***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 
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    Input: BACKGROUND Whether there is an association between depression at the time of acute myocardial infa rct ion and subsequent risk of cardiac complications and death remains controversial . Most studies of this risk factor have been limited to patients of single institutions , and this might account for the varying results . We prospect ively evaluated patients admitted to 5 tertiary care and 5 community hospitals and followed them for 1 year to measure the prevalence and prognostic impact of depressive symptoms after acute myocardial infa rct ion . METHODS Patients were recruited for the study by trained nurse interviewers who had documented acute myocardial infa rct ion within 2 - 3 days of admission . The nurses collected information from the medical records and asked study subjects to complete the  Beck Depression Inventory question naire during their stay in hospital and using a mailed question naire 30 days , 6 months and 1 year later . We obtained information on vital status for patients lost to follow-up from a central death registry . RESULTS Of the 587 study subjects , 550 ( 94 % ) completed the Beck Depression Inventory at baseline and 191 ( 35 % ) had a score of 10 or more , indicating at least mild depression . Rates of depression did not vary over the follow-up period and were similar among patients admitted to tertiary care or community hospitals . Depressed patients were more likely to undergo catheterization ( 57 % v. 47 % , 95 % confidence interval [ CI ] around the difference 0.1%-19.6 % ) and were more likely to undergo percutaneous coronary intervention ( 32 % v. 24 % , 95 % CI around the difference 0.1%-16.2 % ) within 30 days of first admission to hospital . Patients with depression on admission had higher rates of a composite of cardiac complications , including recurrent ischemia , infa rct ion or congestive heart failure during their first stay in hospital or readmission for angina , recurrent acute myocardial infa rct ion , congestive heart failure or arrhythmia ( adjusted hazard ratio 1.4 , 95 % CI 1.05 - 1.86 ) , compared with patients who were not depressed on admission . After 1 year , death rates were higher among patients who were depressed at admission ( 30 patients , 16 % ) compared with nondepressed patients ( 28 patients , 8 % ) , although the difference was not statistically significant ( hazard ratio 1.3 , 95 % CI 0.59 - 3.05 ) . INTERPRETATION Depressive symptoms are common after acute myocardial infa rct ion and are associated with a slight increase in risk of in-hospital catheterization and angiography and readmission because of cardiac complications . Death was infrequent , with no statistically significant difference between the 2 groups Background —Few data are available on the impact of heart failure ( HF ) across all types of acute coronary syndromes ( ACS ) . Methods and Results —The Global Registry of Acute Coronary Events ( GRACE ) is a prospect i ve study of patients hospitalized with ACS . Data from 16 166 patients were analyzed : 13 707 patients without prior HF or cardiogenic shock at presentation were identified . Of these , 1778 ( 13 % ) had an admission diagnosis of HF ( Killip class II or III ) . HF on admission was associated with a marked increase in mortality rates during hospitalization ( 12.0 % versus 2.9 % [ with versus without HF ] , P < 0.0001 ) and at 6 months after discharge ( 8.5 % versus 2.8 % , P < 0.0001 ) . Of note , HF increased mortality rates in patients with unstable angina ( defined as ACS with normal biochemical markers of necrosis ; mortality rates : 6.7 % with versus 1.6 % without HF at admission , P < 0.0001 ) . By logistic regression analysis , admission HF was an independent predictor of hospital death ( odds ratio , 2.2 ; P < 0.0001 ) . Admission HF was associated with longer hospital stay and higher readmission rates .  Patients with HF had lower rates of catheterization and percutaneous cardiac intervention , and fewer received & bgr;-blockers and statins . Hospital development of HF ( versus HF on presentation ) was associated with an even higher in-hospital mortality rate ( 17.8 % versus 12.0 % , P < 0.0001 ) . In patients with HF , in-hospital revascularization was associated with lower 6-month death rates ( 14.0 % versus 23.7 % , P < 0.0001 ; adjusted hazard ratio , 0.5 ; 95 % CI , 0.37 to 0.68 , P < 0.0001 ) . Conclusions —In this observational registry , heart failure was associated with reduced hospital and 6-month survival across all ACS subsets , including patients with normal markers of necrosis . More aggressive treatment of these patients may be warranted to improve prognosis CONTEXT The prevalence and consequences of financial barriers to health care services and medications are not well documented for patients with an acute myocardial infa rct ion ( AMI ) . OBJECTIVE To measure the baseline prevalence of self-reported financial barriers to health care services or medication ( as defined by avoidance due to cost ) among individuals following AMI and their association with subsequent health care outcomes . DESIGN , SETTING , AND PARTICIPANTS The Prospect i ve Registry Evaluating Myocardial Infa rct ion : Event and Recovery ( PREMIER ) , an observational , multicenter US study of patients with AMI over 12 months in 2498 individuals enrolled from January 2003 through June 2004 . MAIN OUTCOME MEASURES Health status symptoms ( Seattle Angina Question naire [ SAQ ] ) , overall health status function ( Short Form-12 ) , and rehospitalization . RESULTS The prevalence of self-reported financial barriers to health care services or medication was 18.1 % and 12.9 % , respectively . Among individuals who reported financial barriers to health care services or medication , 68.9 % and 68.5 % , respectively , were insured . At 1-year follow-up , individuals with financial barriers to