***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: Heart failure ( HF ) is the leading cause of rehospitalization in older adults . The purpose of this pilot study was to examine whether telemonitoring by an advanced practice nurse reduced subsequent hospital readmissions , emergency department visits , costs , and risk of hospital readmission for patients with HF . One hundred two patient/caregiver dyads were r and omized into 2 groups postdischarge ; 84 dyads completed the study . Hospital readmissions , emergency department visits , costs , and days to readmission were abstract ed from medical records . Participants were interviewed soon after discharge and 3 months later about effects of telemonitoring on depressive symptoms , quality of life , and caregiver mastery . There were no significant differences due to telemonitoring for any outcomes . Caregiver mastery , informal social support , and electronic home monitoring were not significant predictors for risk of hospital readmission . Further studies should address the interaction between the advanced practice nurse and follow-up intervention with telemonitoring of patients with HF to better target those who are most likely to benefit OBJECTIVES We sought to identify whether home telemonitoring ( HTM ) improves outcomes compared with nurse telephone support ( NTS ) and usual care ( UC ) for patients with heart failure who are at high risk of hospitalization or death . BACKGROUND Heart failure is associated with a high rate of hospitalization and poor prognosis . Telemonitoring could help implement and maintain effective therapy and detect worsening heart failure and its cause promptly to prevent medical crises . METHODS Patients with a recent admission for heart failure and left ventricular ejection fraction ( LVEF ) < 40 % were assigned r and omly to HTM , NTS , or UC in a 2:2:1 ratio . HTM consisted of twice-daily patient self-measurement of weight , blood pressure , heart rate , and rhythm with automated devices linked to a cardiology center . The NTS consisted of specialist nurses who were available to patients by telephone . Primary care physicians delivered UC . The primary end point was days dead or hospitalized with NTS versus HTM at 240 days . RESULTS Of 426 patients r and omly assigned , 48 % were aged > 70 years , mean LVEF was 25 % ( SD , 8) and median plasma N-terminal pro-brain natriuretic peptide was 3,070 pg/ml ( interquartile range 1,285 to 6,749 pg/ml ) . During 240 days of follow-up , 19.5 % , 15.9 % , and 12.7 % of days were lost as the result of death or hospitalization for UC , NTS , and HTM , respectively ( no significant difference ) . The number of admissions and mortality were similar among patients r and omly assigned to NTS or HTM , but the mean duration of admissions was reduced by 6 days ( 95 % confidence interval 1 to 11 ) with HTM . Patients r and omly assigned to receive UC had higher one-year mortality ( 45 % ) than patients assigned to receive NTS ( 27 % ) or HTM ( 29 % ) ( p = 0.032 ) . CONCLUSIONS Further investigation and refinement of the application of HTM are warranted because it may be a valuable role for the management of selected patients with heart failure Background — Assessment of the quality of care for out patients with heart failure ( HF ) has focused on the development and use of process-based performance measures , with the supposition that these care process measures are associated with clinical outcomes . However , this association has not been evaluated for current and emerging outpatient HF measures . Methods and Results — Performance on 7 HF process measures ( 4 current and 3 emerging ) and 2 summary measures was assessed at baseline in patients from 167 US outpatient cardiology practice s with patients prospect ively followed up for 24 months . Participants included 15 177 patients with reduced left ventricular ejection fraction ( ⩽35 % ) and chronic HF or post – myocardial infa rct ion . Multivariable analyses were performed to assess the process- outcome relationship for each measure in eligible patients . Vital status was available for 11 621 patients .  