***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 education of patients with heart failure ( HF ) is an essential part of disease management . The perspectives of an increasing number of patients and a shortage of professionals force healthcare to explore new strategies in supporting patients to be better informed and more active . Methods : Three hundred and eighty-two patients with HF ( age 71±SD 11.2 years ) were r and omly assigned to either a telemonitoring or a usual care group . Patients received four postal question naires to assess their levels of self-reported knowledge , self-care , self-efficacy and adherence . Generalized estimating equations analysis was performed to assess the effects of telemonitoring during the 1-year follow-up . Corrections for baseline were performed if needed . Results : Baseline differences between groups were found for self-care ( p=0.001 ) and self-efficacy ( p=0.024 ) . Knowledge of patients in the telemonitoring group significantly improved with 0.9 point on a 15-points scale ( p<0.001 ) . Their self-care abilities improved with 1.5 point on a 10-item scale whereas no changes were found in patients receiving usual care ( p<0.001 ) . Self-efficacy of patients in the intervention group improved significantly after 6 months yet was not significantly different after 3 months and 1 year . For patients in the intervention group adherence improved for daily weighing ( p<0.001 ) during the whole follow-up and for fluid intake ( p=0.019 ) after 3 months and after 12 months ( p=0.086 ) . Adherence for activity recommendations improved ( p=0.023 ) after 3 months and importance of medication adherence increased after 6 ( p=0.012 ) and 12 months ( p=0.037 ) . No effects were found regarding appointments , diet , smoking and use of alcohol . Conclusions : Tailored telemonitoring was found to educate patients with HF and to improve their self-care abilities and sense of self-efficacy Substantial progress has been made in the awareness , treatment , and prevention of  cardiovascular disease ( CVD ) in women since the first women-specific clinical recommendations for the prevention of CVD were published by the American Heart Association ( AHA ) in 1999.1 The myth that heart disease is a “ man 's disease ” has been debunked ; the rate of public awareness of CVD as the leading cause of death among US women has increased from 30 % in 1997 to 54 % in 2009.2 The age-adjusted death rate result ing from  coronary heart disease ( CHD ) in females , which accounts for about half of all CVD deaths in women , was 95.7 per 100 000 females in 2007 , a third of what it was in 1980.3,4 Approximately 50 % of this decline in CHD deaths has been attributed to reducing major risk factors and the other half to treatment of CHD including secondary preventive therapies.4 Major r and omized controlled clinical trials such as the Women 's Health Initiative have changed the practice of CVD prevention in women over the past decade.5 The investment in combating this major public health issue for women has been significant , as have the scientific and medical achievements . Despite the gains that have been made , considerable challenges remain . In 2007 , CVD still caused ≈1 death per minute among women in the United States.6 These represent 421 918 deaths , more women 's lives than were cl aim ed by cancer , chronic lower respiratory disease , Alzheimer disease , and accidents combined.6 Reversing a trend of the past 4 decades , CHD death rates in US women 35 to 54 years of age now actually appear to be increasing , likely because of the effects of the obesity epidemic.4 CVD rates in the United States are significantly higher for black females compared with their white counterparts ( 286.1/100 000 versus Background Most patients with heart failure are diagnosed and managed in primary care , however , underdiagnosis and undertreatment are common . We assessed whether implementation of a diagnostic-therapeutic strategy  improves functionality , health-related quality of life , and uptake of heart failure medication in primary care . Methods / Design A selective screening study followed by a single-blind cluster r and omized trial in primary care . The study population consists of patients aged 65 years or over who presented themselves to the general practitioner in the previous 12 months with shortness of breath on exertion . Patients already known with established heart failure , confirmed by echocardiography , are excluded . Diagnostic investigations include history taking , physical examination , electrocardiography , and serum N-terminal pro B-type natriuretic peptide levels . Only participants with an abnormal electrocardiogram or an N-terminal pro B-type natriuretic peptide level exceeding the exclusionary cutpoint for non-acute onset heart failure ( > 15 pmol/L ( ≈ 125 pg/ml ) ) will undergo open-access echocardiography . The diagnosis of heart failure ( with reduced or preserved ejection fraction ) is established by an expert panel consisting of two cardiologists and a general practitioner , according to the criteria of the European Society of Cardiology guidelines . Patients with newly established heart failure are allocated to either the ' care as usual ’ group or the ' intervention ’ group . R and omization is at the level of the general practitioner . In the intervention group general practitioners receive a single half-day training in heart failure management and the use of a structured up-titration scheme . All participants fill out quality of life question naires at baseline and after six months of follow-up . A six-minute walking test will be performed in patients with heart failure . Information on medication and hospitalization rates is extracted from the electronic medical files of the general practitioners . Discussion This study will provide information on the prevalence of unrecognized heart failure in elderly with shortness of breath on exertion , and the r and omized comparison will reveal whether management based on a half-day training of general practitioners in the practical application of an up-titration scheme results in improvements in functionality , health-related quality of life , and uptake of heart failure medication in heart failure patients compared to care as usual . Trial registration Clinical Trials.gov 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 Negative