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: Aims Multiple trials have shown that implantable cardioverter defibrillators ( ICDs ) prolong survival in secondary and primary prevention population s. However , in spite of the efficacy of these devices in terminating life-threatening arrhythmias , total mortality remains high . Methods and results We evaluated 1703 patients ( mean age : 67 ± 12 years , 82 % male ) with conventional ICD indications , who were enrolled and followed between 2001 and 2004 at 128 US centres . Patients were followed for up to a year , and vital status was obtained for 1655 patients ( 97 % , median follow-up : 377 days ) . There were 183 deaths within 1 year of ICD implantation ( 1-year mortality rate : 16 % ) . Predictors of mortality included a history of atrial fibrillation ( AF , P < 0.0001 ) , diabetes ( P = 0.0001 ) , failure to use cholesterol-lowering medications ( P < 0.001 ) , use of digitalis and derivatives ( P < 0.0001 ) , use of diuretics ( P < 0.0001 ) , low body mass index ( BMI , P < 0.0001 ) , increasing age ( P < 0.0001 ) , low left ventricular ejection fraction ( P < 0.0001 ) , low activity hours ( P < 0.0001 ) , elevated resting heart rate ( P = 0.014 ) , low mean arterial pressure ( MAP , P = 0.007 ) , and poor functional status ( New York Heart Association class , P < 0.0001 ) . In multivariate modelling , AF ( P ≤ 0.001 ) , diabetes ( P = 0.004 ) , BMI ( P = 0.001 ) , MAP ( P = 0.040 ) , and functional class ( P = 0.006 ) predicted mortality . Conclusion In this population undergoing ICD implantation , poor functional status , low MAP , diabetes , low BMI , and AF were strongly associated with death within a year Objective To develop and vali date a risk algorithm ( QStroke ) to estimate risk of stroke or transient ischaemic attack in patients without prior stroke or transient ischaemic attack at baseline ; to compare ( a ) QStroke with CHADS2 and CHA2DS2VASc scores in patients with atrial fibrillation and ( b ) the performance of QStroke with the Framingham stroke score in the full population free of stroke or transient ischaemic attack . Design Prospect i ve open cohort study using routinely collected data from general practice during the study period 1 January 1998 to 1 August 2012 . Setting 451 general practice s in Engl and and Wales contributing to the national Q Research data base to develop the algorithm and 225 different Q Research practice s to vali date the algorithm . Participants 3.5 million patients aged 25 - 84 years with 24.8 million person years in the derivation cohort who experienced 77 578 stroke events . For the validation cohort , we identified 1.9 million patients aged 25 - 84 years with 12.7 million person years who experienced 38 404 stroke events . We excluded patients with a prior diagnosis of stroke or transient ischaemic attack and those prescribed oral anticoagulants at study entry . Main outcome measures Incident diagnosis of stroke or transient ischaemic attack recorded in general practice records or linked death certificates during follow-up . Risk factors Self assigned ethnicity , age , sex , smoking status , systolic blood pressure , ratio of total serum cholesterol to high density lipoprotein cholesterol concentrations , body mass index , family history of coronary heart disease in first degree relative under 60 years , Townsend deprivation score , treated hypertension , type 1 diabetes , type 2 diabetes , renal disease , rheumatoid arthritis , coronary heart disease , congestive cardiac failure , valvular heart disease , and atrial fibrillation Results The QStroke algorithm explained 57 % of the variation in women and 55 % in men without a prior stroke . The D statistic for QStroke was 2.4 in women and 2.3 in men . QStroke had improved performance on all measures of discrimination and calibration compared with the Framingham score in patients without a prior stroke . Among patients with atrial fibrillation , levels of discrimination were lower , but QStroke had some improved performance on all measures of discrimination compared with CHADS2 and CHA2DS2VASc . Conclusion QStroke provides a valid measure of absolute stroke risk in the general population of patients free of stroke or transient ischaemic attack as shown by its performance in a separate validation cohort . QStroke also shows some improvement on current risk scoring methods , CHADS2 and CHA2DS2VASc , for the subset of patients with atrial fibrillation for whom anticoagulation may be required . Further research is needed to evaluate the cost effectiveness of using these algorithms in primary care Atrial fibrillation ( AF ) has been established as an independent predictor of long-term mortality after acute myocardial infa rct ion . However , this is less well defined across the whole spectrum of acute coronary syndromes ( ACSs ) . The Acute Coronary Syndrome Prospect i ve Audit is a prospect i ve multicenter registry with 12-month outcome data for 3,393 patients ( 755 with ST-segment elevation myocardial infa rct ion , 1942 with high-risk non-ST-segment elevation ACS [ NSTE-ACS ] , and 696 with intermediate-risk NSTE-ACS ) . A total of 149 patients ( 4.4 % ) had new-onset AF and 387 ( 11.4 % ) had previous AF .  New-onset AF was more , and previous AF was less frequent in those with ST-segment elevation myocardial infa rct ion than in those with high-risk NSTE-ACS or intermediate-risk NSTE-ACS ( p < 0.001 ) . Compared to patients without arrhythmia , patients with new-onset AF and previous AF were significantly older and had more high-risk features at presentation ( p < 0.004 ) . Patients with new-onset AF more often had left main coronary artery disease , result ing in a greater rate of surgical revascularization ( p < 0.001 ) . Only new-onset AF result ed in adverse in-hospital outcomes ( p < 0.001 ) . Only patients with previous AF had greater long-term mortality ( hazard ratio 1.42 , p < 0.05 ) . New-onset AF was only associated with a worse long-term composite outcome ( hazard ratio 1.66 , p = 0.004 ) . However , the odds ratio for the composite outcome was greatest for patients with new-onset AF with intermediate-risk NSTE-ACS ( odds ratio 3.9 , p = 0.02 ) than for those with high-risk NSTE-ACS ( odds ratio 2.0 , p = 0.01 ) or ST-segment elevation myocardial infa rct ion ( odds ratio 1.4 , p = 0.4 ) . In conclusion , new-onset AF was associated with worse short-term outcomes and previous AF was associated with greater mortality even at long-term follow-up . The prognostic burden of new-onset AF differed with the type of ACS presentation BACKGROUND Atrial fibrillation ( AF ) is a common arrhythmia in patients with heart failure ( HF ) , but its prognostic importance is controversial . The effect of AF on long-term outcomes , including mortality and rehospitalization , among unselected HF patients hospitalized with HF in routine clinical practice in Japan was assessed in the present study . METHODS AND RESULTS The Japanese Cardiac Registry of Heart Failure in Cardiology ( JCARE-CARD ) prospect ively studied the characteristics and treatment strategies of a broad sample of patients hospitalized with worsening HF and the outcomes were followed with an average of 2.4 years of follow-up . The study cohort ( n=2,659 ) was grouped according to the presence ( n=937 ; 35.2 % ) or absence ( n=1,722 ; 64.8 % ) of AF at baseline . After multivariable adjustment , patients with and without AF had a comparable risk for all-cause death ( adjusted hazard ratio ( HR ) 0.931 , 95 % confidence interval ( CI ) 0.690 - 1.258 , P=0.643 ) , cardiac death ( adjusted HR 0.949 , 95%CI 0.655 - 1.377 , P=0.784 ) , rehospitalization because of the worsening HF ( adjusted HR 1.