***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 The mineralocorticoid receptor antagonist eplerenone improved clinical outcomes among patients with heart failure with reduced ejection faction ( HFrEF ) in the EMPHASIS-HF ( Eplerenone in Mild Patients Hospitalization And SurvIval Study in Heart Failure ) study . However , similar efficacy and safety have not been established in Japanese patients . We evaluated the efficacy and safety of eplerenone in patients with HFrEF in a multicenter , r and omized , double-blind placebo-controlled outcome study ( Clinical Trials.gov Identifier : NCT01115855 ) . The aim of the study was to evaluate efficacy predefined as consistency of the primary endpoint with that of EMPHASIS-HF at a point estimate of < 1 for the hazard ratio . Methods and Results : HFrEF patients with NYHA functional class II-IV and an EF ≤35 %  received eplerenone ( n=111 ) or placebo ( n=110 ) on top of st and ard therapy for at least 12 months . The primary endpoint was a composite of death from cardiovascular causes or hospitalization for HF . The primary endpoint occurred in 29.7 % of patients in the eplerenone group vs. 32.7 % in the placebo group [ hazard ratio=0.85 ( 95 % CI : 0.53 - 1.36 ) ] . Hospitalization for any cause and changes in plasma BNP and LVEF were favorable with eplerenone . A total of 17 patients ( 15.3 % ) in the eplerenone group and 10 patients ( 9.1 % ) in the placebo group died . Adverse events , including hyperkalemia , were similar between the groups . CONCLUSIONS Eplerenone was well-tolerated in Japanese patients with HFrEF and showed results consistent with those reported in the EMPHASIS-HF study BACKGROUND Atrial fibrillation ( AF ) is a common arrhythmia that frequently recurs after restoration of sinus rhythm ( SR ) . Identifying risk factors for recurrence may help define the best strategy for secondary prevention . METHODS The GISSI-AF trial enrolled 1,442 patients in SR with at least 2 documented AF episodes in the previous 6 months or after cardioversion in the last 2 weeks . Patients were r and omized to valsartan or placebo ; all other treatments for AF or underlying heart diseases were allowed . Primary end points were time to first recurrence of AF and proportion of patients with > 1 AF episode during 1-year follow-up . We evaluated  clinical and electrocardiographic baseline characteristics  of all patients to identify independent predictors for AF recurrence using a Cox multivariable model . RESULTS Risk factors for AF recurrence were a history of 2 or more AF episodes in the previous 6 months , independent of the modality of SR restoration , spontaneous ( HR 1.42 , 95 % CI 1.14 - 1.77 , P = .002 ) , or by cardioversion ( HR 1.19 , 95 % CI 1.01 - 1.40 , P = .038 ) , and a lower heart rate during SR ( HR 0.99 , 95 % CI 0.99 - 1.00 , P = .052 ) . The risk factors were the same for > 1 AF recurrence . Patients treated with amiodarone had a lower risk for both end points ( P < .0001 and P = .017 ) , whereas those on diuretics had a greater risk ( P = .009 and P = .003 ) . CONCLUSIONS In the GISSI-AF study population , AF history had significant prognostic value independent of the modality of SR restoration . Amiodarone and diuretic treatment affected the rate of AF recurrence AIM Supraventricular arrhythmia is a major public health problem because of its prevalence and clinical consequences . The first step of the treatment usually consists in restoring sinusal rhythm . The aim of this study is to evaluate results and predictive factors of success of electrical cardioversion .  