***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 efficacy of disease management programs in improving the outcome of heart failure patients remains uncertain and may vary across health systems . This study explores whether a countrywide disease management program is superior to usual care in reducing adverse health outcomes and improving well-being among community-dwelling adult patients with moderate-to-severe chronic heart failure who have universal access to advanced health-care services and technologies . Methods In this multicenter open-label trial , 1,360 patients recruited after hospitalization for heart failure exacerbation ( 38 % ) or from the community ( 62 % ) were r and omly assigned to either disease management or usual care . Disease management , delivered by multi-disciplinary teams , included coordination of care , patient education , monitoring disease symptoms and patient adherence to medication regimen , titration of drug therapy , and home tele-monitoring of body weight , blood pressure and heart rate . Patients assigned to usual care were treated by primary care practitioners and consultant cardiologists . The primary composite endpoint was the time elapsed till first hospital admission for heart failure exacerbation or death from any cause . Secondary endpoints included the number of all hospital admissions , health-related quality of life and depression during follow-up . Intention-to-treat comparisons between treatments were adjusted for baseline patient data and study center . Results During the follow-up , 388 ( 56.9 % ) patients assigned to disease management and 387 ( 57.1 % ) assigned to usual care had a primary endpoint event . The median ( range ) time elapsed until the primary endpoint event or end of study was 2.0 ( 0–5.0 ) years among patients assigned to disease management , and 1.8 ( 0–5.0 ) years among patients assigned to usual care ( adjusted hazard ratio , 0.908 ; 95 % confidence interval , 0.788 to 1.047 ) . Hospital admissions were mostly ( 70 % ) unrelated to heart failure . Patients assigned to disease management had a better health-related quality of life and a lower depression score during follow-up . Conclusions This comprehensive disease management intervention was not superior to usual care with respect to the primary composite endpoint , but it improved health-related quality of life and depression . A disease-centered approach may not suffice to make a significant impact on hospital admissions and mortality in patients with chronic heart failure who have universal access to health care . Clinical trial registration Clinical trials.gov identifier : NCT00533013 . Trial registration date : 9 August 2007 . Initial protocol release date : 20 September 2007 Abstract Background : Disease management programmes ( DMPs ) improve quality of care for patients with heart failure ( HF ) . However , only a limited number of trials have studied the efficacy of such programmes for patients with heart failure with preserved ejection fraction ( HFPEF ) . Objective : To estimate the impact of a structured , nurse-led patient education programme and care plan in general practice on outcome parameters and events in patients with HFPEF . Methods : Single blinded r and omized clinical trial with an intervention over six months and a follow-up during 12 additional months . In the control group , the patients ( n = 41 ) were managed according to Russian national guidelines . Patients in the intervention group ( n = 44 )  received education on individual lifestyle changes and modifications of cardiovascular disease ( CVD ) risk factors , home-based exercise training and weekly nurse consultations in addition to usual care . Results : Six months after their inclusion , patients in the intervention group significantly improved body mass index , waist circumference , six-min walk test distance , total cholesterol , low-density lipoprotein , left ventricular end-diastolic volume index , quality of life and level of anxiety . After 18 months , there were 11 deaths ( 25 % ) or hospitalizations in the intervention group and 12 ( 29 % ) in the control group ( P = 0.134 ) . Cardiovascular mortality and readmission rate were not reduced significantly after six months of follow-up : the hazard ratio was 0.47 ( 95 % CI : 0.17–1.28 ; P = 0.197 ) . After 18 months , this was 0.85 ( 0.42–1.73 ; P = 0.658 ) . Conclusion : This primary care based DMP for patients with HFPEF improved the patients ’ emotional status and quality of