emotions are linked to the onset and development of coronary heart diseases ( CHD ) , whereas positive emotions are associated with better health and lower mortality rates among patients with these diseases . The objective of this r and omised trial was to improve cardiac patients ' emotional states using a Programme to Improve Well-being ( PIW ) based exclusively on positive interventions ( those that promote intentional behaviours and thoughts to improve well-being ) . METHODS Cardiac patients ( n = 108 ) were r and omly assigned to two parallel groups . In the control group , they participated in only a Cardiac Rehabilitation Programme ( CRP group ) , whereas the intervention group also participated in the PIW ( CRP+PIW group ) . Physical functional capacity , depressive symptoms , hostility , and negative and positive affect were assessed at T1 ( baseline ) and T2 ( 8 weeks later ) . RESULTS At T2 , after controlling for functional capacity , the CRP+PIW group reported a significantly less negative affect than the CRP group . Moreover , the CRP group did not change from T1 to T2 , whereas the CRP+PIW group reported more positive emotions and fewer negative emotions and hostility at T2 than at T1 . CONCLUSIONS Positive interventions effectively improve the emotional state of cardiac patients . We suggest that specific modules should be included in the CRP to improve well-being The purpose of this pilot study was to test the initial efficacy , feasibility , and safety of a specially design ed postacute care transitional rehabilitation intervention for cardiac patients .  Cardiac Transitional Rehabilitation Using Self-Management Techniques ( Cardiac TRUST ) is a family-focused intervention that includes progressive low-intensity walking and education in self-management skills to facilitate recovery following a cardiac event . Using a r and omized two-group design , exercise self-efficacy , steps walked , and participation in an outpatient cardiac rehabilitation ( CR ) program  were compared in a sample of 38 older adults ( 17 Cardiac TRUST , 21 usual care ) . At discharge from postacute care , the intervention group trended toward higher levels of self-efficacy for exercise outcomes than the usual care group . During the 6 weeks following discharge , the intervention group had greater attendance in outpatient CR and a trend toward more steps walked during the first week . The feasibility of the intervention was better for the home health care participants than for those in the skilled nursing facility . The provision of CR during postacute care has the potential to bridge the gap in transitional services from hospitalization to outpatient CR for these patients at high risk for future cardiac events . Further evidence of the efficacy of Cardiac TRUST is warranted Aim : To investigate whether phase II cardiac rehabilitation ( CR ) conducted by a community model of shared care CR ( SC-CR ) including health care centres and general practice was feasible and provided acceptable results and to compare SC-CR to hospital-based CR ( H-CR ) in a r and omised controlled trial . Methods : Patients were r and omised to H-CR or SC-CR after admission for acute coronary syndrome . In SC-CR , the general practitioner took over the responsibility of the remaining rehabilitation , pharmacological treatment and risk factor management after the initial visit to the hospital outpatient clinic . The Municipal Health Care Centres provided courses on smoking cessation , nutrition , and exercise training and contributed to disease education and psychosocial support . The main endpoint was adherence to the CR programme and compliance with lifestyle modifications . Results : In total , 1364 patients were screened , 327 ( 24 % ) were eligible , and 212 ( 65 % ) accepted participation . Phase II CR was completed by 192 ( 91 % ) of the participants . Full adherence to the CR programme was seen in 53 % in SC-CR versus 54 % in H-CR ( relative risk ( RR ) : 0.98 , 95 % confidence interval : 0.73–1.32 ) . In H-CR , patients had higher rates of adherence to dietary advice and health education . In SC-CR , 12 % of patients did not attend the risk factor evaluation and clinical assessment with their general practitioner . No difference in risk factor improvement was found . Exercise training was declined by 25 % in both groups . Conclusion : Adherence to phase II CR was high in both groups . SC-CR did not improve adherence and efficacy , but had comparable effects on medication and risk factors . Thus , SC-CR was safe and effective Background Angina affects more than 50 million people worldwide . Secondary prevention interventions such as cardiac rehabilitation are not widely available for this population . An Internet-based version could offer a feasible alternative . Objective Our aim was to examine the effectiveness of a Web-based cardiac rehabilitation program for those with angina . Methods We conducted a r and omized controlled trial , recruiting those diagnosed with angina from general practitioners ( GPs ) in primary care to an intervention or control group . Intervention group participants were offered a 6-week Web-based rehabilitation program ( “ ActivateYourHeart ” ) . The program was introduced during a face-to-face appointment and then delivered via the Internet ( no further face-to-face contact ) . The program contained information about the secondary prevention of coronary heart disease ( CHD ) and set each user goals around physical activity , diet , managing emotions , and smoking . Performance against goals was review ed throughout the program and goals were then reset/modified . Participants completed an online  exercise 
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In terms of equity , trialists tested interventions design ed to improve utilisation among women and older patients .
Evidence is insufficient for quantitative assessment of whether women-tailored programmes were associated with increased utilisation , and studies that assess motivating women are needed .
For older participants , again while quantitative assessment could not be undertaken , peer navigation may improve enrolment .
Effects on enrolment were larger in studies targeting healthcare providers , training nurses , or allied healthcare providers to intervene face-to-face ; effects on adherence were larger in studies that tested remote interventions .