***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 —Women have an unexplained worse outcome after myocardial infa rct ion ( MI ) compared with men in many studies . Depressive symptoms predict adverse post-MI outcomes and are more prevalent among women than men . We examined whether depressive symptoms contribute to women ’s worse outcomes after MI . Methods and Results —In a prospect i ve multicenter study ( PREMIER ) , 2411 ( 807 women ) MI patients were enrolled .  Depressive symptoms were assessed with the Patient Health Question naire .  Outcomes included 1-year rehospitalization , presence of angina using the Seattle Angina Question naire , and 2-year mortality . Multivariable analyses were used to evaluate the association between sex and these outcomes , adjusting for clinical characteristics . The depressive symptoms score was added to the models to evaluate whether it attenuated the association between sex and outcomes . Depressive symptoms were more prevalent in women compared with men ( 29 % versus 18.8 % , P<0.001 ) . After adjusting for demographic factors , comorbidities , and MI severity , women had a mildly higher risk of rehospitalization ( hazard ratio , 1.20 ; 95 % CI , 1.04 to 1.40 ) , angina ( odds ratio , 1.32 ; 95 % CI , 1.00 to 1.75 ) , and mortality ( hazard ratio , 1.27 ; 95 % CI , 0.98 to 1.64 ) . After adding depressive symptoms to the multivariable models , the relationship further declined toward the null , particularly for rehospitalization ( hazard ratio , 1.14 ; 95 % CI , 0.98 to 1.34 ) and angina ( odds ratio , 1.22 ; 95 % CI , 0.91 to 1.63 ) , whereas there was little change in the estimate for mortality ( hazard ratio , 1.24 ; 95 % CI , 0.95 to 1.62 ) . Depressive symptoms were significantly associated with each of the study outcomes with a similar magnitude of effect in both women and men . Conclusions —A higher prevalence of depressive symptoms in women modestly contributes to their higher rates of rehospitalization and angina compared with men but not mortality after MI . Our results support the recent recommendations of improving recognition of depressive symptoms after MI BACKGROUND Depression is known to co-occur with coronary heart disease ( CHD ) . Depression may also inhibit the effectiveness of cardiac rehabilitation ( CR ) programs by decreasing adherence . Higher prevalence of depression in women may place them at increased risk for non-adherence . OBJECTIVE To assess the impact of a modified , stage-of-change-matched , gender-tailored CR program for reducing depressive symptoms among women with CHD . METHODS A two-group r and omized clinical trial compared depressive symptoms of women in a traditional 12-week CR program to those completing a tailored program that included motivational interviewing guided by the Transtheoretical Model of behavior change . Women in the experimental group also participated in a gender-tailored exercise protocol that excluded men . The Center for Epidemiological Studies Depression ( CES-D ) Scale was administered to 225 women at baseline , post-intervention , and at 6-month follow-up . Analysis of Variance was used to compare changes in depression scores over time . RESULTS Baseline CES-D scores were 17.3 and 16.5 for the tailored and traditional groups , respectively . Post-intervention mean scores were 11.0 and 14.3 ; 6-month follow-up scores were 13.0 and 15.2 , respectively . A significant group by time interaction was found for CES-D scores ( F(2 , 446)=4.42 , p=.013 ) . Follow-up tests revealed that the CES-D scores for the traditional group did not differ over time ( F(2 , 446)=2.00 , p=.137 ) . By contrast , the tailored group showed significantly decreased CES-D scores from baseline to post-test ( F(1 , 223)=50.34 , p<.001 ) ; despite the slight rise from post-test to 6-month follow-up , CES-D scores remained lower than baseline ( F(1 , 223)=19.25 , p<.001 ) . CONCLUSION This study demonstrated that a modified , gender-tailored CR program reduced depressive symptoms in women when compared to a traditional program . To the extent that depression hinders CR adherence , such tailored programs have potential to improve outcomes for women by maximizing adherence . Future studies should explore the mechanism by which such programs produce benefits BACKGROUND