCUs)
• Alaska Native and Native Hawaiian Serving Institutions
• Asian American Native American Pacific Islander Serving Institutions (AANAPISIs)

Nonprofits Other Than Institutions of Higher Education

• Nonprofits with 501(c)(3) IRS Status (Other than Institutions of Higher Education)
• Nonprofits without 501(c)(3) IRS Status (Other than Institutions of Higher Education)

For-Profit Organizations

• Small Businesses
• For-Profit Organizations (Other than Small Businesses)

Governments

• State Governments
• County Governments
• City or Township Governments
• Special District Governments
• Indian/Native American Tribal Governments (Federally Recognized)
• Indian/Native American Tribal Governments (Other than Federally Recognized)
• Eligible Agencies of the Federal Government
• U.S. Territory or Possession

Other

• Independent School Districts
• Public Housing Authorities/Indian Housing Authorities
• Native American Tribal Organizations (other than Federally recognized tribal governments)
• Faith-based or Community-based Organizations
• Regional Organizations

Non-domestic (non-U.S.) Entities (Foreign Institutions) are not eligible to apply.
Non-domestic (non-U.S.) components of U.S. Organizations are not eligible to apply.
Foreign components, as defined in the NIH Grants Policy Statement, are allowed.

Applicant Organizations

Applicant organizations must complete and maintain the following registrations as described in the SF 424 (R&R) Application Guide to be eligible to apply for or receive an award. All registrations must be completed prior to the application being submitted. Registration can take 6 weeks or more, so applicants should begin the registration process as soon as possible. The NIH Policy on Late Submission of Grant Applications states that failure to complete registrations in advance of a due date is not a valid reason for a late submission.

• Dun and Bradstreet Universal Numbering System (DUNS) - All registrations require that applicants be issued a DUNS number. After obtaining a DUNS number, applicants can begin both SAM and eRA Commons registrations. The same DUNS number must be used for all registrations, as well as on the grant application.
• System for Award Management (SAM) (formerly CCR) Applicants must complete and maintain an active registration, which requires renewal at least annually. The renewal process may require as much time as the initial registration. SAM registration includes the assignment of a Commercial and Government Entity (CAGE) Code for domestic organizations which have not already been assigned a CAGE Code.
• NATO Commercial and Government Entity (NCAGE) Code Foreign organizations must obtain an NCAGE code (in lieu of a CAGE code) in order to register in SAM.
• eRA Commons - Applicants must have an active DUNS number and SAM registration in order to complete the eRA Commons registration. Organizations can register with the eRA Commons as they are working through their SAM or Grants.gov registration. eRA Commons requires organizations to identify at least one Signing Official (SO) and at least one Program Director/Principal Investigator (PD/PI) account in order to submit an application.
• Grants.gov Applicants must have an active DUNS number and SAM registration in order to complete the Grants.gov registration.

Program Directors/Principal Investigators (PD(s)/PI(s))

All PD(s)/PI(s) must have an eRA Commons account. PD(s)/PI(s) should work with their organizational officials to either create a new account or to affiliate their existing account with the applicant organization in eRA Commons. If the PD/PI is also the organizational Signing Official, they must have two distinct eRA Commons accounts, one for each role. Obtaining an eRA Commons account can take up to 2 weeks.

Any individual(s) with the skills, knowledge, and resources necessary to carry out the proposed research as the Program Director(s)/Principal Investigator(s) (PD(s)/PI(s)) is invited to work with his/her organization to develop an application for support. Individuals from underrepresented racial and ethnic groups as well as individuals with disabilities are always encouraged to apply for NIH support.

For institutions/organizations proposing multiple PDs/PIs, visit the Multiple Program Director/Principal Investigator Policy and submission details in the Senior/Key Person Profile (Expanded) Component of the SF424 (R&R) Application Guide.

This FOA does not require cost sharing as defined in the NIH Grants Policy Statement.

Applicant organizations may submit more than one application, provided that each application is scientifically distinct.

The NIH will not accept duplicate or highly overlapping applications under review at the same time. This means that the NIH will not accept:

• A new (A0) application that is submitted before issuance of the summary statement from the review of an overlapping new (A0) or resubmission (A1) application.
• A resubmission (A1) application that is submitted before issuance of the summary statement from the review of the previous new (A0) application.
• An application that has substantial overlap with another application pending appeal of initial peer review (see NOT-OD-11-101).

