human
***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 Heart failure treatment guidelines emphasize daily weight monitoring for patients with heart failure , but data to support this practice are lacking . Using a technology-based heart failure monitoring system , we determined whether daily reporting of weight and symptoms in patients with advanced heart failure would reduce rehospitalization and mortality rates despite aggressive guideline -driven heart failure care . METHODS This was a r and omized , controlled trial . Patients hospitalized with New York Heart Association class III or IV heart failure , with a left ventricular ejection fraction < or = 35 % were r and omized to receive heart failure program care or heart failure program care plus the AlereNet system ( Alere Medical , Reno , Nev ) and followed-up for 6 months . The primary end point was 6-month hospital readmission rate . Secondary end points included mortality , heart failure hospitalization readmission rate , emergency room visitation rate , and quality of life . RESULTS Two hundred eighty patients from 16 heart failure centers across the United States were r and omized : 138 received the  AlereNet system and 142 received st and ard care .  Mean age was 59 + /- 15 years and 68 % were male . The population had very advanced heart failure , New York Heart Association class III ( 75 % ) or IV ( 25 % ) , as evidence d by serum norepinepherine levels , 6-minute walk distance and outcomes .  No differences in hospitalization rates were observed . There was a 56.2 % reduction in mortality ( P < .003 ) for patients r and omized to the AlereNet group . CONCLUSIONS This is the largest multicenter , r and omized trial of a technology-based daily weight and symptom-monitoring system for patients with advanced heart failure . Despite no difference in the primary end point of rehospitalization rates , mortality was significantly reduced for patients r and omized to the AlereNet system without an increase in utilization , despite specialized and aggressive heart failure care in both groups Background — Heart failure is associated with frequent hospitalizations , often result ing from volume overload . Measurement of intrathoracic impedance with an implanted device with an audible patient alert may detect increases in pulmonary fluid retention early . We hypothesized that early intervention could prevent hospitalizations and affect outcome . Methods and Results — We studied 335 patients with chronic heart failure who had undergone implantation of an implantable cardioverter-defibrillator alone ( 18 % ) or with cardiac resynchronization therapy ( 82 % ) . All devices featured a monitoring tool to track changes in intrathoracic impedance ( OptiVol ) and other diagnostic parameters . Patients were r and omized to have information available to physicians and patients as an audible alert in case of preset threshold crossings ( access arm ) or not ( control arm ) . The primary end point was a composite of all-cause mortality and heart failure hospitalizations . During 14.9±5.4 months , this occurred in 48 patients ( 29 % ) in the access arm and in 33 patients ( 20 % ) in the control arm ( P=0.063 ; hazard ratio , 1.52 ; 95 % confidence interval , 0.97–2.37 ) . This was due mainly to more heart failure hospitalizations ( hazard ratio , 1.79 ; 95 % confidence interval , 1.08–2.95 ; P=0.022 ) , whereas the number of deaths was comparable ( 19 versus 15 ; P=0.54 ) . The number of outpatient visits was higher in the access arm ( 250 versus 84 ; P<0.0001 ) , with relatively more signs of heart failure among control patients during outpatient visits . Although the trial was terminated as a result of slow enrollment , a post hoc futility analysis indicated that a positive result would have been unlikely . Conclusion — Use of an implantable diagnostic tool to measure intrathoracic impedance with an audible patient alert did not improve outcome and increased heart failure hospitalizations and outpatient visits in heart failure patients . Clinical Trial Registration — URL : http://www . clinical trials.gov . Unique identifier : NCT 00480077 AIMS To evaluate the utility of intrathoracic impedance monitoring for detecting  heart failure ( HF ) deterioration in patients with an implanted cardiac resynchronization/defibrillation device . METHODS AND RESULTS Patients enrolled in the European InSync Sentry Observational Study were audibly alerted by a device algorithm if a decrease in intrathoracic impedance suggested fluid accumulation . Clinical HF status and device data were assessed at enrolment , during regular follow-up , and if patients presented with an alert or HF deterioration .  