***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 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 A 30 minute drive time threshold has often been cited as indicative of accessible health services . Cardiac rehabilitation ( CR ) is a chronic disease management program design ed to enhance and maintain cardiovascular health , and geographic barriers to utilization are often cited . The purpose of this study was to empirically test the drive time threshold for CR utilization . Methods A prospect i ve study , using a multi-level design of coronary artery disease out patients nested within 97 cardiologists . Participants completed a baseline sociodemographic survey , and reported CR referral , enrollment and participation in a second survey 9 months later . CR utilization was verified with CR sites . Geographic information systems were used to generate drive times at 60 , 80 and 100 % of the speed limit to the closest CR site from participants ' homes , to take into consideration various traffic conditions . Bivariate analysis was used to test for differences in CR referral , enrollment and degree of participation by drive time . Logistic regression was used to test drive time increments where significant differences were found . Results Drive times were generated for 1209 out patients . Overall , CR referral was verified for 523 ( 43.3 % ) out patients , with verified enrollment for 444 ( 36.7 % ) participating in a mean of 86.4 ± 25.7 % of prescribed sessions . There were significant differences in CR referral and enrollment by drive time ( ps < .01 ) , but not degree of participation . Logistic regression analysis ( ps < .001 ) revealed that the drive time threshold at 80 % of the posted speed limit for physician referral may be 60 minutes ( OR = .26 , 95 % CI : 0.13 - 0.55 ) , and the threshold for patient CR enrollment may also be 60 minutes ( OR = .11 , 95 % CI : 0.04 - 0.33 ) . Conclusions Physicians may be taking geography into consideration when referring patients to CR . Empirical consideration also reveals that patients are significantly less likely to  enroll in CR  where they must drive 60 minutes or more to the closest program . Once enrolled , distance has no significant effect on degree of participation 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 trials reported since 1983 . The value of cardiac rehabilitation as practised in the UK is open to question Objective Cardiac rehabilitation ( CR ) is pivotal in preventing recurring events of myocardial infa rct ion ( MI ) . This study aims to investigate the effect of a smartphone-based home service delivery ( Care Assessment Platform ) of CR ( CAP-CR ) on  CR  use and health outcomes compared with a traditional , centre-based programme ( TCR ) in post-MI patients . Methods In this unblinded r and omised controlled trial , post-MI patients were r and omised to TCR ( n=60 ; 55.7±10.4 years ) and CAP-CR ( n=60 ; 55.5±9.6 years ) for a 6-week CR and 6-month self-maintenance period . CAP-CR , delivered in participants ’ homes , included health and exercise monitoring , motivational and educational material delivery , and weekly mentoring consultations . CAP-CR uptake , adherence and completion rates were compared with TCR using intention-to-treat analyses . Changes in clinical outcomes ( modifiable lifestyle factors , biomedical risk factors and health-related quality of life ) across baseline , 6 weeks and 6 months were compared within , and between , groups using linear mixed model regression . Results CAP-CR had significantly higher uptake ( 80 % vs 62 % ) , adherence ( 94 % vs 68 % ) and completion ( 80 % vs 47 % ) rates than TCR ( p<0.05 ) . Both groups showed significant improvements in 6-minute walk test from baseline to 6 weeks ( TCR : 537±86–584±99 m ; CAP-CR : 510±77–570±80 m ) , which was maintained at 6 months . CAP-CR  showed slight weight reduction ( 89±20–88±21 kg ) and also demonstrated significant improvements in emotional state ( K10 : median ( IQR ) 14.6 ( 13.4–16.0 ) to 12.6 ( 11.5–13.8 ) ) , and quality of life ( EQ5D-Index : median ( IQR ) 0.84 ( 0.8–0.9 ) to 0.92 ( 0.9–1.0 ) ) at 6 weeks . Conclusions This smartphone-based home care CR programme improved post-MI CR uptake , adherence and completion . The home-based CR programme was as effective in improving physiological and psychological health outcomes  as traditional CR . CAP-CR is a viable option towards optimising use of CR services . Trial registration number ANZCTR12609000251224 Background Cardiac rehabilitation ( CR ) is an established means of reducing mortality , yet is grossly underutilized . This is due to both health system and patient-level factors ; issues that have yet to be investigated