Buttons to access the online ASSIST system or to download application forms are available in Part 1 of this FOA. See your administrative office for instructions if you plan to use an institutional system-to-system solution.

It is critical that applicants follow the Research (R) Instructions in the SF424 (R&R) Application Guide, including Supplemental Grant Application Instructions except where instructed in this funding opportunity announcement to do otherwise. Conformance to the requirements in the Application Guide is required and strictly enforced. Applications that are out of compliance with these instructions may be delayed or not accepted for review.

For information on Application Submission and Receipt, visit Frequently Asked Questions Application Guide, Electronic Submission of Grant Applications.

Although a letter of intent is not required, is not binding, and does not enter into the review of a subsequent application, the information that it contains allows IC staff to estimate the potential review workload and plan the review.

By the date listed in Part 1. Overview Information, prospective applicants are asked to submit a letter of intent that includes the following information:

• Descriptive title of proposed activity
• Name(s), address(es), and telephone number(s) of the PD(s)/PI(s)
• Names of other key personnel
• Participating institution(s)
• Number and title of this funding opportunity

The letter of intent should be sent to:

Ramesh Vemuri, Ph.D.
National Institute on Aging (NIA)
Telephone: 301-402-7700
Email: ramesh.vemuri@nih.gov

All page limitations described in the SF424 Application Guide and the Table of Page Limits must be followed.

The following section supplements the instructions found in the SF424 (R&R) Application Guide and should be used for preparing an application to this FOA.

All instructions in the SF424 (R&R) Application Guide must be followed.

All instructions in the SF424 (R&R) Application Guide must be followed.

All instructions in the SF424 (R&R) Application Guide must be followed.

Facilities and Other Resources: Proposed studies should include sufficient infrastructure, support, and expertise to implement the proposed study within the described setting(s) where research will be conducted. Given the potential vulnerability of complex, older adults and non-hospital based settings, safety measures and risk management for in-home or community-based rehabilitation sessions must be clearly delineated.

All instructions in the SF424 (R&R) Application Guide must be followed. The project should include multidisciplinary teams of scientists, clinicians, and stakeholders comprising expertise in both cardiac rehabilitation, aging/geriatric issues and implementation science. All involved PD/PIs and key personnel in the proposed project should have the necessary expertise in designing and implementing the proposed study specific to the older population and when existing, evidence of successful collaborations and/or partnerships with healthcare delivery organizations or other organizations proposed in the application should be described.

All instructions in the SF424 (R&R) Application Guide must be followed. The budget should include support for personnel to travel to the in-person Investigator Progress meetings (described under Research Objectives and Scope) of awardees of this FOA during years 2 and 5. These program progress meetings are a required aspect of funding and are open to investigators supported under the NIA and NHLBI FOAs and to NIH extramural staff. The budget should include travel costs equivalent to a round-trip airline ticket to the Bethesda, MD area, one night of lodging in a local hotel, and meals and related travel costs for the PD/PI and any essential co-investigators. The proposed travel budget for these meetings should be in accord with the Grants Policy Statement which specifies travel costs are limited to those allowed by formally established organizational policy and, in the case of air travel, the lowest reasonable commercial airfares must be used The budget should also include costs associated with preparation and logistics for DSMB meetings.

All instructions in the SF424 (R&R) Application Guide must be followed.

All instructions in the SF424 (R&R) Application Guide must be followed.

All instructions in the SF424 (R&R) Application Guide must be followed, with the following additional instructions:

Research Strategy: Applications should describe research which clearly targets key barriers at the provider, patient, and healthcare system level that impede utilization of cardiac rehabilitation in older, more vulnerable patients that are eligible/candidates for cardiac rehabilitation by Medicare CR eligibility criteria. Additionally, studies which focus on increasing use of CR by older, vulnerable patients which target providers, patients, and healthcare delivery systems that serve medically underserved, racial/ethnic minority, low income, and/or rural populations are encouraged. The research team should include multidisciplinary teams of scientists, clinicians, and stakeholders comprising expertise in both cardiac rehabilitation, aging/geriatric issues and implementation science The process for engaging and involving stakeholders and collaborators in the project should be highlighted.

