***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 
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    Input: Background —The prognostic value of serum sodium in patients hospitalized for worsening heart failure has not been well defined . Methods and Results —The Outcomes of a Prospect i ve Trial of Intravenous Milrinone for Exacerbations of Chronic Heart Failure ( OPTIME-CHF ) study r and omized 949 patients with systolic dysfunction hospitalized for worsening heart failure to receive 48 to 72 hours of intravenous milrinone or placebo in addition to st and ard therapy .  In a retrospective analysis , we investigated the relationship between admission serum sodium and the primary end point of days hospitalized for cardiovascular causes within 60 days of r and omization , as well as the secondary end points of in-hospital mortality , 60-day mortality , and 60-day mortality/rehospitalization . The number of days hospitalized for cardiovascular causes was higher in the lowest sodium quartile : 8.0 ( 4.5 , 18.5 ) versus 6 ( 4 , 13 ) versus 6 ( 4 , 11.5 ) versus 6 ( 4 , 12 ) days ( P<0.015 for comparison with the lowest quartile ) . Lower serum sodium was associated with higher in-hospital and 60-day mortality : 5.9 % versus 1 % versus 2.3 % versus 2.3 % ( P<0.015 ) and 15.9 % versus 6.4 % versus 7.8 % versus 7 % ( P=0.002 ) , respectively . There was a trend toward higher mortality/rehospitalization for patients who were in the lowest sodium quartile . Multivariable-adjusted Cox proportional hazards analysis showed that serum sodium on admission , when modeled linearly , predicted increased 60-day mortality : sodium ( per 3-mEq/L decrease ) had a hazard ratio of 1.18 with a 95 % CI of 1.03 to 1.36 ( P=0.018 ) . Conclusions —In patients hospitalized for worsening heart failure , admission serum sodium is an independent predictor of increased number of days hospitalized for cardiovascular causes and increased mortality within 60 days of discharge BACKGROUND Congestive heart failure ( CHF ) is a well-recognized risk factor for venous thromboembolism ( VTE ) and is associated with higher mortality in patients with an acute pulmonary embolism ( PE ) . There are very few data on how acute PE affects the clinical course of patients with heart failure . The purpose of this study was to determine the impact of an acute PE on the short-term prognosis of patients hospitalized for decompensated CHF . METHODS This was a prospect i ve cohort study of 198 patients admitted to a coronary care unit between July 2001 and March 2003 with severe decompensated CHF . The primary outcome measure was death or rehospitalization at 3 months . RESULTS PE was confirmed in 18 of 198 patients enrolled ( 9.1 % ) . The groups with and without PE were comparable with regards to demographics , the prevalence of comorbid conditions , and severity of CHF ( p > 0.05 ) . The prevalence of cancer ( p = 0.0001 ) , previous VTE ( p = 0.003 ) , and right ventricular overload ( p = 0.006 ) was higher in the PE group . The presence of PE was also associated with a longer hospital stay ( 37.5 + /- 71.6 days vs 15.4 + /- 15.0 days , p = 0.001 ) [ mean + /- SD ] and a higher incidence of death or rehospitalization at 3 months ( 72.2 % vs 43.9 % , p = 0.02 ) . In a multiple logistic regression analysis , PE remained an independent predictor of death or rehospitalization at 3 months ( odds ratio , 4.0 ; 95 % confidence interval , 1.1 to 15.1 ; p = 0.038 ) . CONCLUSIONS Acute PE commonly complicates the hospital course of patients with severe CHF , increasing the length of hospital stay and the chance of death or rehospitalization at 3 months BACKGROUND The predictive accuracy of physician investigators and nurse coordinators in estimating the risk of rehospitalization and death was determined for 373 hospitalized patients with severe advanced heart failure enrolled in the Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness trial . METHODS AND RESULTS Estimates were made at discharge , and patients were followed for 6 months after hospitalization . A statistical prognostic model was developed from clinical and laboratory data for the end points of rehospitalization and death . Both nurse and physician predictions of death were generally associated with the observed deaths ( c-indices of 0.675 and 0.611 ) , although the nurses ' prediction was significantly better ( chi-square = 4.75 , P = .029 ) . The prediction ability of the prognostic model was similar to the physicians ' model ( c-index = 0.603 ) . The predictions of