Study questions acute hemodialysis treatment

A common approach to treating kidney failure by removing waste products from the blood did not improve survival chances for people who suddenly developed the condition, according to School of Medicine researchers.

Their findings, published online in the journal PLOS One, suggest acute hemodialysis, an aggressive method that is often used for people with sudden kidney failure, may not provide a definitive benefit to the patient.

Said Amber Barnato, senior author of the study and faculty member in clinical and translational science: “Our findings question the accepted notion that acute hemodialysis decreases mortality.” While acknowledging that the study is far from conclusive because it lacks detailed clinical data, she added, “It is impossible to draw conclusions based on an observational study, but I do wonder whether it is time to do a clinical trial on the timing and delivery of acute hemodialysis in the context of acute renal failure and critical illness.”

Barnato and her team examined records for 2,131,248 patients admitted to Pennsylvania hospitals between October 2005 and December 2007. Some of the patients had varying degrees of kidney failure without end-stage renal disease; 6,657 of those patients had received acute hemodialysis. At one year, patients who received acute hemodialysis had nearly twice the risk of death as similarly ill patients who did not receive acute hemodialysis.

Said lead author Sarah Ramer, who performed much of the research while a clinical scientist training program medical student at Pitt and is now at Rutgers: “The most striking finding is the increased mortality risk for patients who received acute hemodialysis, even after risk adjustment which limited the sample to the sickest patients. “We know that there is variation in how doctors decide if and when to dialyze a hospitalized patient. If patients given acute hemodialysis are not carefully chosen, some patients might end up not being helped by the treatment.”

Additional Pitt authors on the study were Elan D. Cohen, Chung-Chou H. Chang and Mark L. Unruh (now at the University of New Mexico).

Funding was provided by a Doris Duke Clinical Research Fellowship and National Institutes of Health (NIH) grant.

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Antibodies may treat BK nephropathy in kidney transplants

A viral infection known as BK that commonly causes kidney transplant dysfunction in patients taking high doses of immunosuppressants may be treated with naturally occurring antibodies that already are widely available, according to a School of Medicine-led research presented at the World Transplant Congress.

The BK virus infects most healthy children in the U.S., but the infection is usually asymptomatic and readily cleared by the immune system. However, following natural infection, latent virus persists in the kidneys for an indefinite time because antibodies in the plasma and circulating T-cells remain at levels that are high enough to prevent virus reactivation.

Said Parmjeet Randhawa, faculty member in transplant pathology, who led the research: “However, if the immune system is suppressed — for example by kidney transplant medications designed to prevent rejection of the organ — viral infection flares up and damages the kidney. This causes a condition called BK virus nephropathy. Currently, there are no anti-viral drugs or vaccines specifically designed for BK nephropathy, and none is likely to be licensed for at least the next 10 years.”

Randhawa and his team found that anti-BK antibodies are present at very high levels in immunoglobulin preparations currently being used to treat other viral infections, as well as immunologic disorders such as antibody mediated rejection of transplanted organs. These antibodies interact with a BK virus surface protein called VP-1 and effectively neutralize the virus. Such neutralized viruses can no longer infect human cells.

“By artificially constructing viruses varying in the composition of the proteins on their surface, we have shown that this neutralizing action is effective against all six common BK virus strains circulating in human populations,” said Randhawa. “These findings open the way to conduct clinical trials for preventing and treating BK nephropathy in kidney transplant patients.”

Because the proposed immunoglobulin preparations are natural products derived from healthy human subjects, associated side effects are expected to be minimal, Randhawa said.

Pitt collaborators on the study were Gang Zeng, Sundaram Hariharan and Ron Shapiro, with researchers from the National Cancer Institute and CSL Behring in King of Prussia.

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Seven transplant awards won

Innovations in surgical techniques, drugs and immunosuppression have improved survival after intestinal and multivisceral transplants, according to a retrospective analysis of more than 500 surgeries done at UPMC over nearly 25 years.

The study was led by Goutham Kumar, a transplant surgery fellow. Kumar was recognized for his work with the Young Investigator Award by the 2014 World Transplant Congress and presented his findings there.

