***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background — Although numerous studies have reported that cardiac rehabilitation ( CR ) is associated with reduced mortality after myocardial infa rct ion , less is known about its association with mortality after percutaneous coronary intervention . Methods and Results — We performed a retrospective analysis of data from a prospect ively collected registry of 2395 consecutive patients who underwent percutaneous coronary intervention in Olmsted County , Minnesota , from 1994 to 2008 . The association of CR with all-cause mortality , cardiac mortality , myocardial infa rct ion , or revascularization was assessed with 3 statistical techniques : propensity score – matched analysis ( n=1438 ) , propensity score stratification ( n=2351 ) , and regression adjustment with propensity score in a 3-month l and mark analysis ( n=2009 ) . During a median follow-up of 6.3 years , 503 deaths ( 199 cardiac ) , 394 myocardial infa rct ions , and 755 revascularization procedures occurred in the study subjects . Participation in CR , noted in 40 % ( 964 of 2395 ) of the cohort , was associated with a significant decrease in all-cause mortality by all 3 statistical techniques ( hazard ratio , 0.53 to 0.55 ; P<0.001 ) . A trend toward decreased cardiac mortality was also observed in CR participants ; however , no effect was observed for subsequent myocardial infa rct ion or revascularization . The association between CR participation and reduced mortality rates was similar for men and women , for older and younger patients , and for patients undergoing elective or nonelective percutaneous coronary intervention . Conclusions — We found that CR participation after percutaneous coronary intervention was associated with a significant reduction in mortality rates . These findings add support to published clinical practice guidelines , performance measures , and insurance coverage policies that recommend CR for patients after percutaneous coronary intervention BACKGROUND Cardiac rehabilitation ( CR ) is well documented , in r and omised trials , to reduce mortality risk after myocardial infa rct ion ( MI ) . Selection of healthy patients for CR  is a relatively unexplored problem . Our aims were to identify predictors of CR-attendance and to describe the prognosis as concerns mortality , re-admission and invasive treatment among CR-attendees as compared to  CR-non-attendees  . METHODS From a cohort of 138 290 persons aged 30 - 69 years , we identified consecutive MI patients , between 1 April 2000 and 31 March 2002 . There were 206 MI patients , who survived until admission , and among the 200 who survived 30 days , 145 ( 72.5 % ) attended a comprehensive CR programme . Data were obtained from patient charts and from Danish population registers , and as a result we had no non-participation for the study . RESULTS The 2-year mortality proportions for patients surviving the first 30 days of admission were 2.8 and 21.8 % among CR-attendees and CR-non-attendees , respectively ( P < 0.0001 ) . Among CR-non-attendees , there was a smaller fraction having an invasive treatment performed as compared with CR-attendees . By multiple logistic regression controlling for age and sex , CR-attendance was associated with chest pain , whereas CR-non-attendance was associated with low gross income , single living and inverted T-wave in the electrocardiogram . CONCLUSION  CR attendance rate was 72.5 % . Non-attendees have a higher mortality risk , which in part may be attributed to selection of healthy patients . Non-attendees are older and more likely to have atypical symptoms at admission , a low socioeconomic status and to live alone . Special attention is needed to improve CR attendance among such patients Background — There is no r and omized , double-blind trial testing the prognostic effect of highly purified omega-3 fatty acids in addition to current guideline -adjusted treatment of acute myocardial infa rct ion . Methods and Results — OMEGA is a r and omized , placebo-controlled , double-blind , multicenter trial testing the effects of omega-3-acid ethyl esters-90 ( 1 g/d for 1 year ) on the rate of sudden cardiac death in survivors of acute myocardial infa rct ion , if given in addition to current guideline -adjusted treatment . Secondary end points were total mortality and nonfatal clinical events .  