Data from 373 subjects were analysed . Fifty-three alert events and a total of 53 clinical events ( HF deterioration defined by worsening of HF signs and symptoms ) were reported during a median of 4.2 months . Adjusted for multiple events per patient , the alert detected clinical HF deterioration with 60 % sensitivity ( 95 % CI 46 - 73 ) and with a positive predictive value of 60 % ( 95 % CI 46 - 73 ) . Higher NYHA class at baseline was predictive for adequate alert events during follow-up ( P < 0.05 ) . In 11 of 20 HF deteriorations without preceding alert , an upstroke of the fluid index occurred without reaching the programmed alert threshold . CONCLUSION A device-based algorithm that alerts patients in case of decreasing intrathoracic impedance facilitates the detection of HF deterioration . Future r and omized , controlled trials are needed to test whether the tailored use of intrathoracic impedance monitoring can improve the ambulatory management of patients with chronic HF and an implanted device Acute heart failure syndromes ( AHFS ) represent the most common discharge diagnoses in adults over age 65 and translate into dramatically increased heart failure – associated morbidity and mortality . Conventional approaches to the early detection of pulmonary and systemic congestion have been shown to be of limited sensitivity . Despite their proven efficacy , disease management and structured telephone support programs have failed to achieve widespread use in part due to their re source intensiveness and reliance upon motivated patients . While once thought to hold great promise , results from recent prospect i ve studies on telemonitoring strategies have proven disappointing . Implantable devices with their capacity to monitor electrophysiologic and hemodynamic parameters over long periods of time and with minimal reliance on patient participation may provide solutions to some of these problems . Conventional electrophysiologic parameters and intrathoracic impedance data are currently available in the growing population of heart failure patients with equipped devices . A variety of implantable hemodynamic monitors are currently under investigation . How best to integrate these devices into a systematic approach to the management of patients before , during , and after AHFS  is yet to be established OBJECTIVES We sought to identify whether home telemonitoring ( HTM ) improves outcomes compared with nurse telephone support ( NTS ) and usual care ( UC ) for patients with heart failure who are at high risk of hospitalization or death . BACKGROUND Heart failure is associated with a high rate of hospitalization and poor prognosis . Telemonitoring could help implement and maintain effective therapy and detect worsening heart failure and its cause promptly to prevent medical crises . METHODS Patients with a recent admission for heart failure and left ventricular ejection fraction ( LVEF ) < 40 % were assigned r and omly to HTM , NTS , or UC in a 2:2:1 ratio . HTM consisted of twice-daily patient self-measurement of weight , blood pressure , heart rate , and rhythm with automated devices linked to a cardiology center . The NTS consisted of specialist nurses who were available to patients by telephone . Primary care physicians delivered UC . The primary end point was days dead or hospitalized with NTS versus HTM at 240 days . RESULTS Of 426 patients r and omly assigned , 48 % were aged > 70 years , mean LVEF was 25 % ( SD , 8) and median plasma N-terminal pro-brain natriuretic peptide was 3,070 pg/ml ( interquartile range 1,285 to 6,749 pg/ml ) . During 240 days of follow-up , 19.5 % , 15.9 % , and 12.7 % of days were lost as the result of death or hospitalization for UC , NTS , and HTM , respectively ( no significant difference ) . The number of admissions and mortality were similar among patients r and omly assigned to NTS or HTM , but the mean duration of admissions was reduced by 6 days ( 95 % confidence interval 1 to 11 ) with HTM . Patients r and omly assigned to receive UC had higher one-year mortality ( 45 % ) than patients assigned to receive NTS ( 27 % ) or HTM ( 29 % ) ( p = 0.032 ) . CONCLUSIONS Further investigation and refinement of the application of HTM are warranted because it may be a valuable role for the management of selected patients with heart failure BACKGROUND We performed a prospect i ve , r and omized investigation assessing the incremental effect of automated health monitoring ( AHM ) technology over and above that of a previously described nurse directed heart failure ( HF ) disease management program . The AHM system measured and transmitted body weight , blood pressure , and heart rate data as well as subjective patient self- assessment s via a st and ard telephone line to a central server . METHODS AND RESULTS A total of 188 consented