The researchers examined 541 intestinal and multivisceral transplants done at UPMC, 1990-2013. The total consisted of 228 pediatric transplants and 313 adult transplants; 252 were intestine-only transplants, 157 were liver-intestine, 89 were full multivisceral, and 43 were modified multivisceral. A majority of the pediatric patients suffered from gastroschisis, followed by volvulus and necrotizing entercolitis. The adult patients needed transplants because of thrombosis, Crohn’s disease or some kind of obstruction.

Researchers analyzed several outcomes and found that preconditioning with certain immunosuppressants, the time the graft is outside of the body, certain blood types and a disparity in the gender of donor and recipient were among the factors predicting graft survival.

Pitt co-authors on the study were George Mazariegos, Guillerme Costa, Gaurav Gupta, Dolly Martin, Geoff Bond, Kyle Soltys, Rakesh Sindhi, Abhinav Humar and Hiroshi Sogawa.

Six other Pitt Schools of the Health Sciences researchers received Young Investigator Awards at this year’s World Transplant Congress:

• Aravind Cherukuri: “Transitional B Cell (TrB) T1/T2 Ratio Is a Marker for Graft Dysfunction in Human Kidney Transplant Recipients (KTRs).”
• Vinayak Rohan: “Outcomes of Liver Transplantation for Unresectable Liver Malignancy in Children.”
• Qing Ding: “TIM-1 Signaling Is Required for Maintenance and Induction of Regulatory B Cells Through Apoptotic Cell Binding or TIM-1 Ligation.”
• Kanishka Mohib: “TIM-4 Expression by C Cells Identifies an Inflammatory B Effector 1 Subset That Promotes Allograft Rejection and Inhibits Tumor Metastases.”
• Dalia Raich-Regue: “Myeloid Dendritic Cell-Specific mTORC2 Deficiency Enhances Alloreactive Th1 and Th17 Cell Responses and Skin Graft Rejection.”
• Tripti Singh: “B Cell Depletion of Naïve Recipients Enhances Graft Reactive T Cell Responses.”

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Childhood disability at all-time high

The percentage of children with disabilities due to neurodevelopmental or mental health conditions continues to rise, particularly among children in more socially advantaged households, according to a School of Medicine analysis that appears in Pediatrics.

The study was led by Amy Houtrow, vice chair of the Department of Physical Medicine and Rehabilitation.

It found that while there has been a decline in physical health-related disabilities by approximately 12 percent, there was a large, nearly 21 percent rise in disabilities classified as neurodevelopmental or mental health in nature.

The researchers studied data from the National Health Interview Survey conducted by the U.S. Centers for Disease Control and Prevention, 2001-11, evaluating each child’s ability to perform activities at home and school.

Although children living in poverty have the highest rates of disability, children living in families at or above 400 percent of the federal poverty level reported a 28.4 percent increase in disabilities over the past 10-year period.

Reasons that may explain the increased rates of disability related to neurodevelopmental or mental health conditions include shifts in diagnostic criteria; overall increases in rates of certain problems including autism; increased awareness of these conditions, and the need for a specific diagnosis to receive services such as early intervention.

Said Houtrow: “This study demonstrates what a lot of pediatricians have been noticing for several years — that they are seeing more neurodevelopmental and mental health problems in their clinical practices. As we look toward the future, the pediatric health care workforce and system needs to adapt to assure the best possible health and functional outcomes for children with disabilities related to neurodevelopmental and mental health conditions.”

The authors concluded that documenting the changes in childhood disabilities is an important step in developing better prevention and treatment strategies and in determining how to create and deliver services to best meet the needs of all children.

Co-investigators were from the American Academy of Pediatrics, the University of California-San Francisco and UCLA.

The research was funded by NIH and Department of Health and Human Services.

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Grant funds EU Ctr.

The European Union Center of Excellence was awarded a grant of almost 90,000 euros from the Delegation of the EU to the U.S. (on behalf of the European Commission).