rehospitalization were much weaker for nurse , physician and prognostic models . CONCLUSIONS Nurses ' estimations of survival in discharged , advanced-stage heart failure patients were superior to either physicians ' or model-based predictions . Not nurses , physicians , or the prognostic model provided useful predictions for rehospitalizations , but this may have result ed from the fact that the rehospitalization estimates did not include the death risk BACKGROUND We sought to examine the relationship between health-related quality of life ( HRQL ) and a first emergency rehospitalization and mortality in patients with heart failure ( HF ) having a wide variation in ventricular ejection fraction and functional status . METHODS Prospect i ve study conducted with 394 patients admitted for HF-related emergencies at 4 Spanish hospitals . Baseline HRQL was measured with a generic question naire , the Medical Outcomes Study 36-item Short Form Survey ( SF-36 ) , and with an HF-specific instrument , the Minnesota Living With Heart Failure ( MLWHF ) question naire . Cox proportional hazards models were used to calculate hazard ratios ( HRs ) for hospitalization and death on the basis of HRQL scores . RESULTS During a median follow-up of approximately 6 months , 138 patients ( 35.0 % ) underwent a first emergency rehospitalization and 70 ( 17.8 % ) died . After adjustment for biomedical , psychosocial , and health care variables , the frequency of hospital readmission was higher in patients with worse scores on the SF-36 physical functioning ( HR , 1.65 ; 95 % confidence interval [ CI ] , 1.11 - 2.44 ; P = .01 ) , general health ( HR , 1.73 ; 95 % CI , 1.19 - 2.52 ; P = .003 ) , and mental health ( HR , 1.65 ; 95 % CI , 1.10 - 2.47 ; P = .02 ) subscales . Results were similar for the mortality end point . For the MLWHF question naire , worse overall and worse physical and emotional summary scores were associated with higher mortality . CONCLUSIONS Worse HRQL is associated with hospital readmission and death in patients with HF . The magnitude of this association , for both physical and mental HRQL components , is comparable to that for other well-known predictors of hospital readmission and death , such as personal history of diabetes , previous hospitalizations , and treatment with angiotensin-converting enzyme inhibitors OBJECTIVE To determine clinical and patient-centered factors predicting non-elective hospital readmissions . DESIGN Secondary analysis from a r and omized clinical trial . CLINICAL SETTING Nine VA medical centers . PARTICIPANTS Patients discharged from the medical service with diabetes mellitus , congestive heart failure , and /or chronic obstructive pulmonary disease ( COPD ) . MAIN OUTCOME MEASUREMENT Non-elective readmission within 90 days . RESULTS Of 1378 patients discharged , 23.3 % were readmitted . After controlling for hospital and intervention status , risk of readmission was increased if the patient had more hospitalizations and emergency room visits in the prior 6 months , higher blood urea nitrogen , lower mental health function , a diagnosis of COPD , and increased satisfaction with access to emergency care assessed on the index hospitalization . CONCLUSIONS Both clinical and patient-centered factors identifiable at discharge are related to non-elective readmission . These factors identify high-risk patients and provide guidance for future interventions . The relationship of patient satisfaction measures to readmission deserves further study BACKGROUND Hospitalizations for decompensated heart failure are frequent . The Initiation Management Pre-discharge Assessment of Carvedilol Heart Failure ( IMPACT-HF ) registry collected observational data in patients hospitalized for worsening heart failure to characterize an unselected group of patients and to confirm the generalizability of the IMPACT-HF main trial population . METHODS AND RESULTS The IMPACT-HF registry was conducted concurrently with the IMPACT-HF study , a r and omized trial of in-hospital initiation of carvedilol compared with the st and ard practice of postdischarge beta-blocker initiation .  