***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: AIMS The cardiac resynchronization therapy in heart failure trial ( CARE-HF ) demonstrated that cardiac resynchronization therapy ( CRT ) reduces morbidity and mortality in patients with heart failure and cardiac dyssynchrony . The aim of this study was to develop a prognostic model to evaluate the relationship between prospect ively defined patient characteristics and treatment on the trial primary outcome of death from any cause or unplanned hospitalization for a major cardiovascular event . METHODS AND RESULTS A total of 813 patients were enrolled in the CARE-HF study and were followed for a mean of 29.4 months . A Cox Proportional Hazards Model was fitted to identify predictors of the primary outcome and any predictors that modified the effect of CRT . Ischaemic aetiology , more severe mitral regurgitation and increased N-terminal pro-brain natriuretic peptide , were associated with an increased risk of death or unplanned cardiovascular hospitalization irrespective of cardiac resynchronization [ Hazard ratio ( HR ) 1.89 , 95 % CI 1.45 - 2.46 , HR 1.71 , 95 % CI 1.38 - 2.12 and HR 1.31 , 95 % CI 1.17 - 1.47 , respectively ] and increasing systolic blood pressure with a decreasing risk of an event ( HR 0.99 , 95 % CI 0.98 - 1.00 ) . The benefits of cardiac resynchronization were modified by systolic blood pressure and interventricular mechanical delay ( IVMD ) . Patients with increasing systolic blood pressure appear to receive reduced benefit from CRT ( HR 1.02 , 95 % CI 1.00 - 1.03 ) , whereas those patients with more severe IVMD appear to benefit more from treatment ( HR 0.99 , 95 % CI 0.98 - 1.00 ) . CONCLUSION Patients with echocardiographic evidence of more severe cardiac dyssynchrony and low systolic blood pressure obtain greater benefit from CRT , although benefits were substantial across the range of subjects included in the trial Aims The beneficial effects of CRT  in patients with advanced heart failure , wide QRS , and low LVEF have been clearly established . Nevertheless , mortality remains high in some patients . The aims of our study were to identify the predictors of mortality in patients treated with CRT  and to design a risk score for mortality . Methods and results A cohort of 608 consecutive patients treated with CRT from 2000 to 2011 in our centre was prospect ively analysed . Baseline clinical and echocardiography variables were analysed and mortality data were collected . During a mean follow-up of 36.2 ± 29.2 months , 174 patients died : 123/174 ( 71 % ) due to cardiovascular causes , 25/174 ( 14 % ) non-cardiac causes , and 26/174 ( 15 % ) unknown aetiology . In a multivariate analysis the predictors of mortality were NYHA class IV [ hazard ratio ( HR ) 2.54 , 95 % confidence interval ( CI ) 1.7–3.7 , P < 0.001 ] , glomerular filtration rate ( GFR ) < 60 mL/min/1.73 m2 ( HR 1.61 , 95 % CI 1.14–2.30 , P = 0.008 ) , AF ( HR 1.67 , 95 % CI 1.19–2.3 , P = 0.01 ) , age ≥70 years ( HR 1.44 , ( 95 % CI 1.04–2.00 , P = 0.02 ) , and LVEF < 22 % ( HR 1.83 , 95 % CI 1.33–2.52 , P ≤ 0.001 ) . The EAARN score ( EF , Age , AF , Renal dysfunction , NYHA class IV ) summarizes the predictors . Each additional predictor increased the mortality : one predictor , HR 3.28 ( 95 % CI 1.37–7.8 , P = 0.008 ) ; two , HR 5.23 ( 95 % CI 2.24–12.10 , P < 0.001 ) ; three , HR 9.63 ( 95 % CI 4.1–22.60 , P < 0.001 ) ; and four or more , HR 14.38 ( 95 % CI 5.8–35.65 , P < 0.001 ) . Conclusion The predictors of mortality have a significant add-on predictive effect on mortality . The EAARN score could be useful to stratify the prognosis of CRT patients OBJECTIVES This study was design ed to examine the use of cardiovascular medications and outcomes in patients with heart failure ( HF ) and renal dysfunction . BACKGROUND Renal insufficiency is associated with poorer outcomes in patients with HF , but the mechanisms are uncertain . In particular , the degree of therapeutic nihilism in these patients , and whether it is appropriate , is unclear . METHODS This was a prospect i ve cohort study with a one-year follow-up . RESULTS In 6,427 patients with cardiologist-diagnosed HF and angiographically proven coronary artery disease ( mean age 69 years ; 65 % men ; one-year mortality , 10 % ) , 39 % had creatinine clearances < 60 ml/min . Patients with renal insufficiency were less likely to be prescribed  angiotensin-converting enzyme ( ACE ) inhibitors , beta-blockers , statins , or aspirin  ( all p < 0.001 ) . However , users of aspirin ( odds ratio [ OR ] 0.69 , 95 % confidence interval [ CI ] 0.57 to 0.85 ) , statins ( OR 0.79 , 95 % CI 0.64 to 0.97 ) , and beta-blockers ( OR 0.75 , 95 % CI 0.62 to 0.90 ) were less likely to die in the subsequent 12 months than nonusers , irrespective of renal function ( all OR adjusted for covariates including atherosclerotic burden and ejection fraction ) . Although ACE inhibitor users with creatinine clearances > or = 60 ml/min had lower 12-month mortality ( OR 0.72 , 95 % CI 0.48 to 0.99 ) , ACE inhibitor users with clearances < 60 ml/min did not ( OR 1.21 , 95 % CI 0.97 to 1.51 ) . CONCLUSIONS Renal insufficiency is common in patients with HF and coronary artery disease , and these patients have more advanced coronary atherosclerosis . Patients with renal insufficiency are less likely to be prescribed efficacious therapies , but have better outcomes if they receive these medications Background — The factors that determine the risk for sudden death or