The one-year grant requires equal matching from the University, bringing the total funds to $248,000, which will be used for faculty and student research and activities. Pitt’s EU Center is one of only four centers nationally to receive continuous funding from the EU since the program began, and was one of 10 centers awarded funding and awarded the designation “Center of Excellence.”

The grant provides funding for one year including support for funding for faculty research on European integration; graduate student research on European integration; conferences and events, including the 15th annual policy conference, with the topic this year of “TransAtlantic Responses to Militant Islam: Comparing U.S. and EU Policies”; the 10th annual faculty research conference, this year with the theme “1989 and Its Aftermath: A ‘New’ Germany? Taking Stock of the Berlin Republic”; the 10th annual graduate student conference on the EU; the 10th annual Jean Monnet symposium, “(Re)Imagining and (Re)Interpreting Spaces, Symbols and Sites in the Baltic Region After 1989”; a science-policy workshop; the Conversations on Europe virtual roundtable series; Model European Union simulations for both undergraduates and high school students; an undergraduate research symposium; outreach activities to community colleges; graduate and undergraduate students for a Brussels study trip; high school teachers and community college instructors for a Brussels visit; a freshman programs trip to New York City for the Europe and the World Learning Community; several visitors from the EU and U.S. to give campus lectures to students and faculty; the summer research scholars program; courses on the politics of the European Union, and a monthly graduate student lecture series: Pizza and Politics.

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Depression leads to faster brain aging

People who develop depression and mild cognitive impairment (MCI) after age 65 are more likely to have biological and brain imaging markers that reflect a greater vulnerability for accelerated brain aging, according to a study by School of Medicine researchers that was published online in Molecular Psychiatry.

Older adults with major depression have double the risk of developing dementia in the future compared with those who have never had the mood disorder, said senior investigator Meryl A. Butters, faculty member in psychiatry. But there’s no clear explanation for why a treatable mood disorder like depression leads to increased risk for dementia, a progressive brain disease. Until now, most studies have examined only one or two biomarkers to get at this question.

Said Butters: “Our study represents a significant advance because it provides a more comprehensive and integrated view of the neurobiological changes related to mild cognitive impairment in late-life. Better understanding of the neurobiology of cognitive impairment in depression can provide new targets for developing more specific treatments, not only for its prevention and treatment, but also for its downstream negative outcomes, including the development of dementia and related disorders.”

The team collected blood samples from 80 older adults in remission after being treated for major depression, 36 of whom had MCI and 44 with normal cognitive function. Their blood was tested for 242 proteins involved in biologic pathways associated with cancer, cardiovascular diseases and metabolic disorders as well as psychiatric and neurodegenerative disorders. The researchers also performed PET and MRI brain scans on the participants to look for indicators of cerebrovascular disease, brain atrophy or shrinkage and beta-amyloid, which is the protein that makes up the brain plaques associated with Alzheimer’s disease.

The MCI group was more likely to have differences in the biologic activity of 24 proteins that are involved in the regulation of immune and inflammatory pathways, intracellular signaling, cell survival and protein and lipid balance.

Brain scans revealed a greater propensity for cerebrovascular disease — for example, small strokes — in the MCI group, but there was no difference in the amount of beta-amyloid deposition.

“If you take these results altogether, they suggest that people with depression and cognitive impairment may be more vulnerable to accelerated brain aging, which in turn puts them at risk for developing dementia,” Butters said. “Ultimately, if we can understand what happens in the brain when people are depressed and suffer cognitive impairment, we can then develop strategies to slow or perhaps stop the impairment from progressing to dementia.”

Next steps include assessing the protein panel in older people with normal cognitive function who have not experienced depression.

Pitt co-authors included Etienne Sibille, Ying Ding, George Tseng, Howard Aizenstein, Frances Lotrich, James T. Becker, Oscar L. Lopez, Michael T. Lotze, William E. Klunk, Charles F. Reynolds and first author Breno S. Diniz, now of the Federal University of Minas Gerais, Brazil.

The project was funded by NIH, the John A. Hartford Foundation Center of Excellence in Geriatric Psychiatry and the Brazilian intramural research program.