The mortality rate at 24 months was 22.1 % . Angiotensin-converting enzyme inhibitor or angiotensin receptor blocker use , & bgr;-blocker use , anticoagulant therapy for atrial fibrillation , cardiac resynchronization therapy , implantable cardioverter-defibrillators , and HF education for eligible patients were each independently associated with improved 24-month survival , whereas aldosterone antagonist use was not . The all-or-none and composite care summary measures were also independently associated with improved survival . Each 10 % improvement in composite care was associated with a 13 % lower odds of 24-month mortality ( adjusted odds ratio , 0.87 ; 95 % confidence interval , 0.84 to 0.90 ; P<0.0001 ) . Conclusions — Current and emerging outpatient HF process measures are positively associated with patient survival . These HF measures may be useful for assessing and improving HF care . Clinical Trial Registration — URL : http://www . clinical trials.gov . Unique identifier : NCT00303979 OBJECTIVE To study the impact of remote patient monitoring ( RPM ) upon the most frequent diagnosis in hospitalized patients over 65 years of age-heart failure ( HF ) . We examined the effect of RPM on hospital utilization and Medicare costs of HF patients receiving home care . MATERIAL S AND METHODS Two studies were simultaneously conducted : A r and omized and a matched-cohort study . In the r and omized study , 168 subjects were r and omly assigned ( after hospitalization ) to home care utilizing  RPM ( live nursing visits and video-based nursing visits ) or to home care receiving live nursing visits only . In the matched-cohort study , 160 subjects receiving home care with RPM ( live nursing visits and video-based nursing visits ) were matched with home care subjects receiving live nursing visits only . RESULTS Regardless of whether outcomes were being analyzed for all subjects ( intention to treat ) or for hospitalized subjects only , hospitalization rates , time to first admission , length of stay , and costs to Medicare did not differ significantly between groups in either study at 30 or 90 days after enrollment . A notable trend , however , emerged across studies : Although time to hospitalization was shorter in the RPM groups than the control groups , RPM groups had lower hospitalization costs . CONCLUSIONS RPM , when utilized in conjunction with a robust management protocol , was not found to significantly differ from live nursing visits in the management of HF in home care . Shorter hospitalization times and lower associated costs may be due to earlier identification of exacerbation . These trends indicate the need for further study Background — Trials investigating efficacy of disease management programs ( DMP ) in heart failure reported contradictory results . Features rendering specific interventions successful are often ill defined . We evaluated the mode of action and effects of a nurse-coordinated DMP ( HeartNetCare-HF , HNC ) . Methods and Results — Patients hospitalized for systolic heart failure were r and omly assigned to HNC or usual care ( UC ) .  Besides telephone-based monitoring and education , HNC addressed individual problems raised by patients , pursued networking of health care providers and provided training for caregivers . End points were time to death or rehospitalization ( combined primary ) , heart failure symptoms , and quality of life ( SF-36 ) . Of 1007 consecutive patients , 715 were r and omly assigned ( HNC : n=352 ; UC : n=363 ; age , 69±12 years ; 29 % female ; 40 % New York Heart Association class III-IV ) . Within 180 days , 130 HNC and 137 UC patients reached the primary end point ( hazard ratio , 1.02 ; 95 % confidence interval , 0.81–1.30 ; P=0.89 ) , since more HNC patients were readmitted . Overall , 32 HNC and 52 UC patients died ( 1 UC patient and 4 HNC patients after dropout ) ; thus , uncensored hazard ratio was 0.62 ( 0.40–0.96 ; P=0.03 ) . HNC patients improved more regarding New York Heart Association class ( P=0.05 ) , physical functioning ( P=0.03 ) , and physical health component ( P=0.03 ) . Except for HNC , health care utilization was comparable between groups . However , HNC patients requested counseling for noncardiac problems even more frequently than for cardiovascular or heart-failure – related issues . Conclusions — The primary end point of this study was neutral . However , mortality risk and surrogates of well-being improved significantly . Quantitative assessment of patient requirements suggested that besides (tele)monitoring individualized care considering also noncardiac problems should be integrated in efforts to achieve more sustainable improvement in heart failure outcomes . Clinical Trial Registration — URL : http://www.controlled-trials.com . Unique identifier : IS RCT N23325295 The evidence base of what works in chronic care management programs is underdeveloped . To fill the gap , we pooled and reanalyzed data from ten r and omized clinical trials of heart failure care management programs to discern how program delivery methods contribute to patient outcomes . We found that patients enrolled in programs using multi-disciplinary teams and in programs using in-person communication  had significantly fewer hospital readmissions and readmission days than routine care patients had . Our study offers policymakers and health plan administrators important guideposts for developing an evidence base on which to build effective policy and programmatic initiatives for chronic care management BACKGROUND Small studies suggest that telemonitoring may improve heart-failure outcomes , but its effect in a large trial has not been established . METHODS We r and omly assigned 1653 patients who had recently been hospitalized for heart failure to undergo either telemonitoring ( 826 patients ) or usual care ( 827 patients ) .  