***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 Case management is believed to promote continuity of care and decrease hospitalization rates , although few controlled trials have tested this approach . OBJECTIVE To assess the effectiveness of a st and ardized telephonic case-management intervention in decreasing re source use in patients with chronic heart failure . METHODS A r and omized controlled clinical trial was used to assess the effect of telephonic case management on re source use .  Patients were identified at hospitalization and assigned to receive 6 months of intervention ( n = 130 ) or usual care ( n = 228 ) based on the group to which their physician was r and omized .  Hospitalization rates , readmission rates , hospital days , days to first rehospitalization , multiple readmissions , emergency department visits , inpatient costs , outpatient re source use , and patient satisfaction were measured at 3 and 6 months . RESULTS The heart failure hospitalization rate was 45.7 % lower in the intervention group at 3 months ( P = .03 ) and 47.8 % lower at 6 months ( P = .01 ) . Heart failure hospital days ( P = .03 ) and multiple readmissions ( P = .03 ) were significantly lower in the intervention group at 6 months . Inpatient heart failure costs were 45.5 % lower at 6 months ( P = .04 ) . A cost saving was realized even after intervention costs were deducted . There was no evidence of cost shifting to the outpatient setting . Patient satisfaction with care was higher in the intervention group . CONCLUSIONS The reduction in hospitalizations , costs , and other re source use achieved using st and ardized telephonic case management in the early months after a heart failure admission is greater than that usually achieved with pharmaceutical therapy and comparable with other disease management approaches Background Many older people in long-term care do not receive evidence -based diagnosis or management for heart failure ; it is not known whether this can be achieved for this population . We initiated an onsite heart failure service , compared with ‘ usual care ’ with the aim of establishing the feasibility of accurate diagnosis and appropriate management . Methods A pilot r and omised controlled trial which r and omised residents from 33 care facilities in North-East Engl and with left ventricular systolic dysfunction ( LVSD ) to usual care or an onsite heart failure service . The primary outcome was the optimum prescription of angiotensin-converting enzyme inhibitors and beta-adrenergic antagonists  at 6 months . Results Of 399 echocardiographically-screened residents aged 65–100 years , 30 subjects with LVSD were eligible ; 28 ( 93 % ) consented and were r and omised ( HF service : 16 ; routine care : 12 ) . Groups were similar at baseline ; six month follow-up was completed for 25 patients ( 89 % ) ; 3 ( 11 % ) patients died . Results for the primary outcome were not statistically significant but there was a consistent pattern of increased drug use and titration to optimum dose in the intervention group ( 21 % compared to 0 % receiving routine care , p=0.250 ) . Hospitalisation rates , quality of life and mortality at 6 months were similar between groups . Conclusions This study demonstrated the feasibility of an on-site heart failure service for older long-term care population s. Optimisation of medication appeared possible without adversely affecting quality of life ; this questions clinicians ’ concerns about adverse effects in this group . This has international implication s for managing such patients . These methods should be replicated in a large-scale study to quantify the scale of benefit . Trial registration IS RCT N19781227 http://www.controlled-trials.com/IS RCT Background — The long-term impact of chronic heart failure management programs over the typical life span of affected individuals is unknown . Methods and Results — The effects of a nurse-led , multidisciplinary , home-based intervention ( HBI ) in a typically elderly cohort of patients with chronic heart failure initially r and omized to either HBI ( n=149 ) or usual postdischarge care ( UC ) ( n=148 ) after a short-term hospitalization were studied for up to 10 years of follow-up ( minimum 7.5 years of follow-up ) . Study end points were all-cause mortality , event-free