The overall goal of the proposed research should be described and should improve referral to, and delivery of, cardiac rehabilitation for eligible older patients. Accordingly, proposing novel methodology which incorporates home or community-based delivery, such as telemedicine, internet-based interventions, or fitness tracking apps (or a hybrid of facility/non-facility based models) to enhance participation in, and completion of, cardiac rehabilitation programs, including innovative, geriatric-sensitive interventions that minimize risk of injury or morbidity, and maximize global function and independence, is encouraged. Applications should describe how they incorporate innovative strategies such as electronic health record reminders to improve provider referral rates. Additionally, specific aspects of age-related changes and conditions integrated within the goals, measures, interventions and/or outcomes should be described. Strategies should strive to evaluate implementation outcomes such as fidelity, acceptability, sustainability, and adoption of the interventions.

Resource Sharing Plan: Individuals are required to comply with the instructions for the Resource Sharing Plans as provided in the SF424 (R&R) Application Guide, with the following modification:

• All applications, regardless of the amount of direct costs requested for any one year, should address a Data Sharing Plan.

Appendix:

Do not use the Appendix to circumvent page limits. Follow all instructions for the Appendix as described in the SF424 (R&R) Application Guide.

When conducting clinical research, follow all instructions for completing PHS Inclusion Enrollment Report as described in the SF424 (R&R) Application Guide

All instructions in the SF424 (R&R) Application Guide must be followed.

See Part 1. Section III.1 for information regarding the requirement for obtaining a unique entity identifier and for completing and maintaining active registrations in System for Award Management (SAM), NATO Commercial and Government Entity (NCAGE) Code (if applicable), eRA Commons, and Grants.gov

Part I. Overview Information contains information about Key Dates and times. Applicants are encouraged to submit applications before the due date to ensure they have time to make any application corrections that might be necessary for successful submission. When a submission date falls on a weekend or Federal holiday, the application deadline is automatically extended to the next business day.

Organizations must submit applications to Grants.gov (the online portal to find and apply for grants across all Federal agencies). Applicants must then complete the submission process by tracking the status of the application in the eRA Commons, NIH’s electronic system for grants administration. NIH and Grants.gov systems check the application against many of the application instructions upon submission. Errors must be corrected and a changed/corrected application must be submitted to Grants.gov on or before the application due date and time. If a Changed/Corrected application is submitted after the deadline, the application will be considered late. Applications that miss the due date and time are subjected to the NIH Policy on Late Application Submission.

Applicants are responsible for viewing their application before the due date in the eRA Commons to ensure accurate and successful submission.

Information on the submission process and a definition of on-time submission are provided in the SF424 (R&R) Application Guide.

This initiative is not subject to intergovernmental review.

All NIH awards are subject to the terms and conditions, cost principles, and other considerations described in the NIH Grants Policy Statement.

Pre-award costs are allowable only as described in the NIH Grants Policy Statement.

Applications must be submitted electronically following the instructions described in the SF424 (R&R) Application Guide. Paper applications will not be accepted.

Applicants must complete all required registrations before the application due date. Section III. Eligibility Information contains information about registration.

For assistance with your electronic application or for more information on the electronic submission process, visit Applying Electronically. If you encounter a system issue beyond your control that threatens your ability to complete the submission process on-time, you must follow the Guidelines for Applicants Experiencing System Issues. For assistance with application submission, contact the Application Submission Contacts in Section VII.

Important reminders:

All PD(s)/PI(s) must include their eRA Commons ID in the Credential field of the Senior/Key Person Profile Component of the SF424(R&R) Application Package. Failure to register in the Commons and to include a valid PD/PI Commons ID in the credential field will prevent the successful submission of an electronic application to NIH. See Section III of this FOA for information on registration requirements.

The applicant organization must ensure that the DUNS number it provides on the application is the same number used in the organization’s profile in the eRA Commons and for the System for Award Management. Additional information may be found in the SF424 (R&R) Application Guide.

See more tips for avoiding common errors.

Upon receipt, applications will be evaluated for completeness and compliance with application instructions by the Center for Scientific Review and responsiveness by components of participating organizations, NIH. Applications that are incomplete, non-compliant and/or nonresponsive will not be reviewed.