life , positively influenced body weight , functional capacity and lipid profile , and attenuated heart remodelling Importance Many patients with chronic heart failure experience reduced health status despite receiving conventional therapy . Objective To determine whether a symptom and psychosocial collaborative care intervention improves heart failure – specific health status , depression , and symptom burden in patients with heart failure . Design , Setting , and Participants A single-blind , 2-arm , multisite r and omized clinical trial was conducted at Veterans Affairs , academic , and safety-net health systems in Colorado among out patients with symptomatic heart failure and reduced health status recruited between August 2012 and April 2015 . Data from all participants were included regardless of level of participation , using an intent-to-treat approach . Interventions Patients were r and omized 1:1 to receive the Collaborative Care to Alleviate Symptoms and Adjust to Illness ( CASA ) intervention or usual care . The CASA intervention included collaborative symptom care provided by a nurse and psychosocial care provided by a social worker , both of whom worked with the patients ’ primary care clinicians and were supervised by a study primary care clinician , cardiologist , and palliative care physician . Main Outcomes and Measures The primary outcome was patient-reported heart failure – specific health status , measured by difference in change scores on the Kansas City Cardiomyopathy Question naire ( range , 0 - 100 ) at 6 months . Secondary outcomes included depression ( measured by the 9-item Patient Health Question naire ) , anxiety ( measured by the 7-item Generalized Anxiety Disorder Question naire ) , overall symptom distress ( measured by the General Symptom Distress Scale ) , specific symptoms ( pain , fatigue , and shortness of breath ) , number of hospitalizations , and mortality . Results Of 314 patients r and omized ( 157 to intervention arm and 157 to control arm ) , there were 67 women and 247 men , mean ( SD ) age was 65.5 ( 11.4 ) years , and 178 ( 56.7 % ) had reduced ejection fraction . At 6 months , the mean Kansas City Cardiomyopathy Question naire score improved 5.5 points in the intervention arm and 2.9 points in the control arm ( difference , 2.6 ; 95 % CI , –1.3 to 6.6 ; P = .19 ) . Among secondary outcomes , depressive symptoms and fatigue improved at 6 months with CASA ( effect size of –0.29 [ 95 % CI , –0.53 to –0.04 ] for depressive symptoms and –0.30 [ 95 % CI , –0.55 to –0.06 ] for fatigue ; P = .02 for both ) . There were no significant changes in overall symptom distress , pain , shortness of breath , or number of hospitalizations . Mortality at 12 months was similar in both arms ( 10 patients died receiving CASA , and 13 patients died receiving usual care ; P = .52 ) . Conclusions and Relevance This multisite r and omized clinical trial of the CASA intervention did not demonstrate improved heart failure – specific health status . Secondary outcomes of depression and fatigue , both difficult symptoms to treat in heart failure , improved . Trial Registration clinical trials.gov Identifier : Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more To determine the reliability and validity of a patient outcome question naire for chronic heart failure , a r and omized , double-blind , placebo-controlled , 3-month trial of pimobendan , an investigational medication with inotropic and vasodilator activities , was performed . Evaluated were 198 ambulatory patients with primarily New York Heart Association ( NYHA ) class III heart failure from 20 referral centers . Baseline therapy included digoxin , diuretics and , in 80 % , a converting enzyme inhibitor . Oral pimobendan at 2.5 ( n = 49 ) , 5.0 ( n = 51 ) , or 10 ( n = 49 ) mg daily or matching placebo ( n = 49 ) was administered . The Minnesota Living with Heart Failure ( LIhFE ) question naire was a primary outcome measure , along with an exercise test . Interitem correlations identified subgroups of questions representing physical and emotional dimensions . Repeated baseline scores were highly correlated ( r = 0.93 ) , as were the physical ( r = 0.89 ) and emotional ( r = 0.88 ) dimension scores . Placebo did not have a significant effect with median ( 25th , 75th percentile ) changes from baseline scores of 1 ( -3 , 5 ) , 1 ( -2 , 3 ) , and 0 ( -1 , 2 ) , respectively ( all p values greater than 0.10 ) . The 5 mg dose significantly improved the total score , 7.5 ( 0 , 18 ; p = 0.01 ) and the physical dimension , 4 ( 0 , 8 ; p = 0.01 ) , compared with placebo . Changes in the total ( r = 0.33 ; p less than 0.01 ) and physical ( r = 0.35 ; p less than 0.01 ) scores were weakly related to changes in exercise times , but corresponded well with changes in patients ' ratings of dyspnea and fatigue . ( ABSTRACT TRUNCATED AT 250 WORDS IMPORTANCE Heart failure ( HF ) has a major effect on patients ' health status , including their symptom burden , functional status , and health-related quality of life . OBJECTIVE To determine the effectiveness of a collaborative care patient-centered disease management ( PCDM ) intervention to improve the health status of patients with HF . DESIGN , SETTING , AND PARTICIPANTS The Patient-Centered Disease Management ( PCDM ) trial was a multisite r and omized clinical trial comparing a collaborative care PCDM intervention with usual care in patients with HF . A population -based sample of 392 patients with an HF diagnosis from 4 Veterans Affairs centers who had a Kansas City Cardiomyopathy Question naire ( KCCQ ) overall summary score of less than 60 ( heavy symptom burden and impaired functional status and quality of life ) were enrolled between May 2009 and June 2011 . INTERVENTIONS The PCDM intervention included collaborative care by a multidisciplinary care team consisting of a nurse coordinator , cardiologist , psychiatrist , and primary care physician ; home telemonitoring and patient self-management support ; and screening and treatment for comorbid depression . MAIN OUTCOMES AND MEASURES The primary outcome was change in the KCCQ overall summary score at 1 year ( a 5-point change is clinical ly significant ) . Mortality , hospitalization , and depressive symptoms ( Patient Health Question naire 9 ) were secondary outcomes . RESULTS There were no significant differences in baseline characteristics between patients r and omized to the PCDM intervention ( n=187 ) vs usual care ( n=197 ) ; baseline mean KCCQ overall summary scores were 37.9 vs 36.9 ( P=.48 ) . There was significant improvement in the KCCQ overall summary scores in both groups after 1 year ( mean change , 13.5 points in each group ) , with no significant difference between groups ( P=.97 ) . The intervention was not associated with greater improvement in the KCCQ overall summary scores when the effect over time was estimated using 3-month , 6-month , and 12-month data ( P=.74 ) . Among secondary outcomes , there were significantly fewer deaths at 1 year in the intervention arm ( 8 of 187 [ 4.3 % ] ) than in the usual care arm ( 19 of 197 [ 9.6 % ] ) ( P = .04 ) . Among those who screened positive for depression , there was a greater improvement in the Patient Health Question naire 9 scores after 1 year in the intervention arm than in the usual care arm ( 2.1 points lower , P=.01 ) . There was no significant difference in 1-year hospitalization rates between the intervention arm and the usual care arm ( 29.4 % vs 29.9 % , P=.87 ) . CONCLUSIONS AND RELEVANCE This multisite r and omized trial of a multifaceted HF PCDM intervention did not demonstrate improved patient health status compared with usual care . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00461513 Background Heart failure ( HF ) patients discharged from rural hospitals have higher 30-day readmission rates .  Self-management ( SM ) reduces readmissions , but adherence to SM guidelines is low in the rural HF population . We tested a home-based intervention to enhance patient activation and lead to improved SM adherence . Methods In this two-group , repeated measures r and omized control trial , the main outcomes were patient reported and clinical outcomes associated with SM adherence , and all-cause readmission at 30 , 90 and 180 days . Results The study included 100 HF patients discharged from a rural critical access hospital . The intervention group received a 12-week SM training and coaching program delivered by telephone and tailored on subjects ’ activation levels . At α = .10 , the PATCH intervention showed significantly greater improvement compared to usual care in patient-reported SM adherence : weighing themselves , following a low-sodium diet , taking prescribed medication , and exercising daily ( all 
    Output:
    
Statistically significant or positive trends were found in mortality , hospitalization rates , self-care ability , quality of life , anxiety , depression , and sleep , but findings were not robust or consistent .