***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: INTRODUCTION Acute coronary syndrome ( ACS ) is an important cause of mortality and significant personal and financial costs . Cardiac rehabilitation ( CR ) programs have shown positive effects in reducing cardiovascular mortality and improving functional capacity . However , adherence is low and appears to be influenced by psychosocial factors , such as patients ' cognitions and emotional state . The objective was to evaluate the efficacy of a brief in-hospital psychological intervention to promote cognitive and emotional adaptation after ACS . METHODS One hundred and twenty-one patients with ACS , admitted to a coronary care unit in a central hospital , were r and omized to an experimental group ( EG , n=65 ) and a control group ( CG , n=56 ) . Portuguese versions of the HADS and BIPQ  were used to measure emotional well-being and illness cognitions . Two 1 h 15 min sessions were conducted 2 - 3 days after hospital admission , and a 20-minute follow-up session took place one month after discharge . Patients were assessed at four different time points : pre-test , post-test , and at 1- and 2-month follow-up . RESULTS The intervention had significant effects on anxiety , depression and illness cognitions . Anxiety and depression were significantly reduced and illness cognitions improved significantly in the EG compared to the control group . For the EG , these changes were maintained or enhanced at 1- and 2-month follow-up , whereas for the CG there was a deterioration in psychosocial adjustment . CONCLUSIONS These results indicate that a brief psychological intervention program delivered during hospitalization for ACS and combined with st and ard medical care can have positive effects in terms of psychosocial outcomes that have proven impact on cardiac rehabilitation and prognosis 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 Background Depression is common after a cardiac event , yet there remain few approaches to management that are both effective and scalable . Purpose We aim ed to evaluate the 6-month efficacy and feasibility of a tele-health program ( MoodCare ) that integrates depression management into a cardiovascular disease risk reduction program for acute coronary syndrome patients with low mood . Methods A two-arm , parallel , r and omized design was used comprising 121 patients admitted to one of six hospitals for acute coronary syndrome . Results Significant treatment effects were observed for Patient Health Question naire 9 ( PHQ9 ) depression ( mean difference [ change ] = −1.8 ; p = 0.025 ; effect size : d = 0.36 ) for the overall sample , when compared with usual medical care . Results were more pronounced effects for those with a history of depression ( mean difference [ change ] = −2.7 ; p = 0.043 ; effect size : d = 0.65 ) . Conclusions MoodCare was effective for improving depression  in acute coronary syndrome patients , producing effect sizes exceeding those of some face-to-face psychotherapeutic interventions and pharmacotherapy . ( Trial Registration Number : ACTRN1260900038623 . Aims This study is a prospect i ve , observational 8-year follow-up of 300 stable unselected coronary artery disease patients entering elective coronary angiography in 2002–03 . Recorded were clinical outcomes , health-related quality of life ( HRQoL ) , and secondary care costs after coronary artery bypass graft ( CABG ) surgery , percutaneous coronary intervention ( PCI ) , or medical therapy ( MT ) . Methods and results HRQoL was measured by the 15D instrument at baseline , 6 months , and 8 years . Regression techniques with an adjustment for relevant baseline characteristics were used to compare the 8-year survival and change in HRQoL between the groups . At baseline , all groups had statistically significantly impaired HRQoL compared with age- and gender-st and ardized general population . Six months after invasive interventions the mean HRQoL score had improved in a statistically significant and clinical ly important manner . This improvement was maintained at 8 years as the HRQoL no longer differed from that of the general population , whereas MT patients were still worse off . However , after adjustment for baseline characteristics , the groups no longer differed regarding 8-year survival or change in HRQoL among survivors . Mean 8-year secondary care costs were without ( with ) adjustment for baseline characteristics : & OV0556;17 498 ( 16 730 ) for CABG , & OV0556;7245 ( 6920 ) for PCI , and & OV0556;4514 ( 4580 ) for MT , respectively . Conclusion When adjusted for baseline characteristics , no statistically significant differences were found between the patient groups in 8-year survival or change in HRQoL among survivors . The 8-year mean secondary care costs of CABG were over two-fold and almost four-fold , even after adjustment for baseline characteristics , compared with those of PCI and MT OBJECTIVE Optimism is prospect ively and independently associated with superior cardiac outcomes , but there has been minimal study of optimism-specific interventions in persons with cardiovascular illness . We aim ed to examine the feasibility and impact of an optimism-promoting program among patients with heart disease in a r and omized controlled trial . METHODS Participants ( N=61 ) were out patients , age 35 - 60 , with coronary artery disease who were r and omized to an 8-week in-person group-based optimism training intervention or an attention-matched educational control condition .  