***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 effectiveness of heart failure disease management programs in patients under cardiologists ' care over long-term follow-up is not established . Methods and Results —We investigated the effects of a disease management program with repetitive education and telephone monitoring on primary ( combined death or unplanned first hospitalization and quality -of-life changes ) and secondary end points ( hospitalization , death , and adherence ) . The REMADHE [ Repetitive Education and Monitoring for ADherence for Heart Failure ] trial is a long-term r and omized , prospect i ve , parallel trial design ed to compare intervention with control . One hundred seventeen patients were r and omized to usual care , and 233 to additional intervention . The mean follow-up was 2.47±1.75 years , with 54 % adherence to the program . In the intervention group , the primary end point composite of death or unplanned hospitalization was reduced ( hazard ratio , 0.64 ; confidence interval , 0.43 to 0.88 ; P=0.008 ) , driven by reduction in hospitalization . The quality -of-life question naire score improved only in the intervention group ( P<0.003 ) . Mortality was similar in both groups . Number of hospitalizations ( 1.3±1.7 versus 0.8±1.3 , P<0.0001 ) , total hospital days during the follow-up ( 19.9±51 versus 11.1±24 days , P<0.0001 ) , and the need for emergency visits ( 4.5±10.6 versus 1.6±2.4 , P<0.0001 ) were lower in the intervention group . Beneficial effects were homogeneous for sex , race , diabetes and no diabetes , age , functional class , and etiology . Conclusions —For a longer follow-up period than in previous studies , this heart failure disease management program model of patients under the supervision of a cardiologist is associated with a reduction in unplanned hospitalization , a reduction of total hospital days , and a reduced need for emergency care , as well as improved quality of life , despite modest program adherence over time BACKGROUND New strategies are required to optimize care in increasing numbers of chronic heart failure patients . The aim of this r and omised trial was to evaluate a remote guidance system . METHODS Intervention group patients received a home TV-channel providing educational material s. Tele-guidance was performed by a Medical Service Centre . Control group patients were followed by cardiologists and HF-nurses . Primary endpoints were total days in hospital for all causes and days alive and out of hospital . Secondary endpoints were : quality of life and knowledge of disease and self care . RESULTS 214 patients were enrolled , median age was 66 years , 89 % had systolic LV dysfunction , and 90 % were in NYHA class II or III . The mean LVEF was 31 % . Over a mean follow-up duration of 288 days , there were 199 hospital admissions in 105 patients . Comparison of the groups revealed no differences for the primary outcomes or for QoL or self care behaviour . Knowledge about heart failure however , increased significantly more in the Intervention group ( p<0.001 ) . CONCLUSION Tele-guidance may play a role in the management of heart failure patients since it takes over some of the tasks of HF-nurses . This may facilitate delivery of optimal care to more patients with the same level of experienced staff OBJECTIVES The purpose of this study was to assess the rate of death and hospitalization for heart failure ( HF ) 1 and 3 years after a r and omized trial of telephone intervention aim ed to improve education and compliance in stable patients with HF ended . BACKGROUND The long-term effects of HF programs are not well known . METHODS In all , 1,518 patients with HF were r and omized into the DIAL ( R and omized Trial of Phone Intervention in Chronic Heart Failure ) . After completion of the trial , patients were followed up to 3 years to assess major outcomes . Compliance with diet , weight control , and treatment was evaluated . The effect of the intervention on mortality and HF hospitalizations was assessed using relative risk ( RR ) , relative risk reduction , and Cox proportional hazards model for adjusting by potential confounders . RESULTS The rate of death or hospitalization for HF was lower in the intervention group ( 37.2 % vs. 42.6 % , RR : 0.81 , 95 % confidence interval [ CI ] : 0.69 to 0.96 ; p = 0.013 ) 1 and 3 years ( 55.7 % vs. 57.5 % , RR : 0.88 , 95 % CI : 0.77 to 1.00 ; p = 0.05 ) after the intervention ended . This benefit was mainly caused by a reduction in admission for HF ( 28.5 % vs. 35.1 % after 3 years , RR : 0.72 , 95 % CI : 0.60 to 0.87 ; p = 0.0004 ) . Patients who showed improvement in 1 or more of 3 key compliance indicators ( diet , weight control , and medication ) had lower risks of events . CONCLUSIONS The benefit observed during the intervention period persisted and was sustained 1 and 3 years after the intervention ended . This effect may be explained by the impact of the educational intervention on patients ' behavior and habits AIMS To test the effect of education and support by a nurse on self-care and re source utilization in patients with heart failure . METHODS A total of 179 patients ( mean age 73 , 58 % male , NYHA III-IV ) hospitalized with heart failure were evaluated prospect ively . Patients were r and omized to the study intervention or to ' care as usual '  . The supportive educative intervention consisted of intensive , systematic and planned education by a study nurse about the consequences of heart failure in daily life , using a st and ard nursing care plan developed by the research ers for older patients with heart failure . Education and support took place during the hospital stay and at a home visit within a week of discharge . Data were collected on self-care abilities , self-care behaviour , readmissions , visits to the emergency heart centre and use of other health care re sources . RESULTS Education and support from a nurse in a hospital setting and at home significantly increases self-care behaviour in patients with heart failure . Patients from both the intervention and the control group increased their self-care behaviour within 1 month of discharge , but the increase in the intervention group was significantly more after 1 month . Although self-care behaviour in both groups decreased during the following 8 months , the increase from baseline remained statistically significant in the intervention group , but not in the control group . No significant effects on re source utilization were found . CONCLUSIONS Intensive , systematic , tailored and planned education and support by a nurse results in an increase in patients ' self-care behaviour . No significant effects were found on use of health care re sources . Additional organisational changes , such as longer follow-up and the availability of a heart failure specialist would probably enhance the effects of education and support 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 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 Suboptimal compliance in taking guideline -based pharmacotherapy in patients with chronic heart failure ( HF ) potentially increases the burden of hospitalizations and diminishes quality of life . By simplifying the medical regimen , once-daily dosing can potentially improve compliance . The Compliance And Quality of Life Study Comparing Once-Daily Controlled-Release Carvedilol CR and Twice-Daily Immediate-Release Carvedilol IR in Patients with Heart Failure ( CASPER ) Trial was design ed to measure differential compliance , satisfaction , and quality of life in chronic HF patients taking carvedilol immediate release ( IR ) twice daily versus the bioequivalent carvedilol controlled-release ( CR ) once daily . METHODS AND RESULTS CASPER was a prospect i ve multicenter , 3-arm , parallel-group , r and omized clinical trial for a 5-month period . The primary objective of the study was to evaluate and compare compliance with  carvedilol IR twice daily ( BID ) and carvedilol phosphate CR  once daily ( QD ) in patients with chronic HF who were taking carvedilol IR .  Secondary objectives included comparisons of quality of life ( Kansas City Cardiomyopathy Question naire ) , satisfaction with medication , and brain natriuretic peptide levels between subjects taking the two formulations . A total of 405 patients with chronic HF and left ventricular dysfunction were r and omized to : ( A ) carvedilol IR twice daily , given double blind ; ( B ) carvedilol CR taken in the morning and placebo in the afternoon , given double blind ; or ( C ) carvedilol CR once daily , open label . Compliance was measured using the medication event monitoring system that captures time of bottle opening . The primary end point was a comparison of taking compliance ( doses taken divided by total number of prescribed doses over the actual duration of the study ) between the double-blind carvedilol IR BID versus the open-label carvedilol CR QD groups . Sample size estimates were based on assumptions of 75 % compliance with BID dosing and 90 % compliance with QD dosing . Mean compliance with carvedilol IR BID was 89.3 % compared with 88.2 % for carvedilol CR QD , and differential mean compliance was 1.1 % ( 95 % CI -4.4 % , 6.6 % ; ie , not significant ) . There were no statistically significant differences in compliance between any of the 3 groups , nor differences in quality of life , treatment satisfaction , or physiologic measures among the 3 study arms . There were also no significant differences in adverse events or side effects among patients switching from carvedilol IR to carvedilol CR in arms B or C over the 5-month study duration compared with patients remaining on carvedilol IR . CONCLUSIONS Compliance among chronic HF patients in the CASPER trial was high at baseline and unaffected by QD versus BID dosing . Over the 5-month follow-up period , there were no differences in adverse events among patients switching from carvedilol IR to CR OBJECTIVE To determine whether enhanced access to primary care affects the diagnostic evaluation , pharmacologic management , or health outcomes of patients hospitalized with congestive heart failure ( CHF ) . DESIGN Multisite r and omized , controlled trial . SETTING Nine Veterans Affairs medical centers . PATIENTS 443 patients who were hospitalized with a diagnosis of CHF . INTERVENTION Enhanced access to primary care , including assignment of a primary care nurse and physician , increased telephone contact , additional outpatient visits , and patient education . MAIN OUTCOME MEASURES Diagnostic evaluation , pharmacologic management , health-related quality of life , and hospital readmission rates . RES 
    Output:
    
Interventions to improve medication adherence among HF patients have significant effects on reducing readmissions and decreasing mortality .