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Pharmacist intervention boosts drug adherence

Community pharmacists can dramatically help their patients stick to their prescription regimens, according to a new study led by researchers at the School of Pharmacy. The findings, reported in Health Affairs, suggest also that greater adherence to medications can lead to a reduction in emergency room visits and hospital admissions, thereby lowering health care costs for a variety of chronic conditions including diabetes and asthma.

About 70 percent of all Medicare patients get their prescriptions filled at neighborhood drug stores, but pharmacists can do more for patients than just prepare medications, said lead investigator Janice Pringle, pharmacy faculty member and director of the Program Evaluation and Research Unit (PERU) in the school. She noted that their training, knowledge and community accessibility perhaps make them the ideal health professionals to help people learn how and why to take their medications.

Said Pringle: “This untapped resource could be harnessed and used to improve public health and reduce overall health care costs. If people took their medications as prescribed, diabetes would not evolve and worsen, blood pressure would normalize, cholesterol would be reduced dramatically and the risk for severe health problems, such as heart attack or stroke, would be reduced. Patients would live longer and probably enjoy a higher quality of life.”

For the study, dubbed the Pennsylvania Project, 283 community pharmacists were trained at workshops by PERU staff to ask customers a few quick questions about medication adherence using established survey tools. They also were taught to have a brief dialog with patients whose screening scores indicated they were at risk of not taking their medications as prescribed by their doctors. The conversation might include questions and reassurances about side effects or a request that the patient talk to the pharmacist after taking the medication for a little while to report how they were feeling.

During 2011, 29,042 people had prescriptions filled at 107 Rite Aid pharmacies that implemented the screening and brief intervention approach (SBI) and 30,454 people who went to 111 “control” pharmacies that didn’t use SBI.

The research team then reviewed insurance claims data to evaluate medication adherence with a measure called “Proportion of Days Covered” or PDC. A PDC of 80 percent, meaning the medication was taken for at least 80 percent of expected period, is considered to be the minimal medication dose needed to achieve the desired clinical outcome. PDC80 values were calculated for both the intervention year and for 2010, the year prior to SBI implementation.

For the five classes of common medications the researchers reviewed, PDC80 rates increased in the SBI group during the intervention compared to the control group, ranging from 3.1 percent for beta blockers to treat high blood pressure to 4.8 percent for oral diabetes drugs.

About 75 percent of the net improvement was due to patients who were at high risk for poor medication adherence achieving the PDC80 benchmark after the intervention.

Health care costs dropped by $341 annually per person for SBI patients taking oral diabetes drugs and by $241 for SBI patients taking statins to lower cholesterol.

Each SBI pharmacy also received monthly PDC-measure feedback reports that allowed pharmacists to gauge their performance relative to peers and helped them identify their population of patients at risk for non-adherence.

The study was co-authored by a researcher from RTI International and funded by Pharmacy Quality Alliance.

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Screening + drug therapy could make hepatitis C rare

Newly implemented screening guidelines and improved, highly effective drug therapies could make hepatitis C a rare disease in the United States by 2036, according to the results of a predictive model developed at the Graduate School of Public Health.

The results of the analysis, performed with the University of Texas MD Anderson Cancer Center, were published in the Annals of Internal Medicine.

A rare disease is one that affects at most one in every 1,500 people. Approximately one in every 100 people in the U.S. currently has chronic hepatitis C, a viral infection that compromises liver function.

Said lead author Mina Kabiri, a doctoral student in the Department of Health Policy and Management: “Making hepatitis C a rare disease would be a tremendous, lifesaving accomplishment. However, to do this, we will need improved access to care and increased treatment capacity, primarily in the form of primary care physicians who can manage the care of infected people identified through increased screening.”

In the U.S., hepatitis C is the leading cause of chronic liver disease and the leading reason for liver transplantation. At 15,100 deaths annually, hepatitis C surpassed the annual number of deaths from HIV in 2007. The economic burden associated with chronic infection is estimated at $6.5 billion a year.