Telemonitoring was accomplished by means of a telephone-based interactive voice-response system that collected daily information about symptoms and weight that was review ed by the patients ' clinicians . The primary end point was readmission for any reason or death from any cause within 180 days after enrollment . Secondary end points included hospitalization for heart failure , number of days in the hospital , and number of hospitalizations . RESULTS The median age of the patients was 61 years ; 42.0 % were female , and 39.0 % were black . The telemonitoring group and the usual-care group did not differ significantly with respect to the primary end point , which occurred in 52.3 % and 51.5 % of patients , respectively ( difference , 0.8 percentage points ; 95 % confidence interval [ CI ] , -4.0 to 5.6 ; P=0.75 by the chi-square test ) . Readmission for any reason occurred in 49.3 % of patients in the telemonitoring group and 47.4 % of patients in the usual-care group ( difference , 1.9 percentage points ; 95 % CI , -3.0 to 6.7 ; P=0.45 by the chi-square test ) . Death occurred in 11.1 % of the telemonitoring group and 11.4 % of the usual care group ( difference , -0.2 percentage points ; 95 % CI , -3.3 to 2.8 ; P=0.88 by the chi-square test ) . There were no significant differences between the two groups with respect to the secondary end points or the time to the primary end point or its components . No adverse events were reported . CONCLUSIONS Among patients recently hospitalized for heart failure , telemonitoring did not improve outcomes . The results indicate the importance of a thorough , independent evaluation of disease-management strategies before their adoption . ( Funded by the National Heart , Lung , and Blood Institute ; Clinical Trials.gov number , NCT00303212 . ) BACKGROUND Clinical registries are used increasingly to analyze quality and outcomes , but the generalizability of findings from registries is unclear . METHODS We linked  data from the Acute Decompensated Heart Failure National Registry ( ADHERE ) to 100 % fee-for-service Medicare cl aims data .  We compared patient characteristics and inpatient mortality of linked and unlinked ADHERE hospitalizations  ; patient characteristics , readmission , and postdischarge mortality of linked ADHERE patients to a r and om 20 % sample of Medicare beneficiaries hospitalized for heart failure ; and characteristics of Medicare sites participating and not participating in ADHERE . RESULTS Among 135,667 ADHERE records for eligible patients ≥ 65 years , we matched 104,808 ( 77.3 % ) records to fee-for-service Medicare cl aims , representing 82,074 patients . Linked hospitalizations were more likely than unlinked hospitalizations to involve women and white patients ; there were no meaningful differences in other patient characteristics . In-hospital mortality was identical for linked and unlinked hospitalizations . In Medicare , ADHERE patients had slightly lower unadjusted mortality ( 4.4 % vs 4.9 % in-hospital , 11.2 % vs 12.2 % at 30 days , 36.0 % vs 38.3 % at 1 year [ P < .001 ] ) and all-cause readmission ( 22.1 % vs 23.7 % at 30 days , 65.8 % vs 67.9 % at 1 year [ P < .001 ] ) . After risk adjustment , modest but statistically significant differences remained . ADHERE hospitals were more likely than non-ADHERE hospitals to be teaching hospitals , have higher volumes of heart failure discharges , and offer advanced cardiac services . CONCLUSION Elderly patients in ADHERE are similar to Medicare beneficiaries hospitalized with heart failure . Differences related to selective en 
    Output:
    
Several studies found that access to a specialist heart failure team/service reduced hospital readmissions and mortality .
In primary care , a collaborative model of care where the primary physician shared the care with a cardiologist , improved patient outcomes compared to a primary physician only .
During hospitalisation , quality improvement programs improved the quality of inpatient care result ing in reduced hospital readmissions and mortality .
In the transitional care phase , heart failure programs , nurse-led clinics , and early outpatient follow-up reduced hospital readmissions .
Conclusion Re design ing systems of care aim ed at improving the translation of evidence into clinical practice and transitional care can potentially improve patient outcomes in a cohort of patients known for high readmission rates and mortality