and eligible patients were r and omized between intervention and control groups in 1:1 ratio . Subjects r and omized to the control arm received the Specialized Primary and Networked Care in Heart Failure ( SPAN-CHF ) heart failure disease management program . Subjects r and omized to the intervention arm received the SPAN-CHF disease management program in conjunction with the AHM system . The primary end point was prespecified as the relative event rate of HF hospitalization between intervention and control groups at 90 days . The relative event rate of HF hospitalization for the intervention group compared with controls was 0.50 ( 95%CI [ 0.25 - 0.99 ] , P = .05 ) . CONCLUSIONS Short-term reductions in the heart failure hospitalization rate were associated with the use of automated home monitoring equipment . Long-term benefits in this model remain to be studied BACKGROUND Heart failure is a common and important cause of morbidity and mortality . Disease management offers promise in reducing the need for hospitalization and improving quality of life for heart failure patients , but experimental data on the efficacy of such programs are limited . METHODS AND RESULTS A total of 151 patients hospitalized with heart failure were r and omized to usual care or scheduled telephone calls by specially trained nurses promoting self-management and guideline -based therapy as prescribed by primary physicians . Nurses also screened patients for heart failure exacerbations , which they managed with supplemental diuretics or by contacting the primary physician for instructions . Outcomes included time to hospital encounter , mortality , number and cost of hospitalizations , functional status , and satisfaction with care . Intervention patients had a longer time to encounter ( hazard ratio [ HR ] = 0.67 ; 95 % confidence interval [ CI ] 0.47 - 0.96 ; P = .029 ) , hospital readmission ( HR = 0.67 ; CI 0.46 - 0.99 ; P = .045 ) , and heart failure-specific readmission ( HR = 0.62 ; CI 0.38 - 1.03 ; P = .063 ) . The number of admissions , hospital days , and hospital costs were significantly lower during the first 6 months after intervention but not at 1 year . The intervention had little effect on functional status , mortality , and satisfaction with care . CONCLUSION A nurse-administered , telephone-based disease management program delayed subsequent health care encounters , but had minimal impact on other outcomes BACKGROUND This trial was design ed to determine whether cardiac-resynchronization therapy ( CRT ) with biventricular pacing would reduce the risk of death or heart-failure events in patients with mild cardiac symptoms , a reduced ejection fraction , and a wide QRS complex . METHODS During a 4.5-year period , we enrolled and followed 1820 patients with ischemic or nonischemic cardiomyopathy , an ejection fraction of 30 % or less , a QRS duration of 130 msec or more , and New York Heart Association class I or II symptoms . Patients were r and omly assigned in a 3:2 ratio to receive CRT plus an implantable cardioverter-defibrillator ( ICD ) ( 1089 patients ) or an ICD alone ( 731 patients ) . The primary end point was death from any cause or a nonfatal heart-failure event ( whichever came first ) . Heart-failure events were diagnosed by physicians who were aware of the treatment assignments , but they were adjudicated by a committee that was unaware of assignments . RESULTS During an average follow-up of 2.4 years , the primary end point occurred in 187 of 1089 patients in the CRT-ICD group ( 17.2 % ) and 185 of 731 patients in the ICD-only group ( 25.3 % ) ( hazard ratio in the CRT-ICD group , 0.66 ; 95 % confidence interval [ CI ] , 0.52 to 0.84 ; P=0.001 ) . The benefit did not differ significantly between patients with ischemic cardiomyopathy and those with nonischemic cardiomyopathy . The superiority of CRT was driven by a 41 % reduction in the risk of heart-failure events , a finding that was evident primarily in a prespecified subgroup of patients with a QRS duration of 150 msec or more . CRT was associated with a significant reduction in left ventricular volumes and improvement in the ejection fraction . There was no significant difference between the two groups in the overall risk of death , with a 3 % annual 
    Output:
    
agent
RESULTS Device diagnostics showed strong correlation with established HF biomarkers and hemodynamic measures .
The findings from this review indicate that device diagnostic parameters predict impending HF much earlier than traditional methods of monitoring do .
Device diagnostics are also more accurate in the early prediction of HF when compared with noninvasive objective measures , particularly when multiple parameters are combined and monitored for trends .