In order to expedite review, applicants are requested to notify the NIA Referral Office by email at ramesh.vemuri@nih.gov when the application has been submitted. Please include the FOA number and title, PD/PI name, and title of the application.

Applicants are required to follow the instructions for post-submission materials, as described in the policy.

Only the review criteria described below will be considered in the review process. As part of the NIH mission, all applications submitted to the NIH in support of biomedical and behavioral research are evaluated for scientific and technical merit through the NIH peer review system.

Reviewers will provide an overall impact score to reflect their assessment of the likelihood for the project to exert a sustained, powerful influence on the research field(s) involved, in consideration of the following review criteria and additional review criteria (as applicable for the project proposed).

Reviewers will consider each of the review criteria below in the determination of scientific merit, and give a separate score for each. An application does not need to be strong in all categories to be judged likely to have major scientific impact. For example, a project that by its nature is not innovative may be essential to advance a field.

Does the project address an important problem or a critical barrier to progress in the field? Is there a strong scientific premise for the project? If the aims of the project are achieved, how will scientific knowledge, technical capability, and/or clinical practice be improved? How will successful completion of the aims change the concepts, methods, technologies, treatments, services, or preventative interventions that drive this field? Does the proposed study address providers, patients, and health care delivery systems that are pertinent to older or more vulnerable populations that are eligible/candidates for cardiac rehabilitation?

Are the PD(s)/PI(s), collaborators, and other researchers well suited to the project? If Early Stage Investigators or those in the early stages of independent careers, do they have appropriate experience and training? If established, have they demonstrated an ongoing record of accomplishments that have advanced their field(s)? If the project is collaborative or multi-PD/PI, do the investigators have complementary and integrated expertise; are their leadership approach, governance and organizational structure appropriate for the project? Does the project include multidisciplinary teams of scientists, clinicians, and stakeholders comprising expertise in cardiac rehabilitation, aging/geriatric issues and implementation science? Does the application describe the process for engaging and involving stakeholders and collaborators in this project? Does the application provide sufficient evidence that the PD/PIs and key personnel have the necessary expertise in designing and implementing the proposed study specific to the older population? Is there evidence of successful collaborations and/or partnerships with healthcare delivery organizations or other organizations proposed in the application?

Does the application challenge and seek to shift current research or clinical practice paradigms by utilizing novel theoretical concepts, approaches or methodologies, instrumentation, or interventions? Are the concepts, approaches or methodologies, instrumentation, or interventions novel to one field of research or novel in a broad sense? Is a refinement, improvement, or new application of theoretical concepts, approaches or methodologies, instrumentation, or interventions proposed? Is the proposed research likely to improve referral to and delivery of cardiac rehabilitation for eligible patients? Does the proposed study consider novel methodology such as telemedicine, Internet-based interventions, or fitness tracking apps to facilitate participation in and completion of cardiac rehabilitation programs? Are specific aspects of age-related changes and conditions integrated within the goals, measures, interventions and/or outcomes?

Are the overall strategy, methodology, and analyses well-reasoned and appropriate to accomplish the specific aims of the project? Have the investigators presented strategies to ensure a robust and unbiased approach, as appropriate for the work proposed? Are potential problems, alternative strategies, and benchmarks for success presented? If the project is in the early stages of development, will the strategy establish feasibility and will particularly risky aspects be managed? Have the investigators presented adequate plans to address relevant biological variables, such as sex, for studies in vertebrate animals or human subjects?

If the project involves human subjects and/or NIH-defined clinical research, are the plans to address 1) the protection of human subjects from research risks, and 2) inclusion (or exclusion) of individuals on the basis of sex/gender, race, and ethnicity, as well as the inclusion or exclusion of children, justified in terms of the scientific goals and research strategy proposed?

Does the application clearly target key barriers at the provider, patient, and healthcare system level that impede utilization of cardiac rehabilitation in older, more vulnerable eligible patients? Does the study target providers, patients, and healthcare delivery systems that serve medically underserved, racial/ethnic minority, low income, and/or rural populations? Does the study propose strategies that include provider interaction with patients to improve adherence to cardiac rehabilitation? Does the study propose innovative strategies such as electronic health record reminders to improve provider referral rates? Does the research propose to evaluate implementation outcomes such as fidelity, acceptability, sustainability, and adoption of the interventions? Is there ample evidence that the research team has the necessary support from healthcare systems to carry out the proposed implementation strategies? Are barriers specific to older adults addressed with novel strategies that employ hybrid models, internet/telemedicine and other technology to augment participation? Are geriatric-sensitive interventions used to minimize the risk of injury or morbidity and maximize global function and independence?