METHODS We studied a series of 143 consecutive electric cardioversion preformed in 131 French patients . RESULTS The rate of successful direct current cardioversion  was 91.2 % . Negative predictive factors are the height body mass index and the age of arrhythmia . Atrial flutter is a predictive factor of success . These results agree with published results . Our study highlights the interest of some nonantiarrhythmic drugs received by the patient during the period before the direct current cardioversion . Thus , a spironolactone treatment appears to be a new predictive factor of the success of electrical cardioversion ( success in patients treated with spironolactone : 100 % vs 89 % without , P = 0.04 ) . CONCLUSIONS Our results agree with usual predictive factors of the success of cardioversion . Nevertheless , a new approach is that of the positive effect of spironolactone on cardioversion . A prospect i ve r and omized study is necessary to confirm this result Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more BACKGROUND Patients with congestive heart failure ( CHF ) often have increased aldosterone activity that leads to hypomagnesemia . Hypomagnesemia can induce arrhythmias , an important cause of death in patients with CHF . We determined whether the aldosterone receptor antagonist spironolactone improved magnesium homeostasis and reduced arrhythmias in patients with CHF . METHODS AND RESULTS We r and omized 116 consecutive patients with CHF into placebo control group  ( n = 58 ) and spironolactone group  ( 20 mg daily , n = 58 ) in addition to conventional therapy .  Plasma magnesium concentration ( PMC ) , erythrocyte magnesium concentration ( EMC ) , and erythrocyte magnesium efflux were not different between the 2 groups of patients before treatment . Compared with control patients , patients treated with spironolactone for 6 months had increased PMC and EMC and decreased erythrocyte magnesium efflux . Patients on spironolactone therapy also had a marked decrease of 24-hour mean heart rate , ventricular and atrial premature beats , and the risk of atrial fibrillation/flutter . Pooled data from the 116 patients showed that patients with a higher EMC or a lower sodium-dependent erythrocyte magnesium efflux had a slower heart rate , fewer ventricular premature beats , and a lower risk of atrial fibrillation/flutter . CONCLUSIONS Our results suggest that reducing cellular magnesium efflux and loss may contribute to the spironolactone-reduced arrhythmias in patients with CHF Non-r and omised studies of the effects of interventions are critical to many areas of healthcare evaluation , but their results may be biased . It is therefore important to underst and and appraise their strengths and weaknesses . We developed ROBINS-I ( “ Risk Of Bias In Non-r and omised Studies - of Interventions ” ) , a new tool for evaluating risk of bias in estimates of the comparative effectiveness ( harm or benefit ) of interventions from studies that did not use r and omisation  to allocate units ( individuals or clusters of individuals ) to comparison groups . The tool will be particularly useful to those undertaking systematic review s that include non-r and omised studies Introduction The aim of this study was to compare the effect of ramipril/canrenone versus ramipril/hydrochlorothiazide ( HCTZ ) combination on atrial fibrillation ( AF ) recurrence in type 2 diabetic hypertensives with and without cardiac autonomic neuropathy ( CAN ) . Material and methods A total of 289 hypertensive type 2 diabetic patients , 95 with CAN , in sinus rhythm but with at least two episodes of AF in the previous 6 months were r and omized to ramipril 5 mg plus canrenone 50 mg ( titrated to 10/100 mg ) or to ramipril 5 mg plus HCTZ 12.5 mg ( titrated to 10/25 mg ) or to amlodipine 5 mg ( titrated to 10 mg ) for 1 year . Clinic blood pressure ( BP ) and a 24-h ECG  were evaluated monthly . Patients were asked to report any episode of symptomatic AF and to perform an ECG as early as possible . Serum procollagen type I carboxy-terminal peptide ( PIP ) and carboxy-terminal telopeptide of collagen type I ( CITP ) were evaluated before and after each treatment period . Results Blood pressure was similarly and significantly reduced by all treatments . A total of 51 % of patients with amlodipine had a recurrence of AF , as did 31 % of patients with ramipril/HCTZ ( p < 0.05 vs. amlodipine ) and 13 % of patients with ramipril/canrenone ( p < 0.01 vs. amlodipine and p < 0.05 