Patients were eligible for registry enrollment if they were hospitalized for heart failure regardless of ejection fraction . There were no exclusions to participation . Patients were followed for 60 days . The IMPACT-HF Registry enrolled 567 patients . The mean age was 71 years , 52 % of the patients were men and 82 % were Caucasian . At discharge , 71 % received an  angiotensin-converting enzyme inhibitor or angiotensin receptor blocker , 41 % received digoxin , and 62 % received beta-blockers . The 60-day rate of rehospitalization or death was 31 % . CONCLUSION The IMPACT-HF registry enrolled elderly patients admitted for worsening heart failure primarily result ing from progressive volume overload . The 60-day rate of death or rehospitalization was high despite the use of evidence -based therapies . New treatments for this population are needed to decrease the morbidity and mortality associated with decompensated heart failure OBJECTIVES This observational study was done to describe the characteristics , hospital course and short term prognosis of patients presenting to an emergency room with decompensated heart failure and to determine the parameters influencing the length of their hospital stay . DESIGN The routine clinical and laboratory characteristics of consecutive patients presenting to an emergency room with decompensated heart failure were documented and the patients followed for six months . SETTING One teaching hospital and one community-based hospital in Montreal , Quebec . PATIENTS A prospect i ve cohort of 153 consecutive patients presenting to the emergency room with decompensated heart failure . Follow-up was by clinic visit and telephone survey at one , three and six months . Follow-up was 100 % . MEASURES OF OUTCOME Length of hospital stay , in-hospital mortality , readmissions and after hospital discharge deaths were measured . RESULTS The average length of hospital stay was 6.2 days with a skewed distribution ranging from one to 56 days . A multivariate analysis showed that the length of hospital stay was associated with increasing left atrial size ( P < 0.05 ) , an ischemic etiology of the heart failure ( P < 0.03 ) and a slow response to diuretic therapy ( P < 0.001 ) . This mathematical model accounted for only a small amount of hospital stay variability ( R2 = 0.22 ) . Six month mortality and morbidity of these patients was high , with 23 % dying and 30 % readmitted for heart failure , but was independent of the duration of the initial hospitalization . CONCLUSIONS This prospect i ve study confirms that the hospital course for congestive heart failure is shortening . The six month prognosis of patients presenting to an emergency room for decompensated heart failure is poor and appears independent of the length of hospital stay Repeated hospitalizations result in high costs and may occur as a result of patient errors in their medication regimen . To reduce rehospitalizations ( hospitalizations within 31 days of the previous discharge ) , health care professionals have turned to the discharge planning process . Using Orem 's theory of self-care , a medication discharge planning program was developed to provide instruction on the requisites necessary for medication self-care . The purpose of this pilot study was to examine the effects of this program on readmissions within 31 days . Five nurses implemented the program for 54 patients with an admitting diagnosis of congestive heart failure . These patients were alternately assigned to a control or an experimental group . The experimental group received the medication discharge planning program . The control group received the usual informal discharge planning provided on the nursing unit . Eight ( 28.6 % ) of the 28 patients in the control group were readmitted within 31 days of the previous discharge . Two ( 7.7 % ) of the 26 patients in the experimental group were readmitted within 31 days . These results showed a statistically significant difference using Fisher 's Exact Test ( p = .05 ) . Those receiving the medication discharge planning program were less likely to be readmitted , suggesting the importance of a medication discharge planning program BACKGROUND We examined the effect of a home-based intervention ( HBI ) on readmission and death among " high-risk " patients with congestive heart failure discharged home from acute hospital care . METHODS Hospitalized patients with congestive heart failure and impaired systolic function , intolerance to exercise , and a history of 1 or more hospital admissions for acute heart failure were r and omized to either usual care ( n=48 ) or HBI at 1 week after discharge ( n=49 ) .  Home 
    Output:
    
Our systematic review identified no model design ed to compare hospital rates of readmission , while models design ed to predict patients ' readmission risk used heterogeneous approaches and found substantial inconsistencies regarding which patient characteristics were predictive .