***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 As  left ventricular assist device ( LVAD ) support duration increases , quality of life ( QoL ) becomes a concern . We review ed the QoL in patients on LVAD support for > or=1 year . METHODS We retrospectively review ed our prospect i ve data base for patients supported > or=1 year by HeartMate pulsatile- ( HM1 ) or continuous-flow ( HM2 ) LVADs from 2000 to 2009 . Transplant or death before 1 year merited exclusion . Metabolic equivalents of tasks ( METs ) , the Minnesota Living with Heart Failure Question naire ( MLHFQ ) , the 6-minute  walk  distance ( 6MWD ) , and New York Heart Association ( NYHA ) class were review ed . Complications and re-admissions were assessed . RESULTS Thirty patients were supported for > or=1 year ( 7 HM1s , 23 HM2s ) . Mean support duration was 594 + /- 173 days . Mean QoL metrics/functional status indicators at 12 months were : 6MWD , 393 + /- 290 m ; MET tolerance , 3.3 + /- 1 ; MLHFQ , 35 + /- 31 ; and NYHA , 1.4 + /- 0.6 . Mean re-admissions/year was 2.9 + /- 2 , with a duration of 13.8 + /- 21 days . Three patients were never re-admitted . Mean out-of-hospital time was 471 + /- 172 days ( 87.3 % of days ) . Infectious complications led to 43 % of re-admissions and occurred in the : drive-line ( 47 % ) at 442 + /- 236 days ; blood ( 37 % ) at 472 + /- 257 days ; and LVAD pocket ( 20 % ) at 550 + /- 202 days . Twenty-three patients ( 77 % ) required additional operations ( 1.7 + /- 1.8/year ) . The most common indication was drive-line infection , but ranged from ischemic bowel to defibrillator exchange . Eight required LVAD exchanges for mechanical ( n = 4 ) , electrical ( n = 3 ) , and thrombotic ( n = 1 ) issues . CONCLUSIONS Although LVAD support is not without complications , patients spend the majority of time outside the hospital enjoying a good quality of life Background : Capacity to exercise may not be fully restored in patients with heart failure even in the long term after ventricular assist device ( VAD ) implantation . The benefits of exercise training in patients with VAD are unknown . Design and methods : Fifteen patients , aged 38.3 ± 15.9 years , bridged to heart transplantation with left ventricular assist device or biventricular assist device were r and omized at a ratio of 2 : 1 to a  training group  ( TG , n = 10 ) or a control group ( n = 5 ) , 6.3 ± 4 months after implantation . Both the groups were advised to walk 30–45 min/day . TG also underwent moderate-intensity aerobic exercise using a bike or treadmill for 45 min , three to five times a week , combined with high-intensity inspiratory muscle training using a computer- design ed software to respiratory exhaustion , two to three times a week for 10 weeks . The patients were tested using cardiopulmonary exercise testing , 6-min walk test , spirometry and electronic pressure manometer for inspiratory muscle strength ( Pimax ) and endurance ( sustained Pimax ) measurement . Quality of life was assessed with the Minnesota Living with Heart Failure question naire . Results : TG improved peak oxygen consumption ( 19.3 ± 4.5 vs. 16.8 ± 3.7 ml/kg per min , P = 0.008 ) and VO2 at ventilatory threshold ( 15.1 ± 4.2 vs. 12 ± 5.6 ml/kg per min , P = 0.01 ) , whereas the ventilation/carbon dioxide slope decreased ( 35.9 ± 5.6 vs. 40 ± 6.5 , P = 0.009 ) . The 6-min walk test distance increased ( 527 ± 76 vs. 462 ± 88 m , P = 0.005 ) and quality of life was improved ( 38.2 ± 11.6 vs. 48.9 ± 12.8 , P = 0.005 ) , as well as Pimax ( 131.8 ± 33 vs. 95.5 ± 28cmH2O , P = 0.005 ) , sustained Pimax ( 484 ± 195 vs. 340 ± 193cmH2O/s/10 3 , P = 0.005 ) , and inspiratoty lung capacity ( 2.4 ± 0.9 vs. 1.7 ± 0.7 L , P = 0.008 ) were improved . No significant changes were noted in the control group . Conclusion : Our findings indicate that exercise training may improve the functional status of