Feasibility was assessed via rates of session attendance and exercise completion , and acceptability was assessed via weekly participant ratings of exercise ease , utility , and likelihood of continuation . The impact of the intervention was assessed via between-group differences in change from baseline optimism ( Life Orientation Test-Revised [ LOT-R ] ) and other psychological self-report outcomes at 8weeks ( primary time point ) and 16weeks , using r and om effects regression models . RESULTS Participants completed a mean of 6.8 ( SD 1.2 ) sessions and 13.9 ( SD 2.4 ) exercises , with mean ratings all > 3.5/5 on measures of acceptability . The intervention was associated with greater improvement in optimism at 8weeks ( β=5.13 ; 95 % confidence interval [CI]=3.55 , 6.70 ; p<0.001 ) and 16weeks ; the intervention was also associated with greater improvements in life satisfaction , hope , and anxiety at both time points , though not with positive or negative affect . CONCLUSIONS A group-based optimism training program  was feasible , acceptable , and associated with improvements in optimism and other psychological measures in cardiac patients . Future larger studies should examine effects on major clinical outcomes BACKGROUND Positive psychologic characteristics have been linked to superior cardiac outcomes . OBJECTIVE Accordingly , in this exploratory study , we assessed positive psychology interventions in patients who had recently undergone a procedure to treat cardiovascular disease . METHOD Participants were r and omly assigned to receive 1 of 3 different 6-week face-to-face interventions or a wait-list control condition . We assessed intervention feasibility and compared changes in psychologic outcome measures postintervention ( 7wk ) and at follow-up ( 15wk ) between intervention and control participants . Across the interventions , 74 % of assigned sessions were completed . RESULTS When comparing outcomes between interventions and control participants ( N = 55 total ) , there were no between-group differences post-intervention , but at follow-up intervention participants had greater improvements in happiness ( β = 14.43 , 95 % CI : 8.66 - 20.2 , p < 0.001 ) , depression ( β = -3.87 , 95 % CI : -7.72 to 0.02 , p = 0.049 ) , and hope ( β = 7.12 , 95 % CI : 1.25 - 13.00 , p = 0.017 ) , with moderate-large effect sizes . Efficacy of the 3 interventions was similar . CONCLUSIONS Future studies are needed to identify an optimal positive psychology intervention for cardiac patients CONTEXT Observational studies have shown that psychosocial factors are associated with increased risk for cardiovascular morbidity and mortality , but the effects of behavioral interventions on psychosocial and medical end points remain uncertain . OBJECTIVE To determine the effect of 2 behavioral programs , aerobic exercise training and stress management training , with routine medical care on psychosocial functioning and markers of cardiovascular risk . DESIGN , SETTING , AND PATIENTS R and omized controlled trial of 134 patients ( 92 male and 42 female ; aged 40 - 84 years ) with stable ischemic heart disease ( IHD ) and exercise-induced myocardial ischemia . Conducted from January 1999 to February 2003 . INTERVENTIONS Routine medical care ( usual care ) ; usual care plus supervised aerobic exercise training for 35 minutes 3 times per week for 16 weeks ; usual care plus weekly 1.5-hour stress management training for 16 weeks . MAIN OUTCOME MEASURES Self-reported measures of general distress ( General Health Question naire [ GHQ ] ) and depression ( Beck Depression Inventory [ BDI ] ) ; left ventricular ejection fraction ( LVEF ) and wall motion abnormalities ( WMA ) ; flow-mediated dilation ; and cardiac autonomic control ( heart rate variability during deep breathing and baroreflex sensitivity ) . RESULTS Patients in the exercise and stress management groups had lower mean ( SE ) BDI scores ( exercise : 8.2 [ 0.6 ] ; stress management : 8.2 [ 0.6 ] ) vs usual care ( 10.1 [ 0.6 ] ; P = .02 ) ; reduced distress by GHQ scores ( exercise : 56.3 [ 0.9 ] ; stress management : 56.8 [ 0.9 ] ) vs usual care ( 53.6 [ 0.9 ] ; P = .02 ) ; and smaller reductions in LVEF during mental stress testing ( exercise : -0.54 % [ 0.44 % ] ; stress management : -0.34 % [ 0.45 % ] ) vs usual care ( -1.69 % [ 0.46 % ] ; P = .03 ) . Exercise and stress management were associated with lower mean ( SE ) WMA rating scores ( exercise : 0.20 [ 0.07 ] ; stress management : 0.10 [ 0.07 ] ) in a subset of patients with significant stress-induced WMA at baseline vs usual care ( 0.36 [ 0.07 ] ; P = .02 ) . Patients in the exercise and stress management groups had greater mean ( SE ) improvements in flow-mediated dilation ( exercise : mean [ SD ] , 5.6 % [ 0.45 % ] ; stress management : 5.2 % [ 0.47 % ] ) vs usual care patients ( 4.1 % [ 0.48 % ] ; P = .03 ) . In a subgroup , those receiving stress management showed improved mean ( SE ) baroreflex sensitivity ( 8.2 [ 0.8 ] ms/mm Hg ) vs usual care ( 5.1 [ 0.9 ] ms/mm Hg ; P = .02 ) and significant increases in heart rate variability ( 193.7 [ 19.6 ] ms ) vs usual care ( 132.1 [ 21.5 ] ms ; P = .04 ) . CONCLUSION For patients with stable IHD , exercise and stress management training reduced emotional distress and improved markers of cardiovascular risk more than usual medical care alone Positive psychology has flourished in the last 5 years . The authors review recent developments in the field , including books , meetings , courses , and conferences . They also discuss the newly created classification of character strengths and virtues , a positive complement to the various editions of the Diagnostic and Statistical Manual of Mental Disorders ( e. g. , American Psychiatric Association , 1994 ) , and present some cross-cultural findings that suggest a surprising ubiquity of strengths and virtues . Finally , the authors focus on psychological interventions that increase individual happiness . In a 6-group , r and om-assignment ,  placebo-controlled Internet study , the authors tested 5 purported happiness interventions and 1 plausible control exercise . They found that 3 of the interventions lastingly increased happiness and decreased depressive symptoms . Positive interventions can supplement traditional interventions that relieve suffering 
    Output:
    
CONCLUSION CBT and PPT  improve several psychological outcomes  in CAD patients .
Depression and anxiety improved immediately after the intervention while stress and vital satisfaction improve in the mid-term .