Psychosocial risk factors tend to cluster together within individuals , likely enhancing the risk of adverse health outcomes . We examined ( 1 ) the influence of clustering of poor device acceptance and Type D personality on anxiety and depressive symptoms , and ( 2 ) the demographic and clinical determinants of patients with clustering , in a large cohort of Danish implantable cardioverter defibrillator ( ICD ) patients . METHODS Patients ( N = 557 ; 81.9 % male ; mean age = 61.9 + /- 14.3 years ) implanted with an ICD between 1989 and 2006 were asked to complete a set of st and ardized and vali date d question naires and were divided into four risk groups : ( 1 ) No risk factors ( neither poor device acceptance nor Type D ) , ( 2 ) Poor device acceptance only , ( 3 ) Type D only , ( 4 ) Clustering ( both poor device acceptance and Type D ) . RESULTS The prevalence of anxiety was significantly higher in patients with clustering of risk factors ( 54.2 % ) compared to patients with poor device acceptance ( 30.0 % ) , Type D personality ( 26.5 % ) , or no risk factors ( 7.6 % ) ( chi(2)= 88.472 ; df = 3 ; P < 0.001 ) . Similarly , the prevalence of depression was higher in the clustering group ( 47.2 % ) compared to patients with poor device acceptance ( 19.1 % ) , Type D personality ( 23.5 % ) , or no risk factors ( 1.8 % ) ( Fisher 's exact = 112.874 ; df = 3 ; P < 0.001 ) . Patients with the clustering of poor device acceptance and Type D had the highest mean scores of anxiety ( P < 0.001 ) and depression ( < 0.001 ) , also when adjusting for demographic and clinical baseline characteristics including shocks . Shocks ( P = 0.006 ) were associated with increased anxiety but not with depression ( P = 0.31 ) . CONCLUSION Patients with poor device acceptance and Type D personality should be identified and monitored in clinical practice , as they may benefit from adjunctive intervention in order to experience the same quality of life benefits following implantation as other patients . Given the cross-sectional nature of the study , these findings should be confirmed using a prospect i ve study design BACKGROUND Significant rates of psychological distress occur in implantable cardioverter defibrillator ( ICD ) patients . Research has demonstrated that women are particularly at risk for developing distress and warrant psychosocial attention . The major objectives were to implement and test the effectiveness of a female-specific psychosocial group intervention on disease-specific quality of life outcomes in outpatient female ICD recipients versus a wait-list control group . METHOD Twenty-nine women were recruited for the study . Fourteen women were r and omized to the intervention group  and participated in a psychosocial intervention focused on female-specific issues ; 15 were r and omized to the wait-list control group .  All women completed individual psychological batteries at baseline and at 1-month follow-up measuring shock anxiety and device acceptance . RESULTS Pre-post measures of shock anxiety demonstrated a significant time by group interaction effect with the intervention group having a significantly greater decrease ( Pillai 's trace = 5.58 , P = 0.026 ) . A significant interaction effect ( Pillai 's trace = 5.05 , P = 0.046 ) was found , such that women under the age of 50 experienced greater reduction in shock anxiety than their middle-aged cohorts . Pre-post measures of device acceptance revealed a significant time by group interaction effect with the intervention group having significantly greater increases ( Pillai 's trace = 5.80 , P = 0.023 ) . CONCLUSIONS Structured interventions for female ICD patients involving ICD-specific education , cognitive behavioral therapy strategies , and group social support provide improvements in shock anxiety and device acceptance at 1-month re- assessment . Young women appear to be an at-risk subgroup of this population and may experience more benefit from psychosocial treatment targeting device-specific concerns OBJECTIVES We sought to examine the combination of adverse psychological factors ( anxiety , depression , and distressed or Type D personality ) as a predictor of ventricular arrhythmias in patients with implantable cardioverter-defibrillators ( ICDs ) .  