***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 CONTEXT Depression and low perceived social support ( LPSS ) after myocardial infa rct ion ( MI ) are associated with higher morbidity and mortality , but little is known about whether this excess risk can be reduced through treatment . OBJECTIVE To determine whether mortality and recurrent infa rct ion are reduced by treatment of depression and LPSS with cognitive behavior therapy ( CBT ) , supplemented with a selective serotonin reuptake inhibitor ( SSRI ) antidepressant when indicated , in patients enrolled within 28 days after MI . DESIGN , SETTING , AND PATIENTS R and omized clinical trial conducted from October 1996 to April 2001 in 2481 MI patients ( 1084 women , 1397 men ) enrolled from 8 clinical centers . Major or minor depression was diagnosed by modified Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition criteria and severity by the 17-item Hamilton Rating Scale for Depression ( HRSD ) ; LPSS was determined by the Enhancing Recovery in Coronary Heart Disease Patients ( ENRICHD ) Social Support Instrument ( ESSI ) . R and om allocation was to usual medical care or CBT-based psychosocial intervention . INTERVENTION Cognitive behavior therapy was initiated at a median of 17 days after the index MI for a median of 11 individual sessions throughout 6 months , plus group therapy when feasible , with SSRIs for patients scoring higher than 24 on the HRSD or having a less than 50 % reduction in Beck Depression Inventory scores after 5 weeks . MAIN OUTCOME MEASURES Composite primary end point of death or recurrent MI ; secondary outcomes included change in HRSD ( for depression ) or ESSI scores ( for LPSS ) at 6 months . RESULTS Improvement in psychosocial outcomes at 6 months favored treatment : mean ( SD ) change in HRSD score , -10.1 ( 7.8 ) in the depression and psychosocial intervention group vs -8.4 ( 7.7 ) in the depression and usual care group ( P<.001 ) ; mean ( SD ) change in ESSI score , 5.1 ( 5.9 ) in the LPSS and psychosocial intervention group vs 3.4 ( 6.0 ) in the LPSS and usual care group ( P<.001 ) . After an average follow-up of 29 months , there was no significant difference in event-free survival between usual care ( 75.9 % ) and psychosocial intervention ( 75.8 % ) . There were also no differences in survival between the psychosocial intervention and usual care arms in any of the 3 psychosocial risk groups ( depression , LPSS , and depression and LPSS patients ) . CONCLUSIONS The intervention did not increase event-free survival . The intervention improved depression and social isolation , although the relative improvement in the psychosocial intervention group compared with the usual care group was less than expected due to substantial improvement in usual care patients OBJECTIVES To describe the effects of a health advocacy , counselling , and activation programme on depressive symptoms among older coronary heart disease ( CHD ) patients . METHODS A r and omised , controlled intervention study in Lieto , South-western Finl and . Older ( 65 years and older ) patients with CHD were r and omly divided into an intervention group ( IG ) ( n = 116 ) and a control group ( CG ) ( n = 106 ) . Outcome measures comprised changes in depressive symptoms ( Zung Self-rating Depression Scale , ZSDS ) . RESULTS Depressive symptoms tended to decrease in IG and to increase in CG among men scoring 45 ZSDS sum points or more at baseline . The differences of the changes between IG and CG were significant in favour of IG . No similar changes were found among women . CONCLUSIONS A health advocacy , counselling , and activation programme aim ed to increase knowledge about CHD , social activities , contacts , roles , support , and exercising was effective in reducing depressive symptoms among male CHD patients suffering from a moderate or high amount of depressive symptoms This preliminary study tested the effects of a home-based walking intervention on total sleep time ( TST ) , nocturnal awakenings , depressive symptoms , physical function , and quality of life ( QOL ) in older women with diastolic heart failure ( DHF ) . Twenty-three women ( mean age , 68+/-11 years ) with New York Heart Association class II or III DHF were r and omized to either a 12-week home-based walking intervention ( n=13 ) or education-only program ( control , n=10 ) . No between-group differences were found in women in the intervention and control groups on any of the outcome variables . When outcomes were compared within each group at baseline and 12 weeks , intervention-group patients had improvement in TST ( P<.01 ) and heart failure-related QOL ( P<.05 ) and a trend for decreased depressive symptoms ( P<.07 ) . Women r and omized to the control group had no change in any outcomes . These preliminary findings suggest that a progressive walking program may improve TST and QOL in older women with DHF . Findings from this study support the need for larger studies to evaluate the long-term benefits of a walking program on sleep patterns , QOL , and psychologic function in this population Background : Psychological morbidity after an acute myocardial infa rct ion ( AMI ) is known to be common , but can be addressed by appropriate rehabilitation . The area in which this research was conducted experiences high rates of deprivation and of coronary heart disease and limited access to hospital-based rehabilitation . Responding to concern about psychological needs of AMI patients , a self-help package was introduced and evaluated alongside st and ard hospital-based cardiac rehabilitation . Aims : To evaluate the impact of a home-based self-help package ( the Heart Manual ) , alongside existing cardiac rehabilitation provision , on psychological morbidity and health status after AMI . A secondary aim was to assess the suitability of the Heart Manual for older patients aged over 80 years . Methods : A controlled observational study , comparing two cohorts of patients discharged from hospital after AMI . The intervention group was given the self-help package in addition to st and ard care . The control group received st and ard care alone . Outcome measures used were the Hospital Anxiety and Depression Scale and the EuroQol . Results : The intervention group showed significant improvement in anxiety and depression scores after 3 months and nonsignificant improvement in general health status .  