Device diagnostics possess a distinct advantage over traditional methods of monitoring for HF because they allow clinicians to remotely monitor the status of their HF patients without relying on patient compliance for data entry and reporting .
Studies regarding the efficacy of device diagnostic parameters suggest that their integration into clinical practice will provide a more accurate and reliable mechanism for assisting clinicians in risk stratifying and predicting potential episodes of decompensated HF
***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 Heart failure treatment guidelines emphasize daily weight monitoring for patients with heart failure , but data to support this practice are lacking . Using a technology-based heart failure monitoring system , we determined whether daily reporting of weight and symptoms in patients with advanced heart failure would reduce rehospitalization and mortality rates despite aggressive guideline -driven heart failure care . METHODS This was a r and omized , controlled trial . Patients hospitalized with New York Heart Association class III or IV heart failure , with a left ventricular ejection fraction < or = 35 % were r and omized to receive heart failure program care or heart failure program care plus the AlereNet system ( Alere Medical , Reno , Nev ) and followed-up for 6 months . The primary end point was 6-month hospital readmission rate . Secondary end points included mortality , heart failure hospitalization readmission rate , emergency room visitation rate , and quality of life . RESULTS Two hundred eighty patients from 16 heart failure centers across the United States were r and omized : 138 received the  AlereNet system and 142 received st and ard care .  Mean age was 59 + /- 15 years and 68 % were male . The population had very advanced heart failure , New York Heart Association class III ( 75 % ) or IV ( 25 % ) , as evidence d by serum norepinepherine levels , 6-minute walk distance and outcomes .  No differences in hospitalization rates were observed . There was a 56.2 % reduction in mortality ( P < .003 ) for patients r and omized to the AlereNet group . CONCLUSIONS This is the largest multicenter , r and omized trial of a technology-based daily weight and symptom-monitoring system for patients with advanced heart failure . Despite no difference in the primary end point of rehospitalization rates , mortality was significantly reduced for patients r and omized to the AlereNet system without an increase in utilization , despite specialized and aggressive heart failure care in both groups Background — Heart failure is associated with frequent hospitalizations , often result ing from volume overload . Measurement of intrathoracic impedance with an implanted device with an audible patient alert may detect increases in pulmonary fluid retention early . We hypothesized that early intervention could prevent hospitalizations and affect outcome . Methods and Results — We studied 335 patients with chronic heart failure who had undergone implantation of an implantable cardioverter-defibrillator alone ( 18 % ) or with cardiac resynchronization therapy ( 82 % ) . All devices featured a monitoring tool to track changes in intrathoracic impedance ( OptiVol ) and other diagnostic parameters . Patients were r and omized to have information available to physicians and patients as an audible alert in case of preset threshold crossings ( access arm ) or not ( control arm ) . The primary end point was a composite of all-cause mortality and heart failure hospitalizations . During 14.9±5.4 months , this occurred in 48 patients ( 29 % ) in the access arm and in 33 patients ( 20 % ) in the control arm ( P=0.063 ; hazard ratio , 1.52 ; 95 % confidence interval , 0.97–2.37 ) . This was due mainly to more heart failure hospitalizations ( hazard ratio , 1.79 ; 95 % confidence interval , 1.08–2.95 ; P=0.022 ) , whereas the number of deaths was comparable ( 19 versus 15 ; P=0.54 ) . The number of outpatient visits was higher in the access arm ( 250 versus 84 ; P<0.0001 ) , with relatively more signs of heart failure among control patients during outpatient visits . Although the trial was terminated as a result of slow enrollment , a post hoc futility analysis indicated that a positive result would have been unlikely . Conclusion — Use of an implantable diagnostic tool to measure intrathoracic impedance with an audible patient alert did not improve outcome and increased heart failure hospitalizations and outpatient visits in heart failure patients . Clinical Trial Registration — URL : http://www . clinical trials.gov . Unique identifier : NCT 00480077 AIMS To evaluate the utility of intrathoracic impedance monitoring for detecting  heart failure ( HF ) deterioration in patients with an implanted cardiac resynchronization/defibrillation device . METHODS AND RESULTS Patients enrolled in the European InSync Sentry Observational Study were audibly alerted by a device algorithm if a decrease in intrathoracic impedance suggested fluid accumulation . Clinical HF status and device data were assessed at enrolment , during regular follow-up , and if patients presented with an alert or HF deterioration .  