Patients ( n=3851 ; female , 25.6 % ; mean age , 64.0 years ) were r and omized in 104 German centers 3 to 14 days after acute myocardial infa rct ion from October 2003 until June 2007 .  Acute coronary angiography was performed in 93.8 % and acute percutaneous coronary intervention in 77.8 % of all patients . During a follow-up of 365 days , the event rates were ( omega and control groups ) as follows : sudden cardiac death , 1.5 % and 1.5 % ( P=0.84 ) ; total mortality , 4.6 % and 3.7 % ( P=0.18 ) ; major adverse cerebrovascular and cardiovascular events , 10.4 % and 8.8 % ( P=0.1 ) ; and revascularization in survivors , 27.6 % and 29.1 % ( P=0.34 ) . Conclusions — Guideline -adjusted treatment of acute myocardial infa rct ion results in a low rate of sudden cardiac death and other clinical events within 1 year of follow-up , which could not be shown to be further reduced by the application of omega-3 fatty acids . Clinical Trial Registration — URL : http://www . clinical trials.gov . Unique identifier : NCT00251134 Background The prognostic effect of early , comprehensive short-term cardiac rehabilitation on top of current , guideline -adjusted treatment of acute myocardial infa rct ion has not sufficiently been evaluated . Design Prospect i ve cohort study . Methods Within the OMEGA study population , the clinical course of 3560 patients still alive 3 months after acute myocardial infa rct ion were evaluated by comparing patients who had attended to cardiac rehabilitation ( 70.6 % ) with those who did not .  Total mortality and major adverse cerebrovascular and cardiovascular events , as well as non-fatal events , were evaluated within the time period of 4–12 months after hospital admission for acute myocardial infa rct ion . The effect of cardiac rehabilitation on clinical events was estimated by using the propensity score method to adjust for confounding parameters in multivariate analysis . Results Patients participating in cardiac rehabilitation  were younger , more often had acute revascularization  , less often experienced non-ST-elevation myocardial infa rct ion , and less often had a history of diabetes or cardiovascular events . Total mortality ( OR 0.46 , 95 % CI 0.27–0.77 ) and major adverse cerebrovascular and cardiovascular events ( OR 0.53 , 95 % CI 0.38–0.75 ) were significantly lower in the rehabilitation group . Subgroup analysis including major clinical characteristics also revealed significantly reduced rates of total death and major adverse cerebrovascular and cardiovascular events in the rehabilitation group . Conclusions Attendance to early , comprehensive short-term cardiac rehabilitation programmes on top of current guideline -adjusted treatment of acute myocardial infa rct ion is associated with a significantly improved 1-year prognosis Health care decision-making requires evidence of the cost-effectiveness of medical therapies . We evaluated the cost-effectiveness of  exercise-based cardiac rehabilitation ( ECR ) implemented according to guidelines . All the patients ( n = 204 ) had experienced a recent acute coronary syndrome and were r and omized to a 1-year ECR ( n = 109 ) or usual care ( UC ) group ( n = 95 ) . The patients ' health-related quality of life was followed using the 15D instrument and  health care costs were collected from electronic health registries . The cost-effectiveness of ECR  was estimated based on intervention and health care costs and quality -adjusted life years ( QALYs ) gained . The total average cost per patient was lower in ECR than in UC . The incremental cost was divided by the baseline-adjusted incremental QALYs ( 0.045 ) , yielding an incremental cost-effectiveness ratio of -€24511/QALYs . A combined endpoint of mortality , recurrent coronary event , or hospitalization for a heart failure occurred for five patients in ECR and 16 patients in UC ( HR 3.9 , 95 % CI 1.4 - 10.6 , P = 0.004 , relative risk reduction 73 % , number needed to treat eight ) . ECR is a dominant treatment option and decreases the occurrence of adverse cardiac events . These results are useful for decision-making when planning optimal utilization of re sources in Finnish health care PURPOSE to assess clinical efficacy of early post discharge rehabilitation of patients with ischemic heart disease ( IHD ) after coronary artery bypass grafting ( CABG ) in conditions of a poly clinical department of cardiological rehabilitation ( stage III of cardiorehabilitation ) . MATERIAL AND METHODS