survival ( event was defined as death or unplanned hospitalization ) , recurrent hospital stay , and cost per life-year gained . Median survival in the HBI cohort was almost twice that of UC ( 40 versus 22 months ; P<0.001 ) , with fewer deaths overall ( HBI , 77 % versus 89 % ; adjusted relative risk , 0.74 ; 95 % CI , 0.53 to 0.80 ; P<0.001 ) . HBI was associated with prolonged event-free survival ( median , 7 versus 4 months ; P<0.01 ) . HBI patients had more unplanned readmissions ( 560 versus 550 ) but took 7 years to overtake UC ; the rates of readmission ( 2.04±3.23 versus 3.66±7.62 admissions ; P<0.05 ) and related hospital stay ( 14.8±23.0 versus 28.4±53.4 days per patient per year ; P<0.05 ) were significantly lower in the HBI group . HBI was associated with 120 more life-years per 100 patients treated compared with UC ( 405 versus 285 years ) at a cost of $ 1729 per additional life-year gained when we accounted for healthcare costs including the HBI . Conclusions — In altering the natural history of chronic heart failure relative to UC ( via prolonged survival and reduced frequency of recurrent hospitalization  ) , HBI is a remarkably cost- and time-effective strategy over the longer term Background —It is not known to what extent initially observed benefits of postdischarge programs of care for patients with chronic congestive heart failure ( CHF ) in respect to event-free survival , readmissions , and healthcare costs persist in the long term . Methods and Results —We prospect ively studied the long-term effects of a multidisciplinary home-based intervention ( HBI ) in a cohort of CHF patients r and omly allocated to either to HBI ( n=149 ) or usual care ( n=148 ) . During a median of 4.2 years of follow-up , there were significantly fewer primary end points ( unplanned readmission or death ) in the HBI versus usual care group : a mean of 0.21 versus 0.37 primary events per patient per month ( P < 0.01 ) . Median event-free survival was more prolonged in the HBI than usual care group ( 7 versus 3 months;P < 0.01 ) . Fewer HBI patients died ( 56 % versus 65%;P = 0.06 ) and had more prolonged survival ( a median of 40 versus 22 months;P < 0.05 ) compared with usual care . Assignment to HBI was both an independent predictor of event-free survival ( RR 0.70;P < 0.01 ) and survival alone ( RR 0.72;P < 0.05 ) . Overall , HBI patients had 78 fewer unplanned readmissions compared with usual care ( 0.17 versus 0.29 readmissions per patient per month;P < 0.05 ) . The median cost of these readmissions was $ A325 versus $ A660/month per HBI and usual care patient ( P < 0.01 ) . Conclusions —The beneficial effects of HBI in reducing frequency of unplanned readmissions in CHF patients persist in the long term and are associated with prolongation of survival OBJECTIVES The goal of this study was to make a head-to-head comparison of 2 common forms of multidisciplinary chronic heart failure ( CHF ) management . BACKGROUND Although direct patient contact appears to be best in delivering CHF management overall , the precise form to optimize health outcomes is less clear . METHODS This prospect i ve , multicenter r and omized controlled trial with blinded endpoint adjudication comprised 280 hospitalized CHF patients ( 73 % male , age 71 ± 14 years , and 73 % with left ventricular ejection fraction ≤45 % ) r and omized to home-based intervention ( HBI ) or specialized CHF clinic-based intervention ( CBI )  . The primary endpoint was all-cause , unplanned hospitalization or death during 12- to 18-month follow-up . Secondary endpoints included type/ duration of hospitalization and healthcare costs . RESULTS The primary endpoint occurred in 102 of 143 ( 71 % ) HBI versus 104 of 137 ( 76 % ) CBI patients ( adjusted hazard ratio [ HR ] : 0.97 [ 95 % confidence interval ( CI ) : 0.73 to 1.30 ] , p = 0.861 ) : 96 ( 67.1 % ) HBI versus 95 ( 69.3 % ) CBI patients had an unplanned hospitalization ( p = 0.887 ) , and 31 ( 21.7 % ) versus 38 ( 27.7 % ) died ( p = 0.252 ) . The median duration of each unplanned hospitalization was significantly less in the HBI group ( 4.0 [ interquartile range ( IQR ) : 2.0 to 7.0 ] days vs. 6.0 [ IQR : 3.5 to 13 ] days ; p = 0.004 ) . Overall , 75 % of all hospitalization was attributable to 64 ( 22.9 % ) patients , of whom 43 ( 67 % ) were CBI patients ( adjusted odds ratio : 2.55 [ 95 % CI : 1.37 to 4.73 ] , p = 0.003 ) . HBI was associated with significantly fewer days of all-cause hospitalization ( -35 % ; p = 0.003 ) and from cardiovascular causes ( -37 % ; p = 0.025 ) but not for CHF ( -24 % ; p = 0.218 ) . Consequently , healthcare costs ( $ AU3.93 vs. $ AU5.53 million ) were significantly less for the HBI group ( median : $ AU34 [ IQR : 13 to 81 ] per day vs. $ AU52 [ 17 to 140 ] per day ; p = 0.030 ) . CONCLUSIONS HBI was not superior to CBI in reducing all-cause death or hospitalization .  