Data from 373 subjects were analysed . Fifty-three alert events and a total of 53 clinical events ( HF deterioration defined by worsening of HF signs and symptoms ) were reported during a median of 4.2 months . Adjusted for multiple events per patient , the alert detected clinical HF deterioration with 60 % sensitivity ( 95 % CI 46 - 73 ) and with a positive predictive value of 60 % ( 95 % CI 46 - 73 ) . Higher NYHA class at baseline was predictive for adequate alert events during follow-up ( P < 0.05 ) . In 11 of 20 HF deteriorations without preceding alert , an upstroke of the fluid index occurred without reaching the programmed alert threshold . CONCLUSION A device-based algorithm that alerts patients in case of decreasing intrathoracic impedance facilitates the detection of HF deterioration . Future r and omized , controlled trials are needed to test whether the tailored use of intrathoracic impedance monitoring can improve the ambulatory management of patients with chronic HF and an implanted device Acute heart failure syndromes ( AHFS ) represent the most common discharge diagnoses in adults over age 65 and translate into dramatically increased heart failure – associated morbidity and mortality . Conventional approaches to the early detection of pulmonary and systemic congestion have been shown to be of limited sensitivity . Despite their proven efficacy , disease management and structured telephone support programs have failed to achieve widespread use in part due to their re source intensiveness and reliance upon motivated patients . While once thought to hold great promise , results from recent prospect i ve studies on telemonitoring strategies have proven disappointing . Implantable devices with their capacity to monitor electrophysiologic and hemodynamic parameters over long periods of time and with minimal reliance on patient participation may provide solutions to some of these problems . Conventional electrophysiologic parameters and intrathoracic impedance data are currently available in the growing population of heart failure patients with equipped devices . A variety of implantable hemodynamic monitors are currently under investigation . How best to integrate these devices into a systematic approach to the management of patients before , during , and after AHFS  is yet to be established OBJECTIVES We sought to identify whether home telemonitoring ( HTM ) improves outcomes compared with nurse telephone support ( NTS ) and usual care ( UC ) for patients with heart failure who are at high risk of hospitalization or death . BACKGROUND Heart failure is associated with a high rate of hospitalization and poor prognosis . Telemonitoring could help implement and maintain effective therapy and detect worsening heart failure and its cause promptly to prevent medical crises . METHODS Patients with a recent admission for heart failure and left ventricular ejection fraction ( LVEF ) < 40 % were assigned r and omly to HTM , NTS , or UC in a 2:2:1 ratio . HTM consisted of twice-daily patient self-measurement of weight , blood pressure , heart rate , and rhythm with automated devices linked to a cardiology center . The NTS consisted of specialist nurses who were available to patients by telephone . Primary care physicians delivered UC . The primary end point was days dead or hospitalized with NTS versus HTM at 240 days . RESULTS Of 426 patients r and omly assigned , 48 % were aged > 70 years , mean LVEF was 25 % ( SD , 8) and median plasma N-terminal pro-brain natriuretic peptide was 3,070 pg/ml ( interquartile range 1,285 to 6,749 pg/ml ) . During 240 days of follow-up , 19.5 % , 15.9 % , and 12.7 % of days were lost as the result of death or hospitalization for UC , NTS , and HTM , respectively ( no significant difference ) . The number of admissions and mortality were similar among patients r and omly assigned to NTS or HTM , but the mean duration of admissions was reduced by 6 days ( 95 % confidence interval 1 to 11 ) with HTM . Patients r and omly assigned to receive UC had higher one-year mortality ( 45 % ) than patients assigned to receive NTS ( 27 % ) or HTM ( 29 % ) ( p = 0.032 ) . CONCLUSIONS Further investigation and refinement of the application of HTM are warranted because it may be a valuable role for the management of selected patients with heart failure BACKGROUND We