In 2012, the Centers for Disease Control and Prevention and the U.S. Preventive Services Task Force recommended that anyone born between 1945 and 1965 —encompassing about 81 percent of chronically infected people — receive a one-time screening for hepatitis C. Hepatitis C often is asymptomatic, meaning that infected people do not know they have it until it is detected through a blood screening.

In early 2014, hepatitis C drug regimens that could be taken orally were introduced to the market, allowing primary care physicians and infectious disease specialists to take on the role of treating hepatitis C patients. The drugs have been shown to be highly effective in making the virus almost undetectable in the blood of patients previously found positive for hepatitis C.

The research team created a highly detailed computer model of the natural history and progression of hepatitis C, both with and without treatment.

The model predicts the number of hepatitis C infections in the United States at any given time from 2001 to 2050, under multiple potential scenarios describing future treatment, while taking into consideration infection status awareness, stage of disease, treatment history and continued drug development, based on data from the National Health and Nutrition Examination Survey (NHANES) and published clinical studies.

To validate the prediction, the researchers ran the model for the years 2003-10 and predicted 2.7 million cases of hepatitis C, which equaled the actual number of cases reported by NHANES.

The research team then considered what would happen if the guidelines were increased to include a one-time universal screening for hepatitis C among all U.S. citizens, not just baby boomers.

“In that scenario, nearly 1 million cases of hepatitis C would be identified in the next 10 years,” said Kabiri. “And that translates into making hepatitis C a rare disease by 2026, a decade earlier than we’d predicted with the current screening guidelines.”

The researchers note that such a measure would bring increased costs. The oral therapy regimen costs as much as $1,000 per day.

The model estimated that universal screening coupled with the new drug therapies would reduce liver-related deaths by 161,500 and liver transplants by 13,900 from 2014 to 2050.

Future research will be needed to determine how the reduction in deaths and transplants offsets the increased costs of screening and drug therapy.

Additional Pitt researchers on this study were Alison B. Jazwinski, Mark S. Roberts and Andrew J. Schaefer.

This study was supported by the National Center for Advancing Translational Sciences of NIH.

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Eating fish weekly boosts brain health

Eating baked or broiled fish once a week is good for the brain, regardless of how much omega-3 fatty acid it contains, according to researchers at the School of Medicine. The findings, published online in the American Journal of Preventive Medicine, add to growing evidence that lifestyle factors contribute to brain health later in life.

Scientists estimate that more than 80 million people will have dementia by 2040, which could become a substantial burden to families and drive up health care costs, noted senior investigator James T. Becker, faculty member in psychiatry. Some studies have predicted that lifestyle changes such as a reduction in rates of physical inactivity, smoking and obesity could lead to fewer cases of Alzheimer’s disease and other conditions of cognitive impairment in the elderly. The antioxidant effect of omega-3 fatty acids, which are found in high amounts in fish, seeds, nuts and certain oils, also has been associated with improved health, particularly brain health.

Said Becker: “Our study shows that people who ate a diet that included baked or broiled, but not fried, fish have larger brain volumes in regions associated with memory and cognition. We did not find a relationship between omega-3 levels and these brain changes, which surprised us a little. It led us to conclude that we were tapping into a more general set of lifestyle factors that were affecting brain health of which diet is just one part.”

Lead investigator Cyrus Raji, who now is in radiology residency training at UCLA, and the research team analyzed data from 260 people who provided information on their dietary intake, had high-resolution brain MRI scans, and were cognitively normal at two time points during their participation in the Cardiovascular Health Study (CHS), a 10-year multicenter effort that began in 1989 to identify risk factors for heart disease in people over 65.

Said Raji: “The subset of CHS participants answered questionnaires about their eating habits, such as how much fish did they eat and how was it prepared. Baked or broiled fish contains higher levels of omega-3s than fried fish because the fatty acids are destroyed in the high heat of frying, so we took that into consideration when we examined their brain scans.”

People who ate baked or broiled fish at least once a week had greater grey matter brain volumes in areas of the brain responsible for memory (4.3 percent) and cognition (14 percent) and were more likely to have a college education than those who didn’t eat fish regularly, the researchers found. But no association was found between the brain differences and blood levels of omega-3s.

