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 Hospital admissions for heart failure are common and readmission rates are high . Many admissions and readmissions may be avoidable , so that alternative strategies are needed to improve long-term management . METHODS We conducted a r and omized trial of the effect of a guideline -based intervention on rates of readmission within 90 days of hospital discharge and costs of care for patients who were hospitalized due to decompensated heart failure . The intervention consisted of comprehensive education of the patient and family , a prescribed diet and intensive application of guidelines ' recommendations on pharmacological therapy . The intervention started before discharge and continued thereafter with follow-up visits for up to 3 months . Two hundred and nine guideline -managed patients were compared to 209 concurrent normally-discharged patients . RESULTS Patients in the study group were more prescribed beta-blockers , ACE-inhibitors , angiotensin receptor blockers , and spironolactone . Sixteen patients ( 8 % ) in the intervention group and 31 ( 15 % ) among controls were readmitted for DRG 127 , within 3 months of discharge ( Fisher 's exact test , p < 0.01 ) , while the 6-month mortality rate was similar between groups ( 9 and 11.5 % respectively ) . Quality of life significantly improved from 5.6 + /- 1.0 to 6.1 + /- 1.9 ( Mann-Whitney U-test , p < 0.05 ) . The overall costs of care were lower for guideline -managed patients ( 110 vs 150 Euro per patient per month ) , due to the lower readmission rates . CONCLUSIONS Our study showed that a guideline -based management program for patients with heart failure at discharge improves quality of life and reduces readmission for DRG 127 and total bed days , allowing relevant cost savings 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 Aim Multidisciplinary disease management programmes ( MDPs ) for heart failure have been shown to be effective in Western countries . However , it is not known whether they improve outcomes in a high population density country with a national health insurance programme . Methods In total , 349 patients hospitalized because of heart failure were r and omized into  control  and MDP groups . All-cause death and re-hospitalization related to heart failure were analyzed . The median follow-up period was approximately 2 years . Results Mean patient age was 60 years ; 31 % were women ; and 50 % of patients had coronary artery disease . MDP was associated with fewer all-cause deaths [ hazard ratio ( HR ) = 0.49 , 95 % confidence interval ( CI ) = 0.27–0.91 , P = 0.02 ] and heart failure-related re-hospitalizations ( HR = 0.44 , 95 % CI = 0.25–0.77 , P = 0.004 ) . MDP was still associated with better outcomes for all-cause death ( HR = 0.53 , 95 % CI = 0.29–0.98 , P = 0.04 ) and heart failure-related re-hospitalization ( HR = 0.46 , 95 % CI = 0.26–0.81 , P = 0.007 ) , after adjusting for age , diuretics , diabetes mellitus , chronic kidney disease , hypertension , sodium , and albumin . However , MDPs ’ effect on all-cause mortality and heart failure-related re-hospitalization was significantly attenuated after adjusting for angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers or & bgr;-blockers . A stratified analysis showed that MDP combined with guideline -based medication had synergistic effects . Conclusions MDP is effective in lowering all-cause mortality and re-hospitalization rates related to heart failure under a national health insurance programme . MDP synergistically improves the effectiveness of guidelines -based medications for heart failure BACKGROUND Patients with heart failure ( HF ) experience depressive symptoms that contribute to poorer outcomes . We tested the effects of a brief cognitive therapy intervention on depressive symptoms , negative thinking , health-related quality of life , and cardiac event-free survival . METHODS AND RESULTS Hospitalized patients with depressive symptoms ( n = 41 , 66 ± 11 years , 45 % female , 81 % New York Heart Association Class III/IV ) were r and omly assigned  to control group or a brief , nurse-delivered cognitive therapy intervention , delivered during hospitalization and followed by a 1-week booster phone call  . Depressive symptoms , negative thinking , and health-related quality of life were measured at 1 week and 3 months . Cardiac event-free survival was assessed at 3 months . Mixed models repeated measures analysis of variance , Kaplan-Meier , and Cox regression were used for data analysis . There were significant improvements in depressive symptoms and health-related quality of life in both groups but no interactions between group and time . The control group had shorter 3-month cardiac event-free survival ( 40 % versus 80 % , P < .05 ) and a 3.5 greater hazard of experiencing a cardiac event ( P = .04 ) than the intervention group . CONCLUSION Nurses can deliver a brief intervention to hospitalized patients with heart failure that may improve short-term , event-free survival . Future research is needed to verify these results with a larger sample size 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 INTRODUCTION AND OBJECTIVES Multidisciplinary strategies for the management of heart failure ( HF ) improve outcomes . We aim ed to evaluate the effectiveness of noninvasive home telemonitoring in ambulatory patients with HF already included in a structured multidisciplinary HF program . METHODS Prospect i ve intervention study with before/after comparison design of an interactive telemedicine platform in HF patients , r and omized 1:1 into two groups : A ) Motiva System with educational videos , motivational messages , and question naires , and B ) Motiva System + self monitoring of blood pressure , heart rate , and weight . Hospitalizations were compared over 12 months prior to and post study inclusion . Quality of life was evaluated using the generic EuroQoL visual analogue scale and the specific question naire Minnesota Living With Heart Failure Question naire . RESULTS There were 92 patients included ( 71 % male ; 66.3 ± 11.5 years ; 71 % ischemic aetiology ) . During real-time telemonitoring over 11.8 months ( interquartile range 8.6 - 12 ) , 14,730 question na 
    Output:
    
agent
Main Findings : The results indicate that an intervention involving any human factor principles may nearly double an individual ’s probability of not being readmitted .