Will the scientific environment in which the work will be done contribute to the probability of success? Are the institutional support, equipment and other physical resources available to the investigators adequate for the project proposed? Will the project benefit from unique features of the scientific environment, subject populations, or collaborative arrangements? Are there sufficient infrastructure, support, and expertise to implement the proposed study within the proposed setting(s) where research will be conducted? Does the application address safety measures and risk management for in-home or community-based rehabilitation sessions?

As applicable for the project proposed, reviewers will evaluate the following additional items while determining scientific and technical merit, and in providing an overall impact score, but will not give separate scores for these items.

For research that involves human subjects but does not involve one of the six categories of research that are exempt under 45 CFR Part 46, the committee will evaluate the justification for involvement of human subjects and the proposed protections from research risk relating to their participation according to the following five review criteria: 1) risk to subjects, 2) adequacy of protection against risks, 3) potential benefits to the subjects and others, 4) importance of the knowledge to be gained, and 5) data and safety monitoring for clinical trials.

For research that involves human subjects and meets the criteria for one or more of the six categories of research that are exempt under 45 CFR Part 46, the committee will evaluate: 1) the justification for the exemption, 2) human subjects involvement and characteristics, and 3) sources of materials. For additional information on review of the Human Subjects section, please refer to the Guidelines for the Review of Human Subjects.

When the proposed project involves human subjects and/or NIH-defined clinical research, the committee will evaluate the proposed plans for the inclusion (or exclusion) of individuals on the basis of sex/gender, race, and ethnicity, as well as the inclusion (or exclusion) of children to determine if it is justified in terms of the scientific goals and research strategy proposed. For additional information on review of the Inclusion section, please refer to the Guidelines for the Review of Inclusion in Clinical Research.

The committee will evaluate the involvement of live vertebrate animals as part of the scientific assessment according to the following criteria: (1) description of proposed procedures involving animals, including species, strains, ages, sex, and total number to be used; (2) justifications for the use of animals versus alternative models and for the appropriateness of the species proposed; (3) interventions to minimize discomfort, distress, pain and injury; and (4) justification for euthanasia method if NOT consistent with the AVMA Guidelines for the Euthanasia of Animals. Reviewers will assess the use of chimpanzees as they would any other application proposing the use of vertebrate animals. For additional information on review of the Vertebrate Animals section, please refer to the Worksheet for Review of the Vertebrate Animal Section.

Reviewers will assess whether materials or procedures proposed are potentially hazardous to research personnel and/or the environment, and if needed, determine whether adequate protection is proposed.

Not Applicable

Not Applicable

Not Applicable

As applicable for the project proposed, reviewers will consider each of the following items, but will not give scores for these items, and should not consider them in providing an overall impact score.

Not Applicable

Reviewers will assess the information provided in this section of the application, including 1) the Select Agent(s) to be used in the proposed research, 2) the registration status of all entities where Select Agent(s) will be used, 3) the procedures that will be used to monitor possession use and transfer of Select Agent(s), and 4) plans for appropriate biosafety, biocontainment, and security of the Select Agent(s).

Reviewers will comment on whether the following Resource Sharing Plans, or the rationale for not sharing the following types of resources, are reasonable: (1) Data Sharing Plan; (2) Sharing Model Organisms; and (3) Genomic Data Sharing Plan (GDS).

For projects involving key biological and/or chemical resources, reviewers will comment on the brief plans proposed for identifying and ensuring the validity of those resources.

Reviewers will consider whether the budget and the requested period of support are fully justified and reasonable in relation to the proposed research.

Applications will be evaluated for scientific and technical merit by (an) appropriate Scientific Review Group(s) convened by NIA, in accordance with NIH peer review policy and procedures, using the stated review criteria. Assignment to a Scientific Review Group will be shown in the eRA Commons.

As part of the scientific peer review, all applications:

• May undergo a selection process in which only those applications deemed to have the highest scientific and technical merit (generally the top half of applications under review) will be discussed and assigned an overall impact score.
• Will receive a written critique.

Appeals of initial peer review will not be accepted for applications submitted in response to this FOA.

Applications will be assigned to the appropriate NIH Institute or Center. Applications will compete for available funds with all other recommended applications submitted in response to this FOA. Following initial peer review, recommended applications will receive a second level of review by the National Advisory Council on Aging. The following will be considered in making funding decisions:

• Scientific and technical merit of the proposed project as determined by scientific peer review.
• Availability of funds.
• Relevance of the proposed project to program priorities.

After the peer review of the application is completed, the PD/PI will be able to access his or her Summary Statement (written critique) via the eRA Commons. Refer to Part 1 for dates for peer review, advisory council review, and earliest start date.

Information regarding the disposition of applications is available in the NIH Grants Policy Statement.

If the application is under consideration for funding, NIH will request "just-in-time" information from the applicant as described in the NIH Grants Policy Statement.

A formal notification in the form of a Notice of Award (NoA) will be provided to the applicant organization for successful applications. The NoA signed by the grants management officer is the authorizing document and will be sent via email to the grantee’s business official.

Awardees must comply with any funding restrictions described in Section IV.5. Funding Restrictions. Selection of an application for award is not an authorization to begin performance. Any costs incurred before receipt of the NoA are at the recipient's risk. These costs may be reimbursed only to the extent considered allowable pre-award costs.

Any application awarded in response to this FOA will be subject to terms and conditions found on the Award Conditions and Information for NIH Grants website. This includes any recent legislation and policy applicable to awards that is highlighted on this website.

All NIH grant and cooperative agreement awards include the NIH Grants Policy Statement as part of the NoA. For these terms of award, see the NIH Grants Policy Statement Part II: Terms and Conditions of NIH Grant Awards, Subpart A: General and Part II: Terms and Conditions of NIH Grant Awards, Subpart B: Terms and Conditions for Specific Types of Grants, Grantees, and Activities. More information is provided at Award Conditions and Information for NIH Grants.

Recipients of federal financial assistance (FFA) from HHS must administer their programs in compliance with federal civil rights law. This means that recipients of HHS funds must ensure equal access to their programs without regard to a person’s race, color, national origin, disability, age and, in some circumstances, sex and religion. This includes ensuring your programs are accessible to persons with limited English proficiency. HHS recognizes that research projects are often limited in scope for many reasons that are nondiscriminatory, such as the principal investigator’s scientific interest, funding limitations, recruitment requirements, and other considerations. Thus, criteria in research protocols that target or exclude certain populations are warranted where nondiscriminatory justifications establish that such criteria are appropriate with respect to the health or safety of the subjects, the scientific study design, or the purpose of the research.

For additional guidance regarding how the provisions apply to NIH grant programs, please contact the Scientific/Research Contact that is identified in Section VII under Agency Contacts of this FOA. HHS provides general guidance to recipients of FFA on meeting their legal obligation to take reasonable steps to provide meaningful access to their programs by persons with limited English proficiency. Please see http://www.hhs.gov/ocr/civilrights/resources/laws/revisedlep.html. The HHS Office for Civil Rights also provides guidance on complying with civil rights laws enforced by HHS. Please see http://www.hhs.gov/ocr/civilrights/understanding/section1557/index.html; and http://www.hhs.gov/ocr/civilrights/understanding/index.html. Recipients of FFA also have specific legal obligations for serving qualified individuals with disabilities. Please see http://www.hhs.gov/ocr/civilrights/understanding/disability/index.html. Please contact the HHS Office for Civil Rights for more information about obligations and prohibitions under federal civil rights laws at http://www.hhs.gov/ocr/office/about/rgn-hqaddresses.html or call 1-800-368-1019 or TDD 1-800-537-7697. Also note it is an HHS Departmental goal to ensure access to quality, culturally competent care, including long-term services and supports, for vulnerable populations. For further guidance on providing culturally and linguistically appropriate services, recipients should review the National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care at http://minorityhealth.hhs.gov/omh/browse.aspx?lvl=2&lvlid=53.

In accordance with the statutory provisions contained in Section 872 of the Duncan Hunter National Defense Authorization Act of Fiscal Year 2009 (Public Law 110-417), NIH awards will be subject to the Federal Awardee Performance and Integrity Information System (FAPIIS) requirements. FAPIIS requires Federal award making officials to review and consider information about an applicant in the designated integrity and performance system (currently FAPIIS) prior to making an award. An applicant, at its option, may review information in the designated integrity and performance systems accessible through FAPIIS and comment on any information about itself that a Federal agency previously entered and is currently in FAPIIS. The Federal awarding agency will consider any comments by the applicant, in addition to other information in FAPIIS, in making a judgement about the applicant’s integrity, business ethics, and record of performance under Federal awards when completing the review of risk posed by applicants as described in 45 CFR Part 75.205 Federal awarding agency review of risk posed by applicants. This provision will apply to all NIH grants and cooperative agreements except fellowships.

Cooperative Agreement Terms and Conditions of Award

Not Applicable

When multiple years are involved, awardees will be required to submit the Research Performance Progress Report (RPPR) annually and financial statements as required in the NIH Grants Policy Statement.

A final RPPR, invention statement, and the expenditure data portion of the Federal Financial Report are required for closeout of an award, as described in the NIH Grants Policy Statement.

The Federal Funding Accountability and Transparency Act of 2006 (Transparency Act), includes a requirement for awardees of Federal grants to report information about first-tier subawards and executive compensation under Federal assistance awards issued in FY2011 or later. All awardees of applicable NIH grants and cooperative agreements are required to report to the Federal Subaward Reporting System (FSRS) available at www.fsrs.gov on all subawards over $25,000. See the NIH Grants Policy Statement for additional information on this reporting requirement.

In accordance with the regulatory requirements provided at 45 CFR 75.113 and Appendix XII to 45 CFR Part 75, recipients that have currently active Federal grants, cooperative agreements, and procurement contracts from all Federal awarding agencies with a cumulative total value greater than $10,000,000 for any period of time during the period of performance of a Federal award, must report and maintain the currency of information reported in the System for Award Management (SAM) about civil, criminal, and administrative proceedings in connection with the award or performance of a Federal award that reached final disposition within the most recent five-year period. The recipient must also make semiannual disclosures regarding such proceedings. Proceedings information will be made publicly available in the designated integrity and performance system (currently FAPIIS). This is a statutory requirement under section 872 of Public Law 110-417, as amended (41 U.S.C. 2313). As required by section 3010 of Public Law 111-212, all information posted in the designated integrity and performance system on or after April 15, 2011, except past performance reviews required for Federal procurement contracts, will be publicly available. Full reporting requirements and procedures are found in Appendix XII to 45 CFR Part 75 Award Term and Conditions for Recipient Integrity and Performance Matters.

We encourage inquiries concerning this funding opportunity and welcome the opportunity to answer questions from potential applicants.

eRA Service Desk (Questions regarding ASSIST, eRA Commons registration, submitting and tracking an application, documenting system problems that threaten submission by the due date, post submission issues)
Finding Help Online: http://grants.nih.gov/support/ (preferred method of contact)
Telephone: 301-402-7469 or 866-504-9552 (Toll Free)

Grants.gov Customer Support (Questions regarding Grants.gov registration and submission, downloading forms and application packages)
Contact Center Telephone: 800-518-4726
Email: support@grants.gov

GrantsInfo (Questions regarding application instructions and process, finding NIH grant resources)
Email: GrantsInfo@nih.gov (preferred method of contact)
Telephone: 301-945-7573

Susan Zieman, Ph.D.
National Institute on Aging (NIA)
Telephone: 301-496-6761
Email: susan.zieman@nih.gov

Ramesh Vemuri, Ph.D.
National Institute on Aging (NIA)
Telephone: 301-402-7700
Email: ramesh.vemuri@nih.gov

Mahasin Ingram
National Institute on Aging (NIA)
Telephone: 301-402-7736
Email: Mahasin.Ingram@mail.nih.gov

Recently issued trans-NIH policy notices may affect your application submission. A full list of policy notices published by NIH is provided in the NIH Guide for Grants and Contracts. All awards are subject to the terms and conditions, cost principles, and other considerations described in the NIH Grants Policy Statement.

Awards are made under the authorization of Sections 301 and 405 of the Public Health Service Act as amended (42 USC 241 and 284) and under Federal Regulations 42 CFR Part 52 and 45 CFR Part 75.