“This suggests that lifestyle factors, in this case eating fish, rather than biological factors contribute to structural changes in the brain,” Becker noted. “A confluence of lifestyle factors likely are responsible for better brain health, and this reserve might prevent or delay cognitive problems that can develop later in life.”

Pitt co-authors included Kirk I. Erickson, Oscar Lopez, Lewis H. Kuller and H. Michael Gach, joined by researchers from the University of Southern California and the University of Navarra, Pamplona, Spain.

The research was supported in part by the National Heart, Lung and Blood Institute, the National Institute of Neurological Disorders and Stroke and the National Institute on Aging (NIA).

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Odds of correct surgery for thyroid cancer patients increased

The routine use of a molecular testing panel developed at UPMC greatly increases the likelihood of performing the correct initial surgery for patients with thyroid nodules and cancer, report researchers from the University of Pittsburgh Cancer Institute (UPCI), partnering with UPMC CancerCenter.

The test, available at the UPMC/UPCI Multidisciplinary Thyroid Center and other diagnostic testing agencies, improved the chances of patients getting the correct initial surgery by 30 percent, according to the study published this month in the Annals of Surgery.

Said lead author Linwah Yip, surgery faculty member in the School of Medicine and UPMC surgical oncologist: “Before this test, about one in five potential thyroid cancer cases couldn’t be diagnosed without an operation to remove a portion of the thyroid.” Previously, “if the portion removed during the first surgery came back positive for cancer, a second surgery was needed to remove the rest of the thyroid. The molecular testing panel now bypasses that initial surgery, allowing us to go right to fully removing the cancer with one initial surgery. This reduces risk and stress to the patient, as well as recovery time and costs.”

Cancer in the thyroid, which is located in the “Adam’s apple” area of the neck, is now the fifth most common cancer diagnosed in women. Thyroid cancer is one of the few cancers that continues to increase in incidence, although the five-year survival rate is 97 percent.

Previously, the most accurate form of testing for thyroid cancer was a fine-needle aspiration biopsy, where a doctor guides a thin needle to the thyroid and removes a small tissue sample for testing. However, in 20 percent of these biopsies, cancer cannot be ruled out. A lobectomy, which is a surgical operation to remove half of the thyroid, is then needed to diagnose or rule out thyroid cancer. In the case of a postoperative cancer diagnosis, a second surgery is required to remove the rest of the thyroid.

Researchers have identified certain gene mutations that are indicative of an increased likelihood of thyroid cancer, and the molecular testing panel developed at UPMC can be run using the sample collected through the initial, minimally invasive biopsy, rather than a lobectomy. When the panel shows these mutations, a total thyroidectomy is advised.

Yip and her colleagues followed 671 UPMC patients with suspicious thyroid nodes who received biopsies. Approximately half the biopsy samples were run through the panel, and the other half were not. Patients whose tissue samples were not tested with the panel had a 2.5-fold higher statistically significant likelihood of having an initial lobectomy and then requiring a second operation.

Said co-author Yuri Nikiforov, pathology faculty member and director of thyroid molecular diagnostics at the UPMC/UPCI Multidisciplinary Thyroid Center: “We’re currently refining the panel by adding tests for more genetic mutations, thereby making it even more accurate. Thyroid cancer is usually very curable, and we are getting closer to quickly and efficiently identifying and treating all cases of thyroid cancer.”

In 2009, the American Thyroid Association (ATA) revised its guidelines to add that doctors may consider the use of molecular markers when the initial biopsy is inconclusive.

Remarked senior author Sally Carty, surgery faculty member and co-director of the UPMC/UPCI Multidisciplinary Thyroid Center: “The ATA is currently revising those guidelines to take into account the latest research, including our findings. The molecular testing panel holds promise for streamlining and eliminating unnecessary surgery not just here but nationwide.”

A previous study led by Yip showed the panel to be cost-saving when used to help in the diagnosis of thyroid cancer.