VAD recipients  even at a later period after implantation and thus , may have additional importance in cases of destination therapy OBJECTIVES The authors sought to provide the pre-specified primary endpoint of the ROADMAP ( Risk Assessment and Comparative Effectiveness of Left Ventricular Assist Device and Medical Management in Ambulatory Heart Failure Patients ) trial at 2 years . BACKGROUND The ROADMAP trial was a prospect i ve nonr and omized observational study of 200 patients ( 97 with a left ventricular assist device [ LVAD ] , 103 on optimal medical management [ OMM ] )  that showed that survival with improved functional status at 1 year was better with LVADs compared with OMM in a patient population of ambulatory New York Heart Association functional class IIIb/IV patients . METHODS The primary composite endpoint was survival on original therapy with improvement in 6-min walk distance ≥75 m. RESULTS Patients receiving LVAD versus OMM had lower baseline health-related quality of life , reduced Seattle Heart Failure Model 1-year survival ( 78 % vs. 84 % ; p = 0.012 ) , and were predominantly INTERMACS ( Interagency Registry for Mechanically Assisted Circulatory Support ) profile 4 ( 65 % vs. 34 % ; p < 0.001 ) versus profiles 5 to 7 . More LVAD patients met the primary endpoint at 2 years : 30 % LVAD versus 12 % OMM ( odds ratio : 3.2 [ 95 % confidence interval : 1.3 to 7.7 ] ; p = 0.012 ) . Survival as treated on original therapy at 2 years was greater for LVAD versus OMM ( 70 ± 5 % vs. 41 ± 5 % ; p < 0.001 ) , but there was no difference in intent-to-treat survival ( 70 ± 5 % vs. 63 ± 5 % ; p = 0.307 ) . In the OMM arm , 23 of 103 ( 22 % ) received delayed LVADs ( 18 within 12 months ; 5 from 12 to 24 months ) . LVAD adverse events declined after year 1 for bleeding ( primarily gastrointestinal ) and arrhythmias . CONCLUSIONS Survival on original therapy with improvement in 6-min walk distance was superior with LVAD compared with OMM at 2 years . Reduction in key adverse events beyond 1 year was observed in the LVAD group . The ROADMAP trial provides risk-benefit information to guide patient- and physician-shared decision making for elective LVAD therapy as a treatment for heart failure . ( Risk Assessment and Comparative Effectiveness of Left Ventricular Assist Device and Medical Management in Ambulatory Heart Failure Patients [ ROADMAP ] ; NCT01452802 ) BACKGROUND Implantable left ventricular assist devices have benefited patients with end-stage heart failure as a bridge to cardiac transplantation , but their long-term use for the purpose of enhancing survival and the quality of life has not been evaluated . METHODS We r and omly assigned 129 patients with end-stage heart failure who were ineligible for cardiac transplantation to receive a left ventricular assist device ( 68 patients ) or optimal medical management ( 61 ) . All patients had symptoms of New York Heart Association class IV heart failure . RESULTS Kaplan-Meier survival analysis showed a reduction of 48 percent in the risk of death from any cause in the group that received left ventricular assist devices as compared with the medical-therapy group ( relative risk , 0.52 ; 95 percent confidence interval , 0.34 to 0.78 ; P=0.001 ) . The rates of survival at one year were 52 percent in the device group and 25 percent in the medical-therapy group ( P=0.002 ) , and the rates at two years were 23 percent and 8 percent ( P=0.09 ) , respectively . The frequency of serious adverse events in the device group was 2.35 ( 95 percent confidence interval , 1.86 to 2.95 ) times that in the medical-therapy group , with a predominance of infection , bleeding , and malfunction of the device . The quality of life was significantly improved at one year in the device group . CONCLUSIONS The use of a left ventricular assist device in patients with advanced heart failure result ed in a