***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: Objective To examine the effects of home-based transitional palliative care for patients with end-stage heart failure ( ESHF ) after hospital discharge . Methods This was a r and omised controlled trial conducted in three hospitals in Hong Kong . The recruited subjects were patients with ESHF who had been discharged home from hospitals and referred for palliative service , and who met the specified inclusion criteria . The interventions consisted of weekly home visits/telephone calls in the first 4 weeks then monthly follow-up , provided by a nurse case manager supported by a multidisciplinary team . The primary outcome measures were any readmission and count of readmissions within 4 and 12 weeks after index discharge , compared using χ2 tests and Poisson regression , respectively . Secondarily , change in symptoms over time between control and intervention groups were evaluated using generalised estimating equation analyses of data collected using the Edmonton Symptom Assessment Scale ( ESAS ) . Results The intervention group ( n=43 ) had a significantly lower readmission rate than the control group ( n=41 ) at 12 weeks ( intervention 33.6 % vs control 61.0 % χ2=6.8 , p=0.009 ) . The mean number ( SE ) of readmissions for the intervention and control groups was , respectively , 0.42 ( 0.10 ) and 1.10 ( 0.16 ) and the difference was significant ( p=0.001 ) . The relative risk ( CI ) for 12-week readmissions for the intervention group was 0.55 ( 0.35 to 0.88 ) . There was no significant difference in readmissions between groups at 4 weeks . However , when compared with the control group , the intervention group experienced significantly higher clinical improvement in depression ( 45.9 % vs 16.1 % , p<0.05 ) , dyspnoea ( 62.2 % vs 29.0 % , p<0.05 ) and total ESAS score ( 73.0 % vs 41.4 % , p<0.05 ) at 4 weeks . There were significant differences between groups in changes over time in quality of life ( QOL ) measured by McGill QOL ( p<0.05 ) and chronic HF ( p<0.01 ) question naires . Conclusions This study provides evidence of the effectiveness of a postdischarge transitional care palliative programme in reducing readmissions and improving symptom control among patients with ESHF . Trial registration number HKCTR-1562 ; Results Background Readmissions are costly and have implication s for quality of care . Studies have been reported to support effects of transitional care programs in reducing hospital readmissions and enhancing clinical outcomes . However , there is a paucity of studies executing full economic evaluation to assess the cost-effectiveness of these transitional care programs . This study is therefore launched to fill this knowledge gap . Methods Cost-effectiveness analysis was conducted alongside a r and omized controlled trial that examined the effects of a  Health-Social Transitional Care Management Program ( HSTCMP ) for medical patients discharged from an acute regional hospital in Hong Kong . The cost and health outcomes were compared between the patients receiving the HSTCMP and usual care . The total costs comprised the pre-program , program , and healthcare utilization costs . Quality of life was measured with SF-36 and transformed to utility values between 0 and 1 . Results The readmission rates within 28 ( control 10.2 % , study 4.0 % ) and 84 days ( control 19.4 % , study 8.1 % ) were significantly higher in the control group . Utility values showed no difference between the control and study groups at baseline ( p = 0.308 ) . Utility values for the study group were significantly higher than in the control group at 28 ( p < 0.001 ) and 84 days ( p = 0.002 ) . The study group also had a significantly higher QALYs gain ( p < 0.001 ) over time at 28 and 84 days when compared with the control group . The intervention had an 89 % chance of being cost-effective at the threshold of £ 20000/QALY . Conclusions Previous studies on transitional care focused mainly on clinical outcomes and not too many included cost as an outcome measure . Studies examining the cost-effectiveness of the post-discharge support services are scanty . This study is the first to examine the cost-effectiveness of a  transitional care program  that used nurse-led services participated by volunteers . Results have shown that a health-social partnership transitional care program is cost-effective in reducing healthcare costs and attaining QALY gains . Economic evaluation helps to inform funders and guide decisions for the effective use of competing healthcare re sources BACKGROUND We conducted this prospect i ve comparative study to examine the feasibility and