We included in this study 36 men with IHD in 3 - 8 weeks ( mean 7.8+/-1.6 weeks ) after CABG . Patients were r and omized in 2groups : patients of the main group attended special " School for patients recovering after CABG " [ School ] ( 60 - 80 min sessions once a week for 5 weeks ) and participated in a program of monitored ( up to 60 min 3 times a week for 4 months ) and unmonitored ( home based ) exercise training . Patients of the control group attended School and were given advice to do physical exercises at home . Follow up duration was 1 year . RESULTS Main group . Compared with baseline values after 4 months exercise duration increased 32.6 % ( p<0.05 ) , this effect persisted at 12 month ; threshold exercise load increased 35.2 % ( p<0.05 ) after 4 , 53.9 % after 6 , and 49.5 % after 12 month . After 4 and 12 months of training some increases of left ventricular ( LV ) ejection fraction and stroke volume , and decrease of LV end systolic volume occurred . Physical training in this group was associated with improvement of parameters of quality of life . During 12 months of follow up there were no significant changes of concentrations of total and low density lipoprotein cholesterol ( TC , LDLC ) . In the control group slight increase of exercise duration was observed only at 12 months ( 9.8 % , p<0.05 ) , and it was not accompanied by dynamics of exercise tolerance . Increases of concentrations of TC ( 10.2 % , p<0.05 ) and LDLC ( 15.6 % , p<0.05 ) were registered at 12 months . Serious cardiovascular complications in the main group ( physical training + educational School ) were three times less frequent than in the control group ( attendance of School only ) ( 11.1 vs. 39.2 % , respectively Background It is widely believed that cardiac rehabilitation following acute myocardial infa rct ion ( MI ) reduces mortality by approximately 20 % . This belief is based on systematic review s and meta-analyses of mostly small trials undertaken many years ago . Clinical management has been transformed in the past 30–40 years and the findings of historical trials may have little relevance now . Objectives The principal objective was to determine the effect of cardiac rehabilitation , as currently provided , on mortality , morbidity and health-related quality of life in patients following MI . The secondary objectives included seeking programmes that may be more effective and characteristics of patients who may benefit more . Design , setting , patients , outcome measures A multi-centre r and omised controlled trial in representative hospitals in Engl and and Wales compared 1813 patients referred to comprehensive cardiac rehabilitation programmes or discharged to ‘ usual care ’ ( without referral to rehabilitation ) .  The primary outcome measure was all-cause mortality at 2 years . The secondary measures were morbidity , health service use , health-related quality of life , psychological general well-being and lifestyle cardiovascular risk factors at 1 year . Patient entry ran from 1997 to 2000 , follow-up of secondary outcomes to 2001 and of vital status to 2006 . A parallel study compared 331 patients in matched ‘ elective ’ rehabilitation and ‘ elective ’ usual care ( without rehabilitation ) hospitals . Results There were no significant differences between patients referred to rehabilitation and controls in mortality at 2 years ( RR 0.98 , 95 % CI 0.74 to 1.30 ) or after 7–9 years ( 0.99 , 95 % CI 0.85 to 1.15 ) , cardiac events , seven of eight domains of the health-related quality of life scale ( ‘ Short Form 36 ’ , SF36 ) or the psychological general well-being scale . Rehabilitation patients reported slightly less physical activity . No differences between groups were reported in perceived overall quality of cardiac aftercare . Data from the ‘ elective ’ hospitals comparison concurred with these findings . Conclusion In this trial , comprehensive rehabilitation following MI had no important effect on mortality , cardiac or psychological morbidity , risk factors , health-related quality of life or activity . This finding is consistent with systematic review s of all tri 
    Output:
    
CROS II confirms the effectiveness of cardiac rehabilitation participation after acute coronary syndrome and after coronary artery bypass grafting in actual clinical practice by reducing total mortality under the conditions of current evidence -based coronary artery disease treatment .