clinical ly meaningful survival benefit and an improved quality of life . A left ventricular assist device is an acceptable alternative therapy in selected patients who are not c and i date s for cardiac transplantation OBJECTIVE Newer generation left ventricular assist devices ( LVADs ) are established for long-term support . The aim of this multi-modal intervention was to improve the body weight , exercise tolerance and psychosocial status in out patients on long-term LVAD support . METHODS Seventy patients participated in this non-r and omized intervention study [ intervention group ( IGr ) n = 34 ; control group ( CGr ) n = 36 ] over 18 months ( T1-T4 ) ; the baseline sample characteristics showed no differences between groups . Dietary counselling and weight management intervention was performed by a dietician based on a specific algorithm . Physical reconditioning followed a home ergometry protocol and was supplemented by psychosocial counselling . The outcomes were measured based on the body mass index ( BMI ) , cardiopulmonary exercise testing and self-report [ hospital anxiety and depression scale ( HADS ) , SF-36 ] . RESULTS The intervention showed a strong positive effect on nutrition and weight management [ 95 % confidence interval ( CI ) : -0.71 - 0.69 ; effect size ( ES ) : 0.907 ; P = 0.02 ) ] , result ing in the normal BMI ( kg/m(2 ) ) values in the IGr ( T1 : 24.0 ± 0.6 ; T4 : 24.5 ± 1.1 ; P = 0.35 ) compared with a significant BMI increase in the CGr ( T1 : 23.8 ± 0.6 ; T4 : 29.7 ± 0.8 ; P = 0.05 ) . Significant differences appeared regarding exercise tolerance ( VO(2)max/% predicted ) in favour of IGr patients ( IGr : 69 ± 2.9 ; CGr 62 ± 3.7 ; P = 0.04 ) . This increase was reflected by patients ' self-reporting based on the SF-36 physical component score ( IGr : P = 0.04 ; CGr : P = 0.54 ) . SF-36 psychosocial component scores showed no changes for both groups . However , CGr showed a tendency for increased anxiety scores relative to their counterparts ( IGr : 4.95 ± 0.4 ; CGr : 6.6 ± 0.9 ; P = 0.03 ) . CONCLUSIONS IGr patients showed a strong benefit from a multi-modal intervention , including dietary counselling , controlled exercise and psychosocial support . Dietary counselling holds potential to prevent obesity in this patient population BACKGROUND Patients with advanced heart failure have improved survival rates and quality of life when treated with implanted pulsatile-flow left ventricular assist devices as compared with medical therapy . New continuous-flow devices are smaller and may be more durable than the pulsatile-flow devices . METHODS In this r and omized trial , we enrolled patients with advanced heart failure who were ineligible for transplantation , in a 2:1 ratio , to undergo implantation of a continuous-flow device ( 134 patients ) or the currently approved pulsatile-flow device ( 66 patients ) . The primary composite end point was , at 2 years , survival free from disabling stroke and reoperation to repair or replace the device . Secondary end points included survival , frequency of adverse events , the quality of life , and functional capacity . RESULTS Preoperative characteristics were similar in the two treatment groups , with a median age of 64 years ( range , 26 to 81 ) , a mean left ventricular ejection fraction of 17 % , and nearly 80 % of patients receiving intravenous inotropic agents . The primary composite end point was achieved in more patients with continuous-flow devices than with pulsatile-flow devices ( 62 of 134 [ 46 % ] vs. 7 of 66 [ 11 % ] ; P<0.001 ; hazard ratio , 0.38 ; 95 % confidence interval , 0.27 to 0.54 ; P<0.001 ) , and patients with continuous-flow devices had superior actuarial survival rates at 2 
    Output:
    
The evidence is currently inadequate to assess the safety and efficacy of exercise-based CR for people with implantable VADs compared with usual care .