performed a prospect i ve , r and omized investigation assessing the incremental effect of automated health monitoring ( AHM ) technology over and above that of a previously described nurse directed heart failure ( HF ) disease management program . The AHM system measured and transmitted body weight , blood pressure , and heart rate data as well as subjective patient self- assessment s via a st and ard telephone line to a central server . METHODS AND RESULTS A total of 188 consented and eligible patients were r and omized between intervention and control groups in 1:1 ratio . Subjects r and omized to the control arm received the Specialized Primary and Networked Care in Heart Failure ( SPAN-CHF ) heart failure disease management program . Subjects r and omized to the intervention arm received the SPAN-CHF disease management program in conjunction with the AHM system . The primary end point was prespecified as the relative event rate of HF hospitalization between intervention and control groups at 90 days . The relative event rate of HF hospitalization for the intervention group compared with controls was 0.50 ( 95%CI [ 0.25 - 0.99 ] , P = .05 ) . CONCLUSIONS Short-term reductions in the heart failure hospitalization rate were associated with the use of automated home monitoring equipment . Long-term benefits in this model remain to be studied BACKGROUND Heart failure is a common and important cause of morbidity and mortality . Disease management offers promise in reducing the need for hospitalization and improving quality of life for heart failure patients , but experimental data on the efficacy of such programs are limited . METHODS AND RESULTS A total of 151 patients hospitalized with heart failure were r and omized to usual care or scheduled telephone calls by specially trained nurses promoting self-management and guideline -based therapy as prescribed by primary physicians . Nurses also screened patients for heart failure exacerbations , which they managed with supplemental diuretics or by contacting the primary physician for instructions . Outcomes included time to hospital encounter , mortality , number and cost of hospitalizations , functional status , and satisfaction with care . Intervention patients had a longer time to encounter ( hazard ratio [ HR ] = 0.67 ; 95 % confidence interval [ CI ] 0.47 - 0.96 ; P = .029 ) , hospital readmission ( HR = 0.67 ; CI 0.46 - 0.99 ; P = .045 ) , and heart failure-specific readmission ( HR = 0.62 ; CI 0.38 - 1.03 ; P = .063 ) . The number of admissions , hospital days , and hospital costs were significantly lower during the first 6 months after intervention but not at 1 year . The intervention had little effect on functional status , mortality , and satisfaction with care . CONCLUSION A nurse-administered , telephone-based disease management program delayed subsequent health care encounters , but had minimal impact on other outcomes BACKGROUND This trial was design ed to determine whether cardiac-resynchronization therapy ( CRT ) with biventricular pacing would reduce the risk of death or heart-failure events in patients with mild cardiac symptoms , a reduced ejection fraction , and a wide QRS complex . METHODS During a 4.5-year period , we enrolled and followed 1820 patients with ischemic or nonischemic cardiomyopathy , an ejection fraction of 30 % or less , a QRS duration of 130 msec or more , and New York Heart Association class I or II symptoms . Patients were r and omly assigned in a 3:2 ratio to receive CRT plus an implantable cardioverter-defibrillator ( ICD ) ( 1089 patients ) or an ICD alone ( 731 patients ) . The primary end point was death from any cause or a nonfatal heart-failure event ( whichever came first ) . Heart-failure events were diagnosed by physicians who were aware of the treatment assignments , but they were adjudicated by a committee that was unaware of assignments . RESULTS During an average follow-up of 2.4 years , the primary end point occurred in 187 of 1089 patients in the CRT-ICD group ( 17.2 % ) and 185 of 731 patients in the ICD-only group ( 25.3 % ) ( hazard ratio in the CRT-ICD group , 0.66 ; 95 % confidence interval [ CI ] , 0.52 to 0.84 ; P=0.001 ) . The benefit did not differ significantly between patients with ischemic cardiomyopathy and those with nonischemic cardiomyopathy . The superiority of CRT was driven by a 41 % reduction in the risk of heart-failure events , a finding that was evident primarily in a prespecified subgroup of patients with a QRS duration of 150 msec or more . CRT was associated with a significant reduction in left ventricular volumes and improvement in the ejection fraction . There was no significant difference between the two groups in the overall risk of death , with a 3 % annual 
    Output:
    