BACKGROUND Little is known about the role of psychological factors and their clustering in the occurrence of life-threatening arrhythmias . METHODS In this prospect i ve study , 391 patients with an ICD ( 81 % men , age 62.3 + /- 10.4 years ) completed anxiety , depression , and Type D personality scales at the time of implantation . The end point was occurrence of ventricular arrhythmia , defined as appropriate ICD therapies , in the first year after implantation . RESULTS Ventricular arrhythmias occurred in 19 % ( n = 75 ) of patients . Increased symptoms of depression ( p = 0.81 ) or anxiety ( p = 0.31 ) did not predict arrhythmias . However , anxious patients with a Type D personality had a significantly increased rate of ventricular arrhythmias ( 21 of 71 ; 29.6 % ) as compared with other ICD patients ( 54 of 320 ; 16.9 % ; hazard ratio [ HR ] : 1.89 ; 95 % confidence interval [ CI ] : 1.14 to 3.13 ; p = 0.013 ) . When controlled for the effects of sex , age , ischemic etiology , left ventricular dysfunction , prolonged QRS duration , and medication , anxious Type D patients ( HR : 1.72 ; 95 % CI : 1.03 to 2.89 ; p = 0.039 ) and secondary prevention patients ( HR : 1.91 ; 95 % CI : 1.14 to 3.20 ; p = 0.014 ) were at increased risk of ventricular arrhythmias . CONCLUSIONS Personality modulated the effect of emotional distress ; anxiety predicted a 70 % increase in risk of arrhythmia in Type D patients but not in other patients . Anxious Type D patients may be identified and offered additional behavioral support after ICD implantation BACKGROUND The Defibrillators in Nonischemic Cardiomyopathy Treatment Evaluation study demonstrated that implantable cardioverter defibrillators ( ICDs ) significantly reduce the risk of sudden cardiac death in patients with nonischemic cardiomyopathy and an ejection fraction of 35 % or less , with no statistically significant decrease in overall mortality . The impact of ICD placement and shock on health-related quality of life ( HRQL ) in this population is unknown . METHODS The 12-Item Medical Outcomes Short-Form Health Survey and the Minnesota Living with Heart Failure Question naire were administered to 458 patients with nonischemic cardiomyopathy , an ejection fraction of 35 % or less , and either nonsustained ventricular tachycardia or 10 or more premature ventricular depolarizations per hour at baseline , 1 month after r and omization , and every 3 months thereafter throughout the trial . The subjects were r and omized to an ICD or st and ard medical therapy . Outcomes were compared using hierarchical linear regression . RESULTS Overall , there were no significant differences in HRQL throughout the trial between patients r and omized to an ICD or st and ard medical therapy . However , in patients with 1 or more ICD shocks , HRQL declined 0.5 + /- 0.2 ( mean + /- SD ) points per shock on the emotional scale of the Minnesota Living with Heart Failure Question naire ( P = .04 ) and 1.0 + /- 0.5 points per shock on the mental component score of the 12-Item Medical Outcomes Short-Form Health Survey ( P = .04 ) . CONCLUSIONS Overall , HRQL was not affected by ICD implantation in patients in the Defibrillators in Nonischemic Cardiomyopathy Treatment Evaluation study . Implantable cardioverter defibrillator shock was associated with a reduction in some measures of HRQL , but the effects were unlikely to result in a clinical ly observable alteration until 5 or more shocks were experienced Objective : To evaluate a minimal , easy , accessible intervention targeting anxiety and reduced quality of life in patients with an implantable cardioverter defibrillator ( ICD ) . An estimated 24 % to 87 % of patients experience anxiety , and 10 % to 15 % have reduced quality of life . Methods : A total of 119 ICD patients were assigned r and omly to usual medical aftercare ( n = 63 ) or additional psychological treatment ( n = 56 ) comprising of written information on medical and psychological consequences of an ICD plus 6 months of individual phone counseling .  Treatment efficacy was evaluated by comparing T0 ( immediately after implantation ) and T 
    Output:
    
Our review shows that there is insufficient evidence to conclude that gender per se is a major autonomous predictor for disparities in psychological distress and QoL in ICD patients .