Principal Conclusions : Interventions with human factor principles reduce readmissions among HF patients .
***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 Hospital admissions for heart failure are common and readmission rates are high . Many admissions and readmissions may be avoidable , so that alternative strategies are needed to improve long-term management . METHODS We conducted a r and omized trial of the effect of a guideline -based intervention on rates of readmission within 90 days of hospital discharge and costs of care for patients who were hospitalized due to decompensated heart failure . The intervention consisted of comprehensive education of the patient and family , a prescribed diet and intensive application of guidelines ' recommendations on pharmacological therapy . The intervention started before discharge and continued thereafter with follow-up visits for up to 3 months . Two hundred and nine guideline -managed patients were compared to 209 concurrent normally-discharged patients . RESULTS Patients in the study group were more prescribed beta-blockers , ACE-inhibitors , angiotensin receptor blockers , and spironolactone . Sixteen patients ( 8 % ) in the intervention group and 31 ( 15 % ) among controls were readmitted for DRG 127 , within 3 months of discharge ( Fisher 's exact test , p < 0.01 ) , while the 6-month mortality rate was similar between groups ( 9 and 11.5 % respectively ) . Quality of life significantly improved from 5.6 + /- 1.0 to 6.1 + /- 1.9 ( Mann-Whitney U-test , p < 0.05 ) . The overall costs of care were lower for guideline -managed patients ( 110 vs 150 Euro per patient per month ) , due to the lower readmission rates . CONCLUSIONS Our study showed that a guideline -based management program for patients with heart failure at discharge improves quality of life and reduces readmission for DRG 127 and total bed days , allowing relevant cost savings 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 Aim Multidisciplinary disease management programmes ( MDPs ) for heart failure have been shown to be effective in Western countries . However , it is not known whether they improve outcomes in a high population density country with a national health insurance programme . Methods In total , 349 patients hospitalized because of heart failure were r and omized into  control  and MDP groups . All-cause death and re-hospitalization related to heart failure were analyzed . The median follow-up period was approximately 2 years . Results Mean patient age was 60 years ; 31 % were women ; and 50 % of patients had coronary artery disease . MDP was associated with fewer all-cause deaths [ hazard ratio ( HR ) = 0.49 , 95 % confidence interval ( CI ) = 0.27–0.91 , P = 0.02 ] and heart failure-related re-hospitalizations ( HR = 0.44 , 95 % CI = 0.25–0.77 , P = 0.004 ) . MDP was still associated with better outcomes for all-cause death ( HR = 0.53 , 95 % CI = 0.29–0.98 , P = 0.04 ) and heart failure-related re-hospitalization ( HR = 0.46 , 95 % CI = 0.26–0.81 , P = 0.007 ) , after adjusting for age , diuretics , diabetes mellitus , chronic kidney disease , hypertension , sodium , and albumin . However , MDPs ’ effect on all-cause mortality and heart failure-related re-hospitalization was significantly attenuated after adjusting for angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers or & bgr;-blockers . A stratified analysis showed that MDP combined with guideline -based medication had synergistic effects . Conclusions MDP is effective in lowering all-cause mortality and re-hospitalization rates related to heart failure under a national health insurance programme . MDP synergistically improves the effectiveness of guidelines -based medications for heart failure BACKGROUND Patients with heart failure ( HF ) experience depressive symptoms that contribute to poorer outcomes . We tested the effects of a brief cognitive therapy intervention on depressive symptoms , negative thinking , health-related quality of life , and cardiac event-free survival . METHODS AND RESULTS Hospitalized patients with depressive symptoms ( n = 41 , 66 ± 11 years , 45 % female , 81 % New York Heart Association Class III/IV ) were r and omly assigned  to control group or a brief , nurse-delivered cognitive therapy intervention , delivered during hospitalization and followed by a 1-week booster phone call  . Depressive symptoms , negative thinking , and health-related quality of life were measured at 1 week and 3 months . Cardiac event-free survival was assessed at 3 months . Mixed models repeated measures analysis of variance , Kaplan-Meier , and Cox regression were used for data analysis . There were significant improvements in depressive symptoms and health-related quality of life in both groups but no interactions between group and time . The control group had shorter 3-month cardiac event-free survival ( 40 % versus 80 % , P < .05 ) and a 3.5 greater hazard of experiencing a cardiac event ( P = .04 ) than the intervention group . CONCLUSION Nurses can deliver a brief intervention to hospitalized patients with heart failure that may improve short-term , event-free survival . Future research is needed to verify these results with a larger sample size 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 INTRODUCTION AND OBJECTIVES Multidisciplinary strategies for the management of heart failure ( HF ) improve outcomes . We aim ed to evaluate the effectiveness of noninvasive home telemonitoring in ambulatory patients with HF already included in a structured multidisciplinary HF program . METHODS Prospect i ve intervention study with before/after comparison design of an interactive telemedicine platform in HF patients , r and omized 1:1 into two groups : A ) Motiva System with educational videos , motivational messages , and question naires , and B ) Motiva System + self monitoring of blood pressure , heart rate , and weight . Hospitalizations were compared over 12 months prior to and post study inclusion . Quality of life was evaluated using the generic EuroQoL visual analogue scale and the specific question naire Minnesota Living With Heart Failure Question naire . RESULTS There were 92 patients included ( 71 % male ; 66.3 ± 11.5 years ; 71 % ischemic aetiology ) . During real-time telemonitoring over 11.8 months ( interquartile range 8.6 - 12 ) , 14,730 question na 
    Output:
    