effectiveness of a palliative care consultation along with st and ard heart failure care in an outpatient setting regarding symptom burden , depression , and quality of life ( QOL ) . METHODS AND RESULTS Thirty-six patients ( 53.6 ± 8.3 years old ) were referred for an outpatient palliative care consultation after discharge . Changes in symptom burden , depression , and QOL at 3 months were compared with 36 patients with symptomatic heart failure matched on age , sex , race , and New York Heart Association functional class . Improvements were observed in symptom burden , depression , and QOL in both groups over time ( all P < .005 ) , but were more pronounced in patients receiving a palliative care consultation ( all P < .035 ) . CONCLUSIONS A palliative care consultation may reduce symptom burden and depression and enhance QOL in patients with symptomatic heart failure . Larger-scale r and omized controlled trials sufficiently powered to assess clinical outcomes are warranted to determine the efficacy of palliative care services in outpatient setting s regarding symptom distress , depression , and QOL in patients with symptomatic heart failure BACKGROUND Ivabradine is indicated to control heart rate in otherwise optimally treated patients with chronic heart failure ( CHF ) and reduced ejection fraction . However , data on its effectiveness outside clinical trials and longer-term effects are scarce . METHODS We performed a prospect i ve cohort study involving 249 German resident cardiologists and analyzed the 1-year effectiveness and safety of ivabradine used in CHF out patients . Data on symptoms , quality of life , and hospitalizations were collected . RESULTS In total , 767 CHF patients were enrolled to receive ivabradine twice daily , of whom 684 ( 90 % ) were still on ivabradine at study end ( mean treatment duration 11.2months ) . The cohort was representative of CHF patients seen in clinical practice in terms of age , risk factor profile , and comorbidities . Concomitant beta-blocker therapy was prescribed in 497 patients ( 65 % ) . After one year , compared to baseline , heart rate in ivabradine-treated patients was 16bpm lower . This reduction was associated with a significant improvement in NYHA class , and less frequent signs of decompensation ( 36 % to 8 % ) . The proportion of hospitalized patients within 1year decreased from 23 % before treatment , to 5 % with ivabradine therapy . These improvements in clinical status were accompanied by a reduction in BNP and an increase in LVEF ( + 5.1 % at 1year ) . Quality of life was significantly improved in all measured dimensions . Adverse drug reactions were noted in 26 patients ( 3 % ) , and were in line with the known safety profile of ivabradine . CONCLUSIONS Ivabradine was effective and well-tolerated in CHF patients seen in clinical practice throughout 1year of treatment OBJECTIVES The purpose of this clinical trial was to evaluate the long-term effects of flosequinan on the morbidity and mortality of patients with severe chronic heart failure . BACKGROUND Flosequinan was the first oral vasodilator to be used in the clinic to augment the effects of digitalis , diuretics , and angiotensin-converting enzyme inhibitors in heart failure . However , the drug activated neurohormonal systems and exerted both positive inotropic and chronotropic effects , raising concerns about its safety during long-term use . METHODS Following a run-in period design ed to minimize the risk of tachycardia , we r and omly assigned 2,354 patients in New York Heart Association functional class III to IV heart failure and with an ejection fraction ≤35 % to receive long-term treatment with placebo or flosequinan ( 75 or 100 mg/day ) in addition to their usual therapy . The primary outcome was all-cause mortality . RESULTS The trial was terminated after a recommendation of the Data and Safety Monitoring Board , because during an average of 10 months of follow-up , 192 patients died in the placebo group and 255 patients died in the flosequinan group ( hazard ratio : 1.39 , 95 % confidence interval : 1.15 to 1.67 ; p = 0.0006 ) . Flosequinan also increased the risk of disease progression , which was paralleled by drug-related increases in heart rate and neurohormonal activation . However , during the first month , patients in the flosequinan group were more likely to report an improvement in well-being and less likely to experience worsening heart failure . Similarly , during the month following drug withdrawal at the end of the trial , patients withdrawn from flosequinan were more likely than those withdrawn from placebo to report symptoms of or to require treatment for