Patients who attended hospital-based rehabilitation classes , and those aged over 80 years , also benefited from the intervention . Conclusion : A home-based self-help rehabilitation package is an effective tool alongside hospital-based rehabilitation classes and can be given to all age groups The purpose of this study was to evaluate the effect of stress management training on quality of life , functional capacity , and heart rate variability in elderly patients with New York Heart Association class I-III congestive heart failure ( CHF ) . While substantial research exists on stress management training for patients with coronary heart disease , there are few data on the value of psychosocial training on patients with CHF . Thirty-three multiethnic patients ( mean age , 66+/-9 years ) were assigned through incomplete r and omization to one of two treatment groups or a wait-listed control group . The 14 participants who completed the treatment attended eight training sessions during a 10-week period . The training consisted of 75-minute sessions adapted from the Freeze-Frame stress management program developed by the Institute of HeartMath . Subjects were assessed at baseline and again at the completion of the training . Depression , stress management , optimism , anxiety , emotional distress , and functional capacity were evaluated , as well as heart rate variability . Significant improvements ( p<0.05 ) were noted in perceived stress , emotional distress , 6-minute walk , and depression , and positive trends were noted in each of the other psychosocial measures . The 24-hour heart rate variability showed no significant changes in autonomic tone . The authors noted that CHF patients were willing study participants and their emotional coping and functional capacity were enhanced . This program offers a simple and cost-effective way to augment medical management of CHF . Given the incompleteness of CHF medical management and the exploding interest in complementary medical intervention , it seems imperative that further work in psychosocial treatment be undertaken Major depressive disorders complicate recovery from acute coronary syndrome in approximately 1 in 5 patients , and have been found to be associated with significant impairments of quality of life and functioning . The aim of the present analysis was to evaluate the efficacy of sertraline in improving quality of life and functioning in patients diagnosed with major depression who had recently been hospitalized for acute coronary syndrome . Three hundred sixty-nine patients hospitalized in the previous month for acute coronary syndrome ( myocardial infa rct ion , 74 % ; unstable angina , 26 % ) who also met criteria for major depressive disorder were r and omized to 24 weeks of double-blind treatment with sertraline ( 50 to 200 mg/day ) or placebo .  Quality -of-life and functional status were assessed using the Quality of Life , Enjoyment , and Satisfaction scale ( Q-LES-Q ) and the Medical Outcomes Study SF-36 . Data from the total sample , and the recurrent depression subgroup , were analyzed . Severe baseline impairment was found in the Q-LES-Q and all subscales of the SF-36 . A multivariate regression analysis identified depression as the strongest predictor of baseline quality -of-life impairment ( partial r , -0.37 , p = 0.001 ) . In the recurrent depression group , treatment with sertraline result ed in significantly greater improvement than placebo in the Q-LES-Q total score and SF-36 mental component summary score , as well as the SF-36 role limitations , emotional , and mental health factors . Depression has a substantial negative impact on quality of life and functioning in patients hospitalized for acute coronary syndrome .  Sertraline was associated with clinical ly meaningful improvement in multiple quality -of-life domains in patients with acute coronary syndrome and recurrent depression BACKGROUND There are inconsistent reports as to whether people with anxiety disorders have a higher mortality risk . AIMS To determine whether anxiety disorders predict mortality in older men and women in the community . METHOD Longitudinal data were used from a large , community-based r and om sample ( n=3107 ) of older men and women ( 55 - 85 years ) in The Netherl and s , with a follow-up period of 7.5 years . Anxiety disorders were assessed according to DSM-III criteria in a two-stage screening design . RESULTS In men , the adjusted mortality risk was 1.78 ( 95 % CI 1.01 - 3.13 ) in cases with diagnosed anxiety disorders at baseline . In women , no significant association was found with mortality . CONCLUSIONS The study revealed a gender difference in the association between anxiety and mortality . For men , but not for women , an increased mortality risk was found for anxiety disorders Objective To compare quality of life in elderly patients with isolated systolic hypertension allocated r and omly to groups to receive placebo or active treatment in the Systolic Hypertension in the Elderly Trial . Design Double-blind r and omized controlled trial . Methods Patients aged 60 years were allocated r and omly to groups to receive first-line treatment with nitrendipine ( with second- and third-line enalapril and hydrochlorothiazide ) or placebo . Trained interviewers administered trail-making tests ( Trail A and B ) , Brief Assessment Index ( a measure of depressed mood ) and four subscales from the Sickness Impact Profile ( Ambulation , Social Interaction , Sleep and Rest , and Home work ) . Results Six hundred and ten patients completed a baseline and at least one follow-up question naire . Trail-making scores were slower in actively treated patients , especially in the first 6 months of follow-up when the between-group effect sizes were 0.25 [ 95 % confidence interval ( CI ) 0.07 to 0.43 ] for Trail-making A and 0.13 ( 95 % CI −0.05 to 0.31 ) for Trail-making B. Across the 4 years of follow-up , patients receiving active treatment were more likely to report problems on the Social Interaction scale than were placebo-treated patients ( odds ratio 1.32 , 95 % CI 1.02 to 1.69 ) , equivalent to a 7 % difference . There were no significant differences between active and placebo treatment in the other Sickness Impact Profile dimensions or in the measure of depression .  Conclusions Active treatment in the Systolic Hypertension in Europe trial was associated with some small adverse impacts on quality of life This study prospect ively examined the role of cognitive behavioral therapy ( CBT ) in ( 1 ) alleviating psychological and somatic distress , and ( 2 ) lowering arrhythmic events requiring shocks . Forty-nine of 61 consecutive patients were 
    Output:
    
Implication s : Mixed evidence for community-based heart disease interventions  on depression outcomes was found .