However , HBI was associated with significantly lower healthcare costs , attributable to fewer days of hospitalization . ( Which Heart failure Intervention is most Cost-effective & consumer friendly in reducing Hospital care [ WHICH ? ] ; ACTRN12607000069459 ) Abstract Objectives : To determine whether specialist nurse intervention improves outcome in patients with chronic heart failure . Design : R and omised controlled trial . Setting : Acute medical admissions unit in a teaching hospital . Participants : 165 patients admitted with heart failure due to left ventricular systolic dysfunction . The intervention started before discharge and continued thereafter with home visits for up to 1 year . Main outcome measures : Time to first event analysis of death from all causes or readmission to hospital with worsening heart failure . Results : 31 patients ( 37 % ) in the intervention group died or were readmitted with heart failure compared with 45 ( 53 % ) in the usual care group ( hazard ratio=0.61 , 95 % confidence interval 0.33 to 0.96).Compared with usual care , patients in the intervention group had fewer readmissions for any reason ( 86 v 114 , P=0.018 ) , fewer admissions for heart failure ( 19 v 45 , P<0.001 ) and spent fewer days in hospital for heart failure ( mean 3.43 v 7.46 days , P=0.0051 ) . Conclusions : Specially trained nurses can improve the outcome of patients admitted to hospital with heart failure . What is already known on this topic Studies have suggested that nurse intervention may reduce readmission in patients with heart failure What this study adds Home based intervention from nurses reduces readmissions for worsening heart failure Regular contact to review treatment and patient education are likely to contribute to this Background Chronic ( systolic ) heart failure ( CHF ) is a common and disabling condition . Adherence to evidence -based guidelines in primary care has been shown to improve health outcomes . The aim was to explore the impact of a multidisciplinary educational intervention for general practitioners ( GPs ) ( Train the trainer = TTT ) on patient and performance outcomes . Methods This paper presents the key findings from the trial and discusses the lessons learned during the implementation of the TTT trial . Primary care practice s were r and omly assigned to the TTT intervention or to the control group .  37 GPs ( 18 TTT , 19 control ) were r and omised and 168 patients diagnosed with ascertained CHF ( 91 TTT , 77 control ) were enrolled . GPs in the intervention group attended four meetings addressing clinical practice guidelines and pharmacotherapy feedback . The primary outcome was patient self-reported quality of life at seven months , using the SF-36 Physical Functioning scale . Secondary outcomes included other SF-36 scales , the Kansas City Cardiomyopathy Question naire ( KCCQ ) , total mortality , heart failure hospital admissions , prescribing , depressive disorders ( PHQ-9 ) , behavioural change ( European Heart Failure Self-Care Behaviour Scale ) , patient-perceived quality of care ( EUROPEP ) and improvement of heart failure using NT-proBNP-levels . Because recruitment targets were not achieved an exploratory analysis was conducted . Results There was high baseline achievement in both groups for many outcomes . At seven months , there were no significant mean difference between groups for the primary outcome measure ( 
    Output:
    
CONCLUSIONS Hospital-initiated CM can be successful in reducing unplanned hospital readmissions for HF and length of hospital stay for people with HF .
9 trials described cost data ; no clear difference emerged between CM and usual care .
There was limited evidence for community-initiated CM which suggested it does not reduce admission