***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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    ***EXAMPLES*** 
    Input: OBJECTIVES The purpose of this study was to assess cost-effectiveness and long-term clinical benefits of renal denervation in resistant hypertensive patients . BACKGROUND Resistant hypertension affects 12 % of hypertensive persons . In the Symplicity HTN-2 r and omized controlled trial , catheter-based renal denervation ( RDN ) lowered systolic blood pressure by 32 ± 23 mm Hg from 178 ± 18 mm Hg at baseline . METHODS A state-transition model was used to predict the effect of RDN and st and ard of care on 10-year and lifetime probabilities of stroke , myocardial infa rct ion , all coronary heart disease , heart failure , end-stage renal disease , and median survival . We adopted a societal perspective and estimated an incremental cost-effectiveness ratio in U.S. dollars per quality -adjusted life-year , both discounted at 3 % per year . Robustness and uncertainty were evaluated using deterministic and probabilistic sensitivity analyses . RESULTS Renal denervation substantially reduced event probabilities ( 10-year/lifetime relative risks : stroke 0.70/0.83 ; myocardial infa rct ion 0.68/0.85 ; all coronary heart disease 0.78/0.90 ; heart failure 0.79/0.92 ; end-stage renal disease 0.72/0.81 ) . Median survival was 18.4 years for RDN versus 17.1 years for st and ard of care . The discounted lifetime incremental cost-effectiveness ratio was $ 3,071 per quality -adjusted life-year . Findings were relatively insensitive to variations in input parameters except for systolic blood pressure reduction , baseline systolic blood pressure , and effect duration . The 95 % credible interval for incremental cost-effectiveness ratio was cost-saving to $ 31,460 per quality -adjusted life-year . CONCLUSIONS The model suggests that catheter-based renal denervation , over a wide range of assumptions , is a cost-effective strategy for resistant hypertension that might result in lower cardiovascular morbidity and mortality BACKGROUND The objective of this study was to examine the association of Joint National Committee ( JNC-V ) blood pressure and National Cholesterol Education Program ( NCEP ) cholesterol categories with coronary heart disease ( CHD ) risk , to incorporate them into coronary prediction algorithms , and to compare the discrimination properties of this approach with other noncategorical prediction functions . METHODS AND RESULTS This work was design ed as a prospect i ve , single-center study in the setting of a community-based cohort . The patients were 2489 men and 2856 women 30 to 74 years old at baseline with 12 years of follow-up . During the 12 years of follow-up , a total of 383 men and 227 women developed  CHD , which was significantly associated with categories of blood pressure , total cholesterol , LDL cholesterol , and HDL cholesterol ( all P<.001 ) . Sex-specific prediction equations were formulated to predict CHD risk according to age , diabetes , smoking , JNC-V blood pressure categories , and NCEP total cholesterol and LDL cholesterol categories . The accuracy of this categorical approach was found to be comparable to CHD prediction when the continuous variables themselves were used . After adjustment for other factors , approximately 28 % of CHD events in men and 29 % in women were attributable to blood pressure levels that exceeded high normal ( > or = 130/85 ) . The corresponding multivariable-adjusted attributable risk percent associated with elevated total cholesterol ( > or = 200 mg/dL ) was 27 % in men and 34 % in women . CONCLUSIONS Recommended guidelines of blood pressure , total cholesterol , and LDL cholesterol effectively predict CHD risk in a middle-aged white population sample . A simple coronary disease prediction algorithm was developed using categorical variables , which allows physicians to predict multivariate CHD risk in patients without overt CHD BACKGROUND Some studies have suggested reductions in blood pressure (BP)with statin treatment , particularly in persons with hypertension . R and omized trial evidence is limited . METHODS We performed a r and omized , double-blind , placebo-controlled trial with equal allocation to simvastatin , 20 mg ; pravastatin sodium,40 mg ; or placebo for 6 months . Nine hundred seventy-three men and women without known cardiovascular disease or diabetes mellitus , with low-density lipoprotein cholesterol screening levels of 115 to 190 mg/dL , had assessment of systolic and diastolic BP ( SBP and DBP , respectively ) .  