concurrently . This study utilized a hierarchical design to examine physician and patient-level factors affecting verified CR enrollment . Design A prospect i ve multisite study , using a multilevel design of 1490 coronary artery disease out patients nested within 97 Ontario cardiology practice s ( mean 15 per cardiologist ) . Methods Cardiologists completed a survey regarding CR attitudes . Out patients were surveyed prospect ively to assess factors affecting CR enrollment . Patients were mailed a follow-up survey 9 months later to self-report CR enrollment This was verified with 40 CR sites . Results Five hundred and fifty ( 43.4 % ) out patients were referred , and 469 ( 37.0 % ) enrolled in CR . In mixed logistic regression analyses , factors affecting verified CR enrollment were greater strength of physician endorsement ( P = 0.005 ) , shorter distance to CR ( P = 0.001 ) , being married ( P = 0.01 ) , and fewer perceived CR barriers ( P = 0.03 ) . Conclusion Both physician and patient factors play a part in CR enrollment . Patient CR barriers should be addressed during referral discussion s , and reasons why physicians fail to uniformly endorse CR exploration . Although distance to CR was related to patient enrollment patterns , greater access to home-based CR services should be provided Background Despite evidence of its benefits , attendance at cardiac rehabilitation ( CR ) programmes is poor . Past studies to identify predictors of non-attendance have been limited by their small sample size , particularly for female patients . The present study was design ed to identify socio-demographic and clinical predictors of non-attendance and drop-out separately for men and women automatically referred to CR programmes . Method and subjects Prospect i ve study of CR programme attendance amongst 808 patients consecutively admitted over an 11-month period to one of two hospitals in Melbourne , Australia , after acute myocardial infa rct ion ( AMI ) , or to undergo coronary artery bypass graft surgery ( CABGS ) or percutaneous coronary intervention ( PCI ) .  Results Of the 652 eligible patients , 573 ( 88 % ) were successfully tracked at 4 months . Of these , 284 ( 49.6 % ) had attended a CR programme , while 272 ( 47.5 % ) had not . Using logistic regression , the significant predictors of programme non-attendance among men were having had a PCI , being a non-driver , and being aged 70 or more . The only factor predictive of non-attendance for women was being aged 70 or more . Amongst attenders , 67 ( 23.6 % ) patients discontinued the programme . Being a smoker , having diabetes and being unemployed at the time of hospital admission were predictive of programme drop-out by men . Being physically inactive at admission was predictive of programme drop-out by women . Conclusions The present study demonstrated a relatively high rate of  CR programme attendance . Special attention needs to be directed towards males who are older , PCI patients , smokers , unemployed or non-drivers , and females who are older or inactive PURPOSE The aim of this study was to analyze the effect of the prolongation of exercise sessions ( from 40 to 60 minutes ) on training adherence in the rehabilitation of patients with coronary artery disease ( CAD ) . METHODS In this prospect i ve , r and omized clinical trial , 417 CAD patients ( mean age = 63 ± 10 years , 78 % males ) followed a 7-week exercise training intervention , 3 sessions each week , at 65 % of the maximal oxygen uptake capacity . Subjects were r and omly assigned to 40-minute ( n = 198 ) or 60-minute ( n = 219 ) exercise sessions , with equal time distribution on the different exercise modalities ( 42%—treadmill , 33%—bike , and 25%—arm cranking device , in each session ) . During the exercise training intervention  , dropout , as well as the reasons for dropout , was registered . RESULTS At 7 weeks of exercise training , dropout rate was comparable between groups ( ∼19.9 % , P > .05 ) . However , patients with acute myocardial infa rct ion and /or coronary artery bypass graft surgery were more likely to complete the exercise training intervention ( P < .05 ) . CONCLUSION The prolongation of the exercise sessions does not interfere with the training adherence in the early rehabilitation of CAD patients Background Despite the established benefits of cardiac rehabilitation , evidence suggests referral to , and subsequent enrollment in , cardiac rehabil 
    Output:
    
We included 29 studies , and there was a general agreement in those factors predicting participation and adherence to CR programs .
A similar pattern was observed for CR adherence .
These factors were very similar when analyzing  adherence to CR programs .