health care services were more likely to have lower SAQ quality -of-life score ( 77.9 vs 86.2 ; adjusted mean difference= -4.0 ; 95 % confidence interval [ CI ] , -6.3 to -1.8 ) , and increased rates of all-cause rehospitalization ( 49.3 % vs 38.1 % ; adjusted hazard ratio [ HR ] , 1.3 ; 95 % CI , 1.1 - 1.5 ) and cardiac rehospitalization ( 25.7 % vs 17.7 % ; adjusted HR , 1.3 ; 95 % CI , 1.0 - 1.6 ) . At 1-year follow-up , individuals with financial barriers to medication were more likely to have angina ( 34.9 % vs 17.9 % ; adjusted odds ratio , 1.55 ; 95 % CI , 1.1 - 2.2 ) , lower SAQ quality -of-life score ( 74.0 vs 86.1 ; adjusted mean difference = -7.6 ; 95 % CI , -10.2 to -4.9 ) , and increased rates of all-cause rehospitalization ( 57.0 % vs 37.8 % ; risk-adjusted HR , 1.5 ; 95 % CI , 1.2 - 1.8 ) and cardiac rehospitalization ( 33.7 % vs 17.3 % ; adjusted HR , 1.7 ; 95 % CI , 1.3 - 2.2 ) . CONCLUSION Financial barriers to health care services and medications are associated with worse recovery after AMI , manifested as more angina , poorer quality of life , and higher risk of rehospitalization Background — The role of the vasopressin system after acute myocardial infa rct ion is unclear . Copeptin , the C-terminal part of the vasopressin prohormone , is secreted stoichiometrically with vasopressin . We compared the prognostic value of copeptin and an established marker , N-terminal pro-B-type natriuretic peptide ( NTproBNP ) , after acute myocardial infa rct ion . Methods and Results — In this prospect i ve single-hospital study , we recruited 980 consecutive post – acute myocardial infa rct ion patients ( 718 men , median [ range ] age 66 [ 24 to 95 ] years ) , with follow-up over 342 ( range 0 to 764 ) days .  Plasma copeptin was highest on admission ( n=132 , P<0.001 , day 1 versus days 2 to 5 ) and reached a plateau at days 3 to 5 . In the 980 patients  , copeptin ( measured at days 3 to 5 ) was elevated in patients who died ( n=101 ) or were readmitted with heart failure ( n=49 ) compared with survivors ( median [ range ] 18.5 [ 0.6 to 441.0 ] versus 6.5 [ 0.3 to 267.0 ] pmol/L , P<0.0005 ) . With logistic regression analysis , copeptin ( odds ratio , 4.14 , P<0.0005 ) and NTproBNP ( odds ratio , 2.26 , P<0.003 ) were significant independent predictors of death or heart failure at 60 days . The area under the receiver operating characteristic curves for copeptin ( 0.75 ) and NTproBNP ( 0.76 ) were similar . The logistic model with both markers yielded a larger area under the curve ( 0.84 ) than for NTproBNP ( P<0.013 ) or copeptin ( P<0.003 ) alone , respectively . Cox modeling predicted death or heart failure with both biomarkers ( log copeptin [ hazard ratio , 2.33 ] , log NTproBNP [ hazard ratio , 2.70 ] ) . In patients stratified by NTproBNP ( above the median of ≈900 pmol/L ) , copeptin above the median ( ≈7 pmol/L ) was associated with poorer outcome ( P<0.0005 ) . Findings were similar for death and heart failure as individual end points . Conclusions — The vasopressin system is activated after acute myocardial infa rct ion . Copeptin may predict adverse outcome , especially in those with an elevated NTproBNP ( more than ≈900 pmol/L ) BACKGROUND Disease management programs ( DMPs ) that use multidisciplinary teams and specialized clinics reduce hospital admissions and improve quality of life and functional status . Evaluations of cardiac DMPs delivered by home health nurses are required . METHODS Between August 1999 and August 2000 we identified consecutive patients admitted to hospital with elevated cardiac enzymes . Patients who agreed were r and omly assigned to participate in a DMP or to receive usual care .  The DMP included 6 home visits by a cardiac-trained nurse , a st and ardized nurses ' checklist , referral criteria for specialty care , communication with the family physician and patient education . We measured readmission days per 1000 follow-up days for angina , congestive heart failure ( CHF ) and chronic obstructive pulmonary disease ( COPD ) ; all-cause readmission days ; and provincial cl aims for emergency department visits , physician visits , diagnostic or therapeutic services and laboratory services . RESULTS We screened 715 consecutive patients admitted with elevated cardiac markers between August 1999 and August 2000 . Of those screened 71 DMP and 75 usual care patients met the diagnostic criteria for myocardial infa rct ion , were eligible for visits from a home health nurse and consented to participate in the study . Readmission days for angina , CHF and COPD per 1000 follow-up days were significantly higher for usual care patients than for DMP patients ( incidence density ratio [ IDR ] = 1.59 , 95 % confidence interval [ CI ] 1.27 - 2.00 , p < 0.001 ) . All-cause readmission days per 1000 follow-up days were significantly higher for usual care patients than for DMP patients ( IDR = 1.53 , 95 % CI 1.37 - 1.71 , p < 0.001 ) . The difference in emergency department encounters per 1000 follow-up days was significant ( IDR = 2.08 , 95 % CI 1.56 - 2.77 , p < 0.001 ) . During the first 25 days after discharge , there were significantly fewer provincial cl aims su bmi tted for DMP patients than for usual care patients for emergency department visits ( p = 0.007 ) , diagnostic or therapeutic services ( p = 0.012 ) and laboratory services ( p = 0.007 ) . INTERPRETATION The results provide evidence that an appropriately developed and implemented community-based inner-city DMP delivered by home health nurses has a positive impact on patient outcomes Although chronic obstructive pulmonary disease ( COPD ) is common in patients with myocardial infa rct ion ( MI ) , its association with long-term mortality after MI is controversial and little is known about its influence on patients ' health status ( symptoms , 
    Output:
    
Patient characteristics may be important predictors of AMI readmission ; however , few variables were consistently identified .