vs. ramipril/HCTZ ) . A similar trend was found in diabetic patients with CAN . Both combinations reduced PIP and increased CITP , but the effects of ramipril/canrenone were significantly more marked . Conclusions These findings suggest that in type 2 diabetic hypertensives , ramipril/canrenone treatment was more effective than ramipril/HCTZ in reducing AF recurrence . This could be related to the greater improvement in cardiac fibrosis Objective :  Postoperative atrial fibrillation ( POAF ) is associated with poor outcomes after  coronary artery bypass graft ( CABG ) surgery . We aim ed to assess the additional value of preoperative plasma aldosterone levels , a biomarker promoting proarrhythmic and profibrotic pathways , for predicting POAF after CABG . Methods : We conducted a prospect i ve cohort study involving consecutive patients with left ventricular ejection fraction ( LVEF ) more than 50 % requiring elective CABG in our university hospital .  Plasma aldosterone levels , two-dimensional echocardiography including left atrial strain analysis and galectin-3 ( Gal-3 ) examination were assessed before cardiac surgery . The primary endpoint was the occurrence of POAF within 30 days after surgery . Results : POAF occurred in 34 ( 24.8 % ) out of the 137 included patients . Compared with controls , patients experiencing POAF were significantly older ( 73 years old ± 8 vs 65 ± 11 , P < 0.001 ) and had higher preoperative plasma aldosterone levels [ 183 pmol/l ( interquartile range 138–300 ) vs 143 pmol/l ( interquartile range 96.5–216.5 ) , P < 0.01 ] . Age [ odds ratio ( OR ) , 1.088 ; 95 % confidence interval ( CI ) ( 1.038–1.140 ) ; P = 0.0004 ] and plasma aldosterone levels [ OR , 1.007 ; 95 % CI ( 1.003–1.012 ) ; P = 0.0013 ] were independently associated with POAF in multivariate analysis and could therefore be combined to predict the occurrence of POAF [ ‘ Aldoscore ’ , OR , 2.7 ; 95 % CI ( 1.7–4.3 ) ; P < 0.0001 ] . Reverse transcriptase PCR analysis performed on right atrial appendage and plasma examination revealed that Gal-3 was activated in POAF patients . Conclusion : We developed the preoperative ‘ Aldoscore ’ for POAF risk stratification among patients with preserved LVEF requiring elective CABG . This new tool may be helpful to identify good responders to interventions targeting the proarrhythmic and profibrotic pathways of aldosterone OBJECTIVES The aim of this report was to show that the rate of cardiovascular events is increased in patients with either subtype of primary aldosteronism ( PA ) . BACKGROUND Primary aldosteronism involves hypertension ( HTN ) , hypokalemia , and low plasma renin . The two major PA subtypes are unilateral aldosterone-producing adenoma ( APA ) and bilateral adrenal hyperplasia . METHODS During a three-year period , the diagnosis of PA was made in 124 of 5,500 patients referred for comprehensive evaluation and management . Adenomas were diagnosed in 65 patients and idiopathic hyperaldosteronism in 59 patients . During the same period , clinical characteristics and cardiovascular events of this group were compared with those of 465 patients with essential hypertension ( EHT ) r and omly matched for age , gender , and systolic and diastolic blood pressure . RESULTS A history of stroke was found in 12.9 % of patients with PA and 3.4 % of patients with EHT ( odds ratio [ OR ] = 4.2 ; 95 % confidence interval [ CI ] 2.0 to 8.6 ] ) . Non-fatal myocardial infa rct ion was diagnosed in 4.0 % of patients with PA and in 0.6 % of patients with EHT ( OR = 6.5 ; 95 % CI 1.5 to 27.4 ) . A history of atrial fibrillation was diagnosed in 7.3 % of patients with PA and 0.6 % of patients with EHT ( OR = 12.1 ; 95 % CI 3.2 to 45.2 ) . The occurrence of cardiovascular complications was comparable in both subtypes of PA . CONCLUSIONS Patients presenting with PA experienced more cardiovascular events than did EHT patients independent of blood pressure . The 
    Output:
    
Conclusions MRAs seem to be effective in AF prevention , especially regarding recurrent AF episodes