***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 BACKGROUND Increases in life stress have been linked to poor prognosis , after myocardial infa rct ion ( MI ) . Previous research suggested that a programme of monthly screening for psychological distress , combined with supportive and educational home nursing interventions for distressed patients , may improve post-MI survival among men . Our study assessed this approach for both men and women . We aim ed to find out whether the programme would reduce 1-year cardiac mortality for women and men . METHODS We carried out a r and omised , controlled trial of 1376 post-MI patients ( 903 men , 473 women ) assigned to the intervention programme ( n = 692 ) or usual care ( n = 684 ) for 1 year . All patients completed a baseline interview that included assessment of depression and anxiety . Survivors were also interviewed at 1 year . FINDINGS The programme had no overall survival impact . Preplanned analyses showed higher cardiac ( 9.4 vs 5.0 % , p = 0.064 ) and all-cause mortality ( 10.3 vs 5.4 % , p = 0.051 ) among women in the intervention group . There was no evidence of either benefit or harm among men ( cardiac mortality 2.4 vs 2.5 % , p = 0.94 ; all-cause mortality 3.1 vs 3.1 % , p = 0.93 ) . The programme 's impact on depression and anxiety among survivors was small . INTERPRETATION Our results do not warrant the routine implementation of programmes that involve psychological-distress screening and home nursing intervention for patients recovering from MI . The poorer overall outcome for women , and the possible harmful impact of the intervention on women , underline the need for further research and the inclusion of adequate numbers of women in future post-MI trials Background Depression is up to two to three times as common in people with long-term conditions . It negatively affects medical management of disease and self-care behaviors , and leads to poorer quality of life and high costs in primary care . Screening and treatment of depression is increasingly prioritized , but despite initiatives to improve access and quality of care , depression remains under-detected and under-treated , especially in people with long-term conditions .  Collaborative care is known to positively affect the process and outcome of care for people with depression and long-term conditions , but its effectiveness outside the USA is still relatively unknown . Furthermore , collaborative care has yet to be tested in setting s that resemble more naturalistic setting s that include patient choice and the usual care providers . The aim of this study was to test the effectiveness of a collaborative-care intervention , for people with depression and diabetes/coronary heart disease in National Health Service ( NHS ) primary care , in which low-intensity psychological treatment services are delivered by the usual care provider - Increasing Access to Psychological Therapies ( IAPT ) services . The study also aim ed to evaluate the cost-effectiveness of the intervention over 6 months , and to assess qualitatively the extent to which collaborative care was implemented in the intervention general practice s. Methods This is a cluster r and omized controlled trial of 30 general practice s allocated to either collaborative care or usual care . Fifteen patients per practice will be recruited after a screening exercise to detect patients with recognized depression ( ≥10 on the nine-symptom Patient Health Question naire ; PHQ-9 ) . Patients in the collaborative-care arm with recognized depression will be offered a choice of evidence -based low-intensity psychological treatments based on cognitive and behavioral approaches . Patients will be case managed by psychological well-being practitioners employed by IAPT in partnership with a practice nurse and /or general practitioner . The primary outcome will be change in depressive symptoms at 6 months on the 90-item Symptoms Checklist ( SCL-90 ) . Secondary outcomes include change in health status , self-care behaviors , and self-efficacy . A qualitative process evaluation will be undertaken with patients and health practitioners to gauge the extent to which the collaborative-care model is implemented , and to explore sustainability beyond the clinical trial . Discussion COINCIDE will assess whether collaborative care can improve patient-centered outcomes , and evaluate access to and quality of care of co-morbid depression of varying intensity in people with diabetes/coronary heart disease . Additionally , by working with usual care providers such as IAPT , and by identifying and evaluating interventions that are effective and appropriate for routine use in the NHS , the COINCIDE trial offers opportunities to address translational gaps between research and implementation . Trial Registration NumberIS RCT N80309252Trial 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 & NA ; The feasibility of altering a Type A style of life was investigated in 1012 nonsmoking predominantly male postinfa rct ion volunteers in the San Francisco Bay area . A total of 862 were r and omly allocated into an experimental section receiving a combination of Type A and cardiac counseling , or a control section receiving cardiac counseling alone . The remaining 150 formed a nonr and om but statistically equivalent comparison section . Assessment s of