implantable cardioverter defibrillator therapy in patients receiving cardiac resynchronization therapy ( CRT ) therapies  are largely unknown . Methods and Results — We hypothesized that clinical measures of heart failure severity and the presence of comorbid conditions would predict the risk of malignant arrhythmias in the 1520 patients enrolled in the Comparison of Medical Therapy , Pacing , and Defibrillation in Heart Failure ( COMPANION ) Trial . Outcomes in the CRT group after implantable cardioverter defibrillator therapy were also evaluated . The CRT-defibrillator device reduced the risk of sudden death by 56 % compared with drug therapy ( 17 of 595 [ 2.9 % ] versus 18 of 308 [ 5.8 % ] , P<0.02 ) . CRT therapy was not associated with sudden death risk reduction ( 48 of 617 [ 7.8 % ] ) . Other factors associated with reduced sudden death risk were left ventricular ejection fraction > 20 % ( HR , 0.55 [ 95 % CI , 0.35 to 0.87 ] ; P=0.01 ) , QRS duration > 160 ms ( HR , 0.63 [ 95 % CI , 0.40 to 0.997 ] ; P=0.05 ) , and female gender ( HR , 0.56 [ 95 % CI , 0.34 to 0.94 ] ; P=0.003 ) . The risk for sudden death was increased by advanced New York Heart Association class IV heart failure ( HR , 2.62 [ 95 % CI , 1.61 to 4.26 ] ; P<0.011 ) and renal dysfunction ( HR , 1.69 [ 95 % CI , 1.06 to 2.69 ] ; P=0.03 ) . An appropriate shock was experienced in 88 ( 15 % ) of the 595 CTR-D patients . In the CRT-defibrillator patients , female gender ( HR , 0.54 [ 95 % CI , 0.31 to 0.94 ] ; P=0.03 ) and use of neurohormonal antagonists were associated with reduced risk . Class IV heart failure status increased risk . Appropriate implantable cardioverter defibrillator therapy was positively associated with risk of death or all-cause hospitalization ( HR , 1.57 ; P<0.002 ) , pump failure death or hospitalization ( HR , 2.35 ; P<0.001 ) , and sudden death ( HR , 2.99 ; P=0.03 ) , but not total mortality ( HR , 1.3 ; P=0.28 ) . Conclusions — In CRT c and i date s , sudden cardiac death risk is associated with higher New York Heart Association class and renal dysfunction . In CRT-defibrillator recipients , reduction in the risk of an appropriate shock is associated with medical therapy with neurohormonal antagonists , female gender , and New York Heart Association functional class III versus IV clinical status . Shock therapy was associated with worse outcome BACKGROUND Chronic kidney disease ( CKD ) severity is associated with increased morbidity and mortality in congestive heart failure . There is a paucity of data regarding renal improvement after cardiac resynchronization therapy ( CRT ) and its potential impact on clinical outcomes , especially in patients with severe CKD . METHOD This was a retrospective analysis of a prospect ively collected cohort of 260 patients with CKD undergoing CRT at a single center . Renal function was compared before and after CRT . The primary end point was a composite of death , heart transplant , and left ventricular assist device ( LVAD ) , assessed at 5 years . RESULTS Patients with more severe CKD demonstrated increased risk of death , transplant , or LVAD following CRT ( P = 0.015 ) . Renal response ( estimated glomerular filtration rate improvement ≥10 mL/min/1.73 m(2 ) ) was observed in 14 % of all patients and 28 % of patients with stage IV CKD . Independent predictors of renal response included left ventricular ejection fraction improvement ( odds ratio [ OR ] 1.06 , confidence interval [ CI ] 1.01 - 1.10 ) , angiotensin-converting enzyme inhibitor/angiotensin receptor blocker use ( OR 4.31 , CI 1.08 - 17.23 ) , and advanced CKD stage ( OR 2.19 , CI 1.14 - 4.23 ) . Renal response independently decreased hazard of the primary outcome ( HR 0.24 , CI 0.08 - 0.73 , P = 0.01 ) . Renal responders with stage IV CKD had 80 % 5-year event-free survival , compared to 0 % for nonrenal responders in stage IV ( P = 0.03 ) . CONCLUSION Although severity of CKD is associated with poorer outcome after CRT , improvement in renal function can occur in patients across all CKD stages . Renal responders , including those with stage IV CKD , demonstrate favorable 5-year outcomes . Assessment of renal response may help better prognostic outcomes following CRT AIMS The CArdiac REsynchronization-Heart Failure study r and omized patients with left ventricular ejection fraction < or = 35 % , markers of cardiac dyssynchrony , and persistent moderate or severe symptoms of heart failure despite pharmacological therapy , to implantation of a cardiac resynchronization therapy ( CRT ) device or not . The main study observed substantial benefits on morbidity and mortality during a mean follow-up of 29.4 months [ median 29.6 , interquartile range ( IQR ) 23.6 - 34.6 ] . Prior to study closure , an extension phase lasting a further 8 months ( allowing time for data analysis and presentation ) was declared during which cross-over was discouraged . METHODS AND RESULTS This was an extension of the already reported open-label r and omized trial described above . The primary outcome of the extension phase was all-cause mortality from the time of r and omization to completion of the extension phase . The secondary outcome was mode of death . The mean follow-up was 37.4 months ( median 37.6 , IQR 31.5 - 42.5 , range 26.1 - 52.6 months ) . There were 154 deaths ( 38.1 % ) in 404 patients assigned to medical therapy and 101 deaths ( 24.7 % ) in  
    Output:
    
Baseline renal dysfunction has an adverse effect on-all cause mortality in patients who underwent CRT