Blood pressure values were compared for placebo vs statins by intention-to-treat ( ITT ) analysis . Additional analyses were performed that ( 1 ) were confined to subjects with neither high baseline BP ( SBP>140 mm Hg or DBP>90 mm Hg ) nor receiving BP medications , to exclude groups in whom BP medications or medication changes may have influenced results , and ( 2 ) separately evaluated simvastatin and pravastatin ( vs placebo ) . The time course of BP changes after statin initiation and the effect of stopping statins on BP were examined . RESULTS Statins modestly but significantly reduced BP relative to placebo , by 2.2 mm Hg for SBP ( P=.02 ) and 2.4 mm Hg for DBP ( P<.001 ) in ITT analysis . Blood pressure reductions ranged from 2.4 to 2.8 mm Hg for both SBP and DBP with both simvastatin and pravastatin , in those subjects with full follow-up , and without potential for influence by BP medications ( ie , neither receiving nor meriting BP medications ) . CONCLUSIONS Reductions in SBP and DBP occurred with hydrophilic and lipophilic statins and extended to normotensive subjects . These modest effects may contribute to the reduced risk of stroke and cardiovascular events reported on statins . Trial Registration clinical trials.gov Identifier : NCT00330980 Abstract Objective To establish the predictive accuracy of the Framingham risk score for coronary heart disease in a representative British population . Design Prospect i ve cohort study . Setting 24 towns in the United Kingdom . Participants 6643 British men aged 40 - 59 years and free from cardiovascular disease at entry into the British regional heart study . Main outcome measures Comparison of observed 10 year coronary heart disease mortality and event rates with predicted rates for each individual , using the relevant Framingham risk equation . Results Of 6643 men , 2.8 % ( 95 % confidence interval 2.4 % to 3.2 % ) died from coronary heart disease compared with 4.1 % predicted ( relative overestimation 47 % , P < 0.0001 ) . A fatal or non-fatal coronary heart disease event occurred in 10.2 % ( 9.5 % to 10.9 % ) of the men compared with 16.0 % predicted ( relative overestimation 57 % , P < 0.0001 ) . These relative degrees of overestimation were similar at all levels of coronary heart disease risk , so that overestimation of absolute risk was greatest for those at highest risk . A simple adjustment provided an improved level of accuracy . In a “ high risk score ” approach , most cases occur in the low risk group . In this case , 84 % of the deaths from coronary heart disease and non-fatal events occurred in the 93 % of men classified at low risk ( < 30 % in 10 years ) by the Framingham score . Conclusion Guidelines for the primary prevention of coronary heart disease advocate offering preventive measures to individuals at high risk . Currently recommended risk scoring methods derived from the Framingham study significantly overestimate the absolute coronary risk assigned to individuals in the United Kingdom BACKGROUND Contemporary clinical trials commonly measure quality of life and medical costs to establish whether therapies are both effective and cost effective . Cost-effectiveness analysis , however , requires a measure of patient utility or preferences for various health states . Because utilities are not often measured directly , we sought to develop a method of translating st and ard quality -of-life scales into a patient utility measure . METHODS Five hundred fifty-three patients enrolled in the Bypass Angioplasty Revascularization Investigation Study of Economics and Quality of Life completed a battery of  quality -of-life measures  and a time trade-off utility assessment  an average of 7.3 years after r and om assignment . RESULTS The mean time trade-off score was 8.54 ( SD = 2.53 ) out of a maximum of 10 ; median score was 9.95 . The distribution of scores was skewed , with 12 % of patients at the highest possible score of 10 . Patients with recurrent angina had significantly lower time trade-off scores than patients without angina ( mean 7.03 vs 8.70 , P < .05 ) . Time trade-off scores were moderately correlated with each quality -of-life measure ( Spearman coefficients 0.38 - 0.52 ) . Time trade-off scores could be predicted by combinations of 4 ( r2 = 0.29 ) , 5 ( r2 = 0.31 ) , or 6 ( r2 = 0.32 ) variables . CONCLUSIONS Time trade-off utility scores can be inferred from commonly used quality -of-life measures . Angina significantly reduces patient utility scores Renal sympathetic hyperactivity is seminal in the maintenance and progression of hypertension . Catheter-based renal sympathetic denervation has been shown to significantly reduce blood pressure ( BP ) in patients with hypertension . Durability of effect beyond 1 year using this novel technique has never been reported . A cohort of 45 patients with resistant hypertension ( systolic BP ≥160 mm Hg on ≥3 antihypertension drugs , including a diuretic ) has been originally published . Herein , we report longer-term follow-up data on these and a larger group of similar patients subsequently treated with catheter-based renal denervation in a nonr and omized manner . We treated 153 patients with catheter-based renal sympathetic denervation at 19 centers in Australia , Europe , and the United States . Mean age was 57±11 years , 39 % were women , 31 % were diabetic , and 22 % had coronary artery disease . Baseline values included mean office BP of 176/98±17/15 mm Hg , mean of 5 antihypertension medications , and an estimated glomerular filtration rate of 83±20 mL/min per 1.73 m2 . The median time from first to last radiofrequency energy ablation was 38 minutes . The procedure was without complication in 97 % of patients ( 149 of 153 ) . The 4 acute procedural complications included 3 groin pseudoaneurysms and 1 renal artery dissection , all managed without further sequelae . Postprocedure office BPs were reduced by 20/10 , 24/11 , 25/11 , 23/11 , 26/14 , and 32/14 mm Hg at 1 , 3 , 6 , 12 , 18 , and 24 months , respectively . In conclusion , in patients with resistant hypertension  , catheter-based renal sympathetic denervation results in a substantial reduction in BP sustained out to ≥2 years of follow-up , without significant adverse events Abstract Objectives To measure the effectiveness and cost effectiveness of providing care in a chest pain observation unit compared with routine care for patients with acute , undifferentiated chest pain . Design Cluster r and omised controlled trial , with 442 days r and omised to the chest pain observation unit or routine care , and cost effectiveness analysis from a health service costing perspective . Setting The emergency department at the Northern General Hospital , Sheffield , United Kingdom . Participants 972 patients with acute , undifferentiated chest pain ( 479 attending on days when care was delivered in the chest pain observation unit , 493 on days of routine care ) followed up until six months after initial attendance . Main outcome measures The proportion of participants admitted to hospital , the proportion with acute coronary syndrome sent home inappropriately , major adverse cardiac events over six months , health utility , hospital reattendance and readmission , and costs per patient to the health service . Results Use of a chest pain observation unit reduced the proportion of patients admitted from 54 % to 37 % ( difference 17 % , odds ratio 0.50 , 95 % confidence interval 0.39 to 0.65 , P < 0.001 ) and the proportion discharged with acute coronary syndrome from 14 % to 6 % ( 8 % , −7 % to 23 % , P = 0.264 ) . Rates of cardiac event were unchanged . Care in the chest pain observation unit was associated with improved health utility during follow up ( 0.0137 quality adjusted life years gained , 95 % confidence interval 0.0030 to 0.0254 , P = 0.022 ) and a saving of £ 78 per patient ( −£56 to £ 210 , P = 0.252 ) . Conclusions Care in a chest pain observation unit can improve outcomes and may reduce costs to the health service . It seems to be more effective and more cost effective than routine care Aims Patients with chronic heart failure ( CHF ) show impaired health-related quality of life ( HRQoL ) , an important target for therapeutic intervention . Impaired iron homeostasis may be one mechanism underlying the poor physical condition of CHF patients . This detailed sub analysis of the previously published FAIR-HF study evaluated baseline HRQoL in iron-deficient patients with CHF and the effect of intravenous ferric carboxymal 
    Output:
    
Conclusion RDN is an effective clinical procedure that offers patients a meaningful and cost-effective alternative for achieving SBP control , where traditional combination , anti-hypertensive pharmacologic strategies have been proven to be ineffective