worsening heart failure . CONCLUSIONS Although flosequinan produced meaningful symptomatic benefits during short- and long-term treatment , the drug increased the risk of death in patients with severe chronic heart failure CONTEXT There are few r and omized controlled trials on the effectiveness of palliative care interventions to improve the care of patients with advanced cancer . OBJECTIVE To determine the effect of a nursing-led intervention on quality of life , symptom intensity , mood , and re source use in patients with advanced cancer . DESIGN , SETTING , AND PARTICIPANTS R and omized controlled trial conducted from November 2003 through May 2008 of 322 patients with advanced cancer in a rural , National Cancer Institute- design ated comprehensive cancer center in New Hampshire and affiliated outreach clinics and a VA medical center in Vermont . INTERVENTIONS A multicomponent , psychoeducational intervention ( Project ENABLE [ Educate , Nurture , Advise , Before Life Ends ] ) conducted by advanced practice nurses consisting of 4 weekly educational sessions and monthly follow-up sessions until death or study completion ( n = 161 ) vs usual care ( n = 161 ) . MAIN OUTCOME MEASURES Quality of life was measured by the Functional Assessment of Chronic Illness Therapy for Palliative Care ( score range , 0 - 184 ) . Symptom intensity was measured by the Edmonton Symptom Assessment Scale ( score range , 0 - 900 ) . Mood was measured by the Center for Epidemiological Studies Depression Scale ( range , 0 - 60 ) . These measures were assessed at baseline , 1 month , and every 3 months until death or study completion . Intensity of service was measured as the number of days in the hospital and in the intensive care unit ( ICU ) and the number of emergency department visits recorded in the electronic medical record . RESULTS A total of 322 participants with cancer of the gastrointestinal tract ( 41 % ; 67 in the usual care group vs 66 in the intervention group ) , lung ( 36 % ; 58 vs 59 ) , genitourinary tract ( 12 % ; 20 vs 19 ) , and breast ( 10 % ; 16 vs 17 ) were r and omized . The estimated treatment effects ( intervention minus usual care ) for all participants were a mean ( SE ) of 4.6 ( 2 ) for quality of life ( P = .02 ) , -27.8 ( 15 ) for symptom intensity ( P = .06 ) , and -1.8 ( 0.81 ) for depressed mood ( P = .02 ) . The estimated treatment effects in participants who died during the study were a mean ( SE ) of 8.6 ( 3.6 ) for quality of life ( P = .02 ) , -24.2 ( 20.5 ) for symptom intensity ( P = .24 ) , and -2.7 ( 1.2 ) for depressed mood ( P = .03 ) . Intensity of service did not differ between the 2 groups . CONCLUSION Compared with participants receiving usual oncology care , those receiving a nurse-led , palliative care-focused intervention addressing physical , psychosocial , and care coordination provided concurrently with oncology care had higher scores for quality of life and mood , but did not have improvements in symptom intensity scores or reduced days in the hospital or ICU or emergency department visits . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00253383 PURPOSE This study evaluates the implementation of Disease Specific Advance Care Planning ( DS-ACP ) for heart failure patients in a large health care system . The DS-ACP model uses a trained facilitator to guide communication between patient and proxy regarding patient values and goals for treatment in worst-case scenarios , develop a disease specific documentation plan , and identify needed re sources . METHODS Referral and DS-ACP service delivery data were merged with electronic health record data . Process measures for implementation are described . Patients who participated in DS-ACP  are compared with those who did not on demographics , medical characteristics , and outcomes such as inpatient readmissions , and hospice use among those who died . A chart audit was completed on a sample of patients to examine differences in advance care planning documentation between participants and non participants . RESULTS Nearly one third ( 31.8 % ) of the 1894 heart failure patients referred to DS-ACP participated . Referral method was associated with participation . A chart audit revealed 94.3 % of those completing the DS-ACP process , had a 
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mean difference = 1.81 ; 95 % CI = -0.14 to 3.77 ; P = 0.07).Compared with control intervention , palliative care intervention was found to significantly reduce readmission , ESAS , PHQ-9 , and improve heart failure question naire , but showed no influence on mortality and quality of life question naire in patients with heart failure