change in Type A behavior were made by the participant , his or her spouse , a work colleague , and an independent rater of a videotaped structured interview . Psychometric analyses indicated that these instruments were valid and reliable measures of Type A behavior . After 24 months , participants receiving Type A/cardiac counseling exhibited a significantly greater reduction in Type A behavior than the other two sections , and had a lower cardiovascular recurrence rate than the comparison section only . No differences among the three sections were observed in total cholesterol or resting blood pressure . The results suggest that Type A behavior can be altered by group counseling in postinfa rct ion volunteers and that such alteration is superior to no group counseling at all in the secondary prevention of coronary heart disease Background — Depression is independently associated with poor outcomes among patients with acute cardiac disease .  Collaborative care depression management programs have been used in out patients to improve depression outcomes , but such a program had never been initiated in the hospital or used for patients with a wide range of cardiac illnesses . Methods and Results — This was a prospect i ve , r and omized trial of a low-intensity , 12-week collaborative care program versus usual care for 175 depressed patients hospitalized for acute coronary syndrome , arrhythmia , or heart failure . Study outcomes , assessed using mixed regression models to compare groups at 6 weeks , 12 weeks , and 6 months , included mental health ( depression , cognitive symptoms of depression , anxiety , and mental health-related quality of life ) and medical ( physical health-related quality of life , adherence to medical recommendations , and cardiac symptoms ) outcomes . Collaborative care subjects ( n=90 ) had significantly greater improvements on all mental health outcomes at 6 and 12 weeks , including rates of depression response ( collaborative care , 59.7 % versus usual care 33.7 % ; odds ratio , 2.91 ; P=0.003 at 6 weeks ; 51.5 % versus 34.4 % ; odds ratio , 2.02 ; P=0.04 at 12 weeks ) , though these effects decreased after intervention . At 6 months , intervention subjects had significantly greater self-reported adherence and significantly reduced number and intensity of cardiac symptoms . Conclusions — Among patients with a broad range of cardiac diagnoses , a collaborative care depression management program initiated during hospitalization led to significant improvements in multiple clinical ly important mental health outcomes and had promising effects on relevant medical outcomes after intervention . Clinical Trial Registration — URL : http://www . clinical trials.gov . Unique identifier : NCT00847132 Background An evaluation study of an individual lifestyle advice intervention to reduce cardiovascular risk behaviours ( high fat consumption , smoking , physical inactivity ) . Methods A r and omized , controlled trial at the cardiology outpatient clinic of the University Hospital Maastricht . Participants were at high risk of incurring a cardiovascular event . Changes in risk behaviours and behavioural determinants were assessed with self-administered vali date d question naires . Results Question naires were completed by 1270 patients at baseline , 1169 after 4 months ( 92 % ) , and 1032 after 18 months ( 81.3 % ) . After 4 months , intention-to-treat analyses revealed a decrease in fat consumption ( −5.6 % , P=0.000 ) , a reduction in the percentage of smokers [ odds ratio ( OR ) 0.57 , 95 % confidence intervals ( CI ) 0.33–0.97 ] and a trend towards a maintained physical activity level ( OR 1.28 , 95 % CI 0.97–1.70 ) . No long-term effects were found . Conclusion The lifestyle advice intervention was potentially effective in changing cardiovascular risk behaviours , but should be further improved to be effective in secondary cardiovascular prevention . The main limitations of the study were related to the r and omization procedure and the self- selection of patients and cardiologists Background Depression is common in people with coronary heart disease ( CHD ) and associated with worse outcome . This study explored the acceptability and feasibility of procedures for a trial and for an intervention , including its potential costs , to inform a definitive r and omized controlled trial ( RCT ) of a nurse-led personalised care intervention for primary care CHD patients with current chest pain and probable depression . Methods Multi-centre , outcome assessor-blinded , r and omized parallel group study . CHD patients reporting chest pain and scoring 8 or more on the HADS were r and omized to personalized care ( PC ) or treatment as usual ( TAU ) 
    Output:
    
Meta-regression exploring a limited number of intervention characteristics found no significant predictors of intervention effects for total mortality and cardiac mortality .
This up date d Cochrane Review found that for people with CHD , there was no evidence that psychological treatments had an effect on total mortality , the risk of revascularisation procedures , or on the rate of non-fatal MI , although the rate of cardiac mortality was reduced and psychological symptoms ( depression , anxiety , or stress ) were alleviated ; however , the GRADE assessment s suggest considerable uncertainty surrounding these effects .