Additional Pitt researchers on this study were Laura I. Wharry, Michaele J. Armstrong, Ari Silbermann, Kelly L. McCoy, Michael T. Stang, Nobuyuki P. Ohori, Marina N. Nikiforov, Shane O. LeBeau, Christopher Coyne, Steven P. Hodak, Julie E. Bauman, Jonas T. Johnson and Mitch E. Tublin.

This study was funded by a grant from UPMC.

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Pitt innovation challenge poses new health care questions

In the second competition of its kind, Pitt will award up to $375,000 to teams of creative thinkers who have fresh ideas to solve tough, health-related problems.

As in the previous Pitt Innovation Challenge (PInCh), the Clinical and Translational Science Institute (CTSI), in collaboration with the University’s Office of the Provost and the Innovation Institute, also will provide winning teams with project managers to implement their plans.

The next challenge seeks answers to the question, “From cell to community:  How can we individualize solutions for better health(care)?”

Solutions could involve personalizing the medical experience; tailoring treatments for a specific disease using genetic information; leveraging family history or other individually unique data, or developing patient-focused interventions.

Said CTSI director Steven Reis, associate vice chancellor for clinical research/health sciences and medicine faculty member: “The success of the first PInCh showed that scientists and other community members can come up with creative approaches to tackle difficult problems. The competition provides a way of making good ideas a reality.”

Since their selection at a public judging event in May, the funded teams from the first PInCh have been making great progress with their projects, Reis noted.

The first step requires submission of a two-minute video by Sept. 15 that introduces the team, defines the health problem that is being tackled and briefly outlines the solution. Early round winners will be invited to a final round on Nov. 12 at a public event in which teams will make short presentations to a panel of judges.

Teams that bring together collaborators from different perspectives, institutions and disciplines are encouraged, but at least one person must be a Pitt faculty member.

The solution could be a device, a software application, an intervention strategy or any other approach the team identifies.

For more information and to register a team, go to www.pinch.pitt.edu.

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Pacemakers more likely after dementia

People with dementia are more likely to get implanted pacemakers for heart rhythm irregularities, such as atrial fibrillation, than people who don’t have cognitive difficulties, according to researchers at the School of Medicine. In a research letter published online in JAMA Internal Medicine, the researchers noted the finding runs counter to expectations that less aggressive interventions are the norm for patients with the incurable and disabling illness.

To look at the relationships between cognitive status and implantation of a pacemaker, lead investigator Nicole Fowler, an Indiana University researcher formerly at the School of Medicine, and her team examined data from 33 Alzheimer Disease Centers (ADCs) entered between September 2005 and December 2011 into the National Alzheimer’s Coordinating Center uniform data set.

Data from more than 16,000 people who had a baseline and at least one follow-up visit at an ADC were reviewed. At baseline, 48.5 percent of participants had no cognitive impairment, 21.3 percent had a mild cognitive impairment (MCI), and 32.9 percent had dementia.

The researchers found that participants with cognitive impairment were significantly older and more likely to be male, have ischemic heart disease and a history of stroke. Rates of atrial fibrillation and congestive heart failure were similar among the groups.

The likelihood of getting a pacemaker, a device that regulates the heart beat, was lowest for those who had no cognitive difficulties and highest for dementia patients.

Said Fowler: “Participants who had dementia before assessment for a new pacemaker were 1.6 times more likely to receive a pacemaker compared to participants without cognitive impairment, even after clinical factors were taken into account. This was a bit surprising because aggressive interventions might not be appropriate for this population, whose lives are limited by a severely disabling disease. Future research should explore how doctors, patients and families come to make the decision to get a pacemaker.”

There was no difference among the groups in the rates of implantation of cardioverter defibrillators, which deliver a small shock to get the heart to start beating again if it suddenly stops.

Pitt co-authors of the paper included Jie Li, Charity G. Moore, Samir Saba, Oscar L. Lopez and Amber E. Barnato. A researcher from Duke University Medical Center also contributed to the research.

The project was funded by the Agency for Healthcare Research and Quality and NIA.

—Compiled by Marty Levine

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The University Times Research Notes column reports on funding awarded to Pitt researchers as well as findings arising from University research.

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