UPMC Physician Resources

Dr. Charles Reynolds wins 2016 Pardes Humanitarian Prize in Mental Heath

The Brain & Behavior Research Foundation recently announced Charles F. Reynolds, III, MD, as one of the winners of the 2016 Pardes Humanitarian Prize in Mental Health. Dr. Reynolds was recognized for pioneering work in geriatric psychiatry and treatment of late-life depression. Dr. Reynolds’ fellow 2016 Parades winners included Vikram Patel, PhD, F Med Sci, for transformative work in advancing mental health care in resource-poor countries. and an Honorary Tribute to the late Senator Edward M. Kennedy for his powerful and unwavering commitment to advocating on behalf of people with mental illness.

The Pardes Humanitarian Prize in Mental Health is awarded annually to recognize individuals whose contributions have made a profound and lasting impact in advancing the understanding of mental health and improving the lives of people suffering from mental illness. It focuses public attention on the burden mental illness places on individuals and society, and the urgent need to expand mental health services globally. Established in 2014, The Pardes Humanitarian Prize in Mental Health is named in honor of Herbert Pardes, MD, a noted psychiatrist, advocate for the mentally ill, and the award’s first recipient.

Dr. Reynolds 2016 Pardes Humanitarian Prizewinner Video

“The 2016 Pardes Prize recipients have applied their scientific knowledge, deep understanding of human behavior and compassion to improve the lives of millions of people suffering from mental illness, especially those living in poverty,” said Dr. Pardes, President of the Brain & Behavior Research Foundation’s Scientific Council and Executive Vice Chair of the Board of Trustees at NewYork-Presbyterian Hospital. “Their work has expanded our scope of mental illness treatment around the world. They have taught us about the needs of our diverse human family and how to use knowledge for the greater good of humanity.”

Dr. Pardes added, “Dr. Patel and Dr. Reynolds exemplify what it means to be a humanitarian.  Dr. Patel’s mission is to bring desperately needed psychiatric care to people living in countries where access to these services is limited or non-existent. Dr. Reynolds is a pioneer in geriatric psychiatry whose mission is to help the elderly lead full and productive lives in their later years.   We honor them both for their outstanding commitment to alleviating the pain and suffering of mental illness.”

Dr. Reynolds and his colleagues have made groundbreaking contributions to the prevention and treatment of depression in older adults. Depression has been identified by the World Health Organization as a leading cause of disability worldwide and a major contributor to the global burden of disease across the life cycle.

Dr. Reynolds helped to define a new global health priority as depression prevention in older adults, now recognized as a feasible public health goal. He and his colleagues have also demonstrated that depression treatment reduces both suicidal risk and cancer-related mortality risk in elderly medical patients, and his work has informed long-term treatment strategies to prevent recurrence and to delay dementia in depression with mild cognitive impairment.

Dr. Reynolds leads an NIMH study with the Goa Medical College/India and with Sangath to develop and test a scalable model of depression prevention. Building upon the contribution of Pardes Prize co-recipient Dr. Vikram Patel, this work uses lay health counselors for early intervention in mildly symptomatic older adults, thereby optimizing scarce mental health resources to prevent depression onset. The NIMH-sponsored center in late life mood disorders, which Dr. Reynolds directs at the University of Pittsburgh School of Medicine, has mentored 25 research-career development (NIH K) awardees since 1995.

In addition to co-founding the Global Consortium on Depression Prevention and editing the American Journal of Geriatric Psychiatry, Dr. Reynolds has served as president of the American College of Psychiatrists, the International College for Geriatric Psychoneuropharmacology, the American Association for Geriatric Psychiatry, and the American Foundation for Suicide Prevention. He has received the APA Weinberg Award for lifetime contributions in geriatric psychiatry, the American College of Psychiatrists’ research award in geriatrics, the International Psychogeriatric Association lifetime service award, and the Exemplary Psychiatrist Award from the National Alliance for the Mentally Ill.

“It is a privilege and an honor to be a recipient of the Pardes Humanitarian Prize. In our youth-focused culture, the elderly and their struggles with mental illness are often overlooked and neglected. Late-life depression is a global health priority that has immense impact on older individuals and their families. It is my sincere hope that as a society we can work to restore the joy of living to older adults affected by mental illness,” Dr. Reynolds said.

Advances in Inflammatory Bowel Diseases Conference 2016

The 2016 Advances in Inflammatory Bowel Diseases Conference (AIBD) is being held December 8-10, 2016 in Orlando.

This event will showcase emerging treatment options including therapies and surgical management as well as advancements in quality of care in the field of IBD, and presentations and keynote speeches from experts who are leaders in their field.

Several UPMC faculty and staff will speak on a number of topics including:

CLINICAL ORGANIZING COMMITTEE MEMBERS:                               

Sandra Kim, MD
Miguel Regueiro, MD

MEET THE EXPERTS LUNCHEONS

 December 9, 2016: Can we better position biologics to optimize the management of Crohn’s disease?
Miguel Regueiro, MD

 December 10, 2016: An under-recognized ‘extra-intestinal’ manifestation of IBD: how best to manage stress, anxiety, and depression in our IBD patients.
Eva Szigethy, MD, PhD

 CLINICAL TRACK AGENDA
December 8, 2016: Session II-A: Current Therapeutic Approaches for the Optimal Medical Management of IBD

3:40 pm What will be the hot IBD clinical topics in 2017?
Miguel Regueiro, MD

Session Track V-A: Challenges in IBD: Case discussions

Moderators: Miguel Regueiro, MD, Corey A. Siegel, MD, MS
10:30 to 12:30 pm

December 9, 2016: Session VI-A: Case-based Clinical Breakout Sessions
Presented at both 2:00 and 3:00 pm

New models of care for IBD: The patient centered medical home and increasing patient engagement: Case studies
Miguel Regueiro, MD, Eva Szigethy, MD, PhD, Corey A. Siegel, MD, MS

December 10, 2016: Session VIII-A: Advances in the Care of IBD Patients

8:40 am Is there an optimal approach to prevent recurrence in post-operative Crohn’s disease?
Miguel Regueiro, MD

9:00 am Approaches used to avoid and treat narcotic dependence
Eva Szigethy, MD, PhD

PEDIATRIC TRACK AGENDA
December 9, 2016: Session VI-D: Progress in Pediatric IBD

Moderators: Sandra C. Kim, MD, Francisco A Sylvester, MD
2:00 to 4:00 pm
and
2:20 pm Extraintestinal manifestations in pediatric IBD – a survey of conditions and treatments: Rheumatologic manifestations
Sandra C. Kim, MD

Session VII-D: Advances in Pediatric IBD

5:00 pm Case discussions with expert 5 person panel
Panelists: Sandra C. Kim, MD, Millie D. Long, MD, MPH, Francisco A. Sylvester, MD

December 10, 2016: Session VIII-D: Common Clinical Challenges in Pediatric IBD

9:00 am What are effective approaches to counsel our pediatric IBD patients, who are undergoing surgery for Crohn’s disease or ulcerative colitis?
Sandra C. Kim, MD

 Session IX-D: Targeting Therapies for the Pediatric Patient

11:10 am Topics in ulcerative colitis
Panelists: Athos Bousvaros, MD, MPH, Sandra C. Kim, MD, Francisco A. Sylvester, MD

UPMC Updates in Otolaryngology: A Monthly Webinar Series

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The UPMC Department of Otolaryngology presents a free webinar series — UPMC Updates in Otolaryngology.

Upcoming webinars include:

December 6, 2016 – 8 p.m.: Tinnitus Retraining Therapy: How to Live with the Sounds
Presented by: Lori Zitelli, AuD, CCA-A
Moderated by: David Eibling, MD — Professor, Department of Otolaryngology

January 10, 2017 – 8 p.m.: Evaluation of Noisy Breathing in Infants and Children
Presented by: Jeffrey Simons, MD — Associate Professor, Department of Pediatric Otolaryngology
Moderated by: Jonas Johnson, MD, FACS — Professor and Chairman, Department of Otolaryngology

February 7, 2017 – 8 p.m.: Update in Implantable Hearing Devices
Presented by: Barry Hirsch, MD — Professor, Department of Otolaryngology
Moderated by: Jonas Johnson, MD, FACS — Professor and Chairman, Department of Otolaryngology

March 7, 2017 – 8 p.m.: Neurostimulation Therapy for Obstructive Sleep Apnea
Presented by: Ryan Soose, MD — Assistant Professor, Department of Otolaryngology
Moderated by: Bridget Hathaway, MD — Assistant Professor, Department of Otolaryngology

April 4, 2017 – 8 p.m.: Update on Sino-Nasal Malignancy
Presented by: Eric Wang, MD — Associate Professor, Department of Otolaryngology
Moderated by: David Eibling, MD — Professor, Department of Otolaryngology

May 9, 2017 – 8 p.m.: Advances and Novel Therapeutics in the Treatment of Chronic Rhinosinusitis
Presented by: Stella Lee, MD — Associate Professor, Department of Otolaryngology
Moderated by: TBD

June 6, 2017 –8 p.m.: Advances in Management of Oropharynx Cancer: HPV, Robotic Surgery, and Immunotherapy
Presented by: Robert Ferris, MD, PhD — Associate Professor, Department of Otolaryngology
Moderated by: Barry Schaitkin, MD, FACS — Professor, Department of Otolaryngology

For more information, to register for a webinar, or to view all past webinars, visit the Chorus Call website.

 

Center for Advanced Robotics Training Thoracic Surgery Course — December 9-10, 2016

December 9-10, 2016

Overview:

The Center for Advanced Robotics Training (CART) program in thoracic surgery offers an in-depth introduction to advanced pulmonary, mediastinal, and esophageal procedures, including lobectomy, thymectomy, and esophagectomy. Instructed by leaders in the field of minimally invasive thoracic surgery, the program features individualized didactic and hands-on experience, including overview of the operating suite setup, review of equipment and instruments, and step-by-step guidance in performing critical aspects of these complex procedures through simulation and cadaver work. The course offerings are highly customizable to address the specific procedural interest, skill level, and needs of each participant.

Day One: December 9

7 a.m. Introduction to CART 8 a.m. Observation of Live

Surgery

12 p.m. Lunch

1 p.m. Simulation Lab Sessions

5 p.m. Review of Curriculum Pathway and Practical Skill Session Goals

7 p.m. Working Dinner with Step-by-Step Technical Video Presentation

9:00 p.m. Adjourn

Day Two: December 10

7 a.m. Breakfast

8 a.m. Robotic Practical Skills Cadaver Lab #1

12 p.m. Lunch

1 p.m. Simulation Lab Session

3 p.m. Robotic Practical Skills Cadaver Lab #2

Cost: $4,000/surgeon

Maximum attendance: 4 surgeons

For more information, please contact:

Daniel Battista, MBA, Administrative Director

UPMC Center for Advanced Robotics Training (CART) UPMCRoboticTrainingCenter@upmc.edu

1-844-304-2278

UPMC.com/CART

Center for Advanced Robotics Training Complex Pancreatic Resections Course — December 15-16, 2016

December 15-16, 2016

Overview:

This course will serve as an introduction to the advanced robotic curriculum, and will also expose participants to the skill sets necessary to safely perform advanced robotic pancreatic resections. The UPMC Robotic Hepatobiliary and Pancreatic Surgery (HPB) program under the direction of Dr. David Bartlett and Dr. Herbert Zeh is a highly accomplished surgical program. This team has performed over 600 major pancreatic and liver resections, including nearly 300 pancreaticoduodenectomies and more than 100 robotic liver resections. They have published a number of highly-cited articles in this field. Over the last several years, this program has dedicated significant resources to developing a comprehensive proficiency-based curriculum for advanced robotic skills.

Day One: December 15

7 a.m. Case Observation (Robotic Whipple*)

3 p.m. Didactic Session

Robotic nurse coordinator

Robotic distal pancreatectomy

Robotic pancreaticoduodenectomy

Overview of robotic simulation and training curriculum

Overview of biotissue drills/testing

6 p.m. Working Dinner

Video presentations: scope of robotic HPB cases

Day Two: December 16

7 a.m. Continental Breakfast

8 a.m. – 12 p.m. Simulator/ Inanimate and Biotissue Skill Evaluations

12 – 1 p.m. Lunch

1 – 4 p.m. Cadaver Lab

*If surgical procedure is cancelled due to unforeseen circumstances, a previously recorded full-length procedure will be used for discussion

Cost: $4,000/surgeon

Maximum attendance: 6 surgeons

This activity has been approved for AMA PRA Category 1 Credit(s)™

 

For more information, please contact:

Daniel Battista, MBA, Administrative Director

UPMC Center for Advanced Robotics Training (CART) UPMCRoboticTrainingCenter@upmc.edu

1-844-304-227

MidAtlantic AIDS Education and Training Center Hosts World AIDS Day 2016 Conference

WHAT: To observe the 28th World AIDS Day, The MidAtlantic AIDS Education and Training Center (MAAETC), based at the University of Pittsburgh Graduate School of Public Health, will collaborate with UPMC and local HIV/AIDS clinics to host an all-day educational event. The World AIDS Day 2016 conference will bring together experts in the field of HIV to enable physicians, nurses and other HIV care providers to improve care. Experts will discuss prevention including PreP, aging and HIV, antiretroviral treatment, and substance use and HIV.

To learn more or register, visit https://www.maaetc.org/events/view/8202.

WHY: Despite advances in HIV treatment, there continues to be an increase in HIV infections. This necessitates routine testing for everyone, to identify and link persons with HIV to care so that they can live longer lives. New treatment is available to prevent HIV infection, and concerns and issues are emerging among persons aging with HIV infection.

WHO:

• Introductions by Corey O’Connor, councilman, City of Pittsburgh, and Donald S. Burke, MD, Dean, Pitt Public Health.

• Speakers include:

o Rachel Levine, MD, physician general, Commonwealth of Pennsylvania
o Harold Wiesenfeld, MD, MPH, Allegheny County Health Department, and Magee-Womens Hospital of UPMC
o Donna Gallagher, PhD, MSN, ANP-BC, FAAN,
New England AIDS Education and Training Center
o Ken Ho, MD, MPH, medical director, Pitt Men’s Study,
University of Pittsburgh School of Medicine
o Antoine Douaihy, MD, medical director, Addiction Medicine,
University of Pittsburgh Department of Psychiatry

WHEN: 8:30 a.m. to 5:30 p.m., Thursday, Dec. 1

WHERE: University Club, 123 University Place, Pittsburgh, 15260

Note to Media: To cover this event, contact Allison Hydzik at 412-647-9975 or HydzikAM@upmc.edu.

Westminster College and UPMC Schools of Nursing Announce New Partnership with Focus on Rural Health Care

The Westminster College School of Nursing will launch its inaugural program in Fall Semester 2017 in a collaborative agreement with the UPMC’s Jameson Memorial Hospital School of Nursing in New Castle, leading to both a nursing diploma and a bachelor of science in nursing (BSN) degree in the new four-year program.

First-year students will take pre-nursing and liberal arts courses at Westminster and matriculate to UPMC Jameson’s School of Nursing. For years two and three, students will follow the UPMC Jameson program while earning credits at Westminster toward the BSN degree. At the completion of the UPMC Jameson program, students will test for the licensing examination for registered nurse (RN) licensure. During the fourth year students will complete higher level nursing courses at Westminster to earn the BSN.

“The bachelor’s degree in nursing is now considered the gold standard for entry into nursing practice within health care,” said Tricia Ryan, newly appointed School of Nursing director at Westminster. “With the collaboration between Westminster College and UPMC Jameson’s School of Nursing, our students will experience the ‘best of both worlds’ in nursing education with this brilliant combination of nursing and the liberal arts.”

“The health care needs of the communities in and surrounding New Wilmington and New Castle are diverse and unique in many ways and provide rich opportunities for these future nurses to develop specialized skills to serve patients in rural areas,” said Linda Kmetz, PhD, executive director of UPMC Schools of Nursing and director of UPMC Shadyside School of Nursing. “During their time at UPMC Jameson School of Nursing, students will have rare opportunities to study and gain practical experience in telemedicine, behavioral health, obstetrics, pediatrics and Amish health customs and practices, in addition to rural medicine.”

Other highlights of the partnership include opportunities for students to study Spanish medical language; a nursing licensure exam pass rate of current UPMC Jameson students that is consistently above the national average; a strong pipeline to nursing positions in home care, primary care offices, in case management and in traditional settings at UPMC’s community hospitals including Horizon, Hamot and Jameson; and opportunities to experience global health through Westminster’s mission programs in the Dominican Republic.

Genetic Test Helps Improve Outcomes in Heart Stent Patients

A genetic test recently implemented at UPMC Presbyterian can significantly reduce the risk of cardiovascular events by helping to identify more effective medication for some heart patients, according to the results of a large study conducted in part at the University of Pittsburgh and UPMC. The findings are being presented today at the American Heart Association’s Scientific Sessions in New Orleans.

The test identifies a genetic deficiency that affects the body’s ability to activate clopidogrel, a common anti-clotting drug given after a coronary artery stent is inserted. About 30 percent of all patients have the genetic deficiency, which can lead to decreased clopidogrel effectiveness and increased risk for adverse cardiovascular events, such as strokes, heart attacks and death.

In the current study from the National Institutes of Health’s Implementing Genomics in Practice (IGNITE) Network, researchers at the University of Pittsburgh School of Pharmacy and other sites throughout the country analyzed medical outcomes in 1,815 patients who had genetic testing at the time of their cardiac procedure. The testing allows physicians to pinpoint the best anti-clotting medication for each patient.

The study reported significant results: About 60 percent of patients with the genetic deficiency were given a different, more effective medication. Using the genetic data to guide changes in therapy reduced the percentage of deaths, heart attacks or strokes by nearly half compared with those who continued taking clopidogrel, the researchers found. Among those who had the genetic deficiency and continued taking clopidogrel, 8 percent experienced one of those complications.

“We saw significantly fewer adverse events among patients who were switched to an alternative drug,” said Larisa Cavallari, PharmD, director of the Center for Pharmacogenomics at the University of Florida College of Pharmacy who led the multi-institutional study.

Earlier this year, UPMC Presbyterian became one of the first medical centers in the country to make this test available for patients as part of the PreCISE-Rx (Pharmacogenomics-guided Care to Improve the Safety and Effectiveness of Medications) initiative. Approximately 10 percent of the study population was analyzed by the team at Pitt and UPMC, one of the affiliates in the IGNITE Network.

“This study is a major step forward as it shows applying pharmacogenomics to achieve a precision medicine approach in cardiac stent patients can provide significant benefits,” said Philip Empey, PharmD, PhD, assistant professor of pharmacy and therapeutics at the Pitt School of Pharmacy and leader of the Pitt team.

PreCISE-Rx is a leading initiative of the Institute for Precision Medicine (IPM), a joint effort by UPMC and Pitt to move biomedical research into personalized well-being and clinical care.

“The success of PreCISE-Rx demonstrates that the IPM is well-positioned to dramatically improve the standard of care through precision medicine by taking advantage of the world-class clinical and research expertise in Pittsburgh,” said Adrian Lee, PhD, professor of pharmacology and chemical biology at Pitt, and director of the Women’s Cancer Research Center, University of Pittsburgh Cancer Institute.

Other institutions that participated in the clopidogrel research were the University of North Carolina, the University of Maryland-Baltimore, the University of Alabama-Birmingham, Vanderbilt University Medical Center, the University of Illinois-Chicago, Indiana University-Indianapolis, Sanford Health, Duke University and the University of Pennsylvania.

International Team Decodes Cellular Death Signals

A multidisciplinary international team of scientists solved the mystery of a recently discovered type of controlled cell death, mapping the path to potential therapies for conditions ranging from radiation injury to cancer. The study, led in part by the University of Pittsburgh, is reported today in two papers in Nature Chemical Biology.

Ferroptosis is a way the body uses iron (which is “ferro” in Latin) to catalyze a reaction that safely destroys and recycles a malfunctioning or damaged cell. Until this study, scientists didn’t know how the body signaled – within the damaged cell and to other cells – that this well-regulated death needed to occur.

“Our team successfully decoded the signaling language that cells use to trigger ferroptosis,” said Valerian E. Kagan, PhD, DSc, professor in the Pitt Graduate School of Public Health’s Department of Environmental and Occupational Health, and lead author of one of the papers. “You can think of it like the scanners and radios that policemen use to find and arrest a criminal.

“The goal is to communicate enough information to neutralize the problem and remove the criminal, or damaged cell, but without creating such a commotion that you disrupt the society, which, in this example, would be other, well-functioning cells.”

Through two years of experiments bridging fields ranging from public health and critical care medicine to basic biology and chemistry, the team analyzed hundreds of molecular combinations generated in the ferroptotic process to discover that only four molecules actually signal for the cell to die. All four are phospholipids – naturally occurring molecules that make up cell membranes.

“Scientists have long known that these lipids were important for encasing the cell and giving it structure,” said Kagan. “What they didn’t know – what we’ve only learned in recent scientific history – is that they do so much more, including communicating and signaling messages like ‘danger’ inside the cell itself, to other cells and to the cellular community as a whole, so that organisms can function in a coordinated way.”

Kagan and Hülya Bayɪr, MD, professor in Pitt’s Department of Critical Care Medicine and senior author of one of the papers, had previously worked together to decode another type of more well-known cell death, called apoptosis. They then decided to pursue the more esoteric ferroptosis, which had first been discovered in 2012.

“Ferro means iron, and we live in Pittsburgh, the Iron City – it would be a shame for us not to understand this process,” said Kagan, whose team looked for therapeutic value as they decoded the signaling process.

Kagan and Bayɪr also study ways to protect people against radiation, such as what would be given off in a terrorist attack. The findings gave them reason to think that ferroptosis may underlie radiation induced cellular damage as well.

“More and more, we’re appreciating that the damage from acute radiation is happening to the lining of the intestine, and that damage triggers a cascade of health complications that lead to sepsis, a very deadly syndrome,” said Bayɪr. “We believe that the radiation is triggering ferroptosis in the cells that line the intestine. If we can stop that process and get the body to repair, rather than systematically destroy, those cells, we might save the victims of devastating dirty bomb attacks.”

Conversely, in cancer, the body is failing to destroy dysfunctional cancer cells, allowing tumors to grow unchecked. By understanding the ferroptotic pathway, the researchers hope to find medications that can prompt it to recognize and kill cancer cells.

The researchers have already partnered with several UPMC clinicians to explore ways to translate their scientific findings into therapies that could help patients.

Sebastian Doll, PhD, José Pedro Friedman Angeli, PhD, and Marcus Conrad, PhD, all of Helmholtz Zentrum München in Germany, are lead or senior authors on the accompanying Nature Chemical Biology publication. In addition to a multi-disciplinary team of Pitt leading investigators, including  Joel Greenberger, MD, Rama K. Mallampalli, MD, Claudette St Croix, PhD, Simon Watkins, PhD, and Ivet Bahar, PhD, and others at Helmholtz Zentrum München, additional co-authors are from the University of Heidelberg in Germany and Columbia University in New York.

This research is supported by National Institutes of Health grants P01HL114453, U19AI068021, NS076511, NS061817, P41GM103712 and ES020693; Deutsche Forschungsgemeinschaft grants CO 291/2-3 and CO 291/5-1; and the Human Frontier Science Program grant HFSP-RGP0013/2014.

Heart Failure Care Improving, but Hospitalizations on the Rise

Although hospitalizations have increased in recent years for patients with congestive heart failure, survival rates and length of stay have improved, according to new research from experts at the University of Pittsburgh School of Medicine and UPMC Heart and Vascular Institute. The results, published in the journal Clinical Cardiology and presented Sunday at the American Heart Association Scientific Sessions, were based on more than 15 million US hospital admissions between 1996 and 2009 due to congestive heart failure.

The prevalence of heart failure is increasing in the US due to its aging population and significant advancements in management of associated co-morbidities, such as ischemic heart disease, diabetes, stroke, peripheral vascular disease and hypertension. More than 5 million Americans are living with heart failure, and close to 500,000 patients are newly diagnosed each year.

Heart failure also is a common cause of hospital admissions, leading to significant costs for the nation’s health care system. A recent report from the American Heart Association estimated the annual direct and indirect costs associated with heart failure in the US at more than $30.7 billion. However, until this study, little was known about recent trends involving those admissions, including length of stay and in-hospital mortality.

“There has been significant progress in heart failure management over the past two decades, but more has to be done,” said Muhammad Bilal Munir, MD, clinical instructor of medicine in Pitt’s Division of General Internal Medicine and corresponding author of the study. “The number of hospitalizations has increased, identifying a need to implement heart failure quality measures stringently to reduce these admissions, therefore reducing heart failure-associated health care costs.”

The number of heart failure hospitalizations increased from 1,000,766 in 1996 to about 1,173,832 in 2009, according to study results. The mean length of stay fell from 6.07 days in 1996 to about 5.26 days in 2009, and inpatient mortality rates declined from 4.92 percent in 1996 to 3.41 percent in 2009.

Researchers say the findings likely reflect the changes in the management of heart failure across the country, which include numerous advances in care such as new drug therapies and sophisticated devices. Further efforts are needed to curb the cost of heart failure management, experts agreed, with a focus on reducing heart failure hospital admissions and readmissions, especially for patients with less severe symptoms who could be treated with aggressive outpatient management.

Additional study authors are Michael S. Sharbaugh, MPH; Floyd W. Thoma; Muhammad Umer Nisar, MD; Amir S. Kamran, MD; Andrew D. Althouse, PhD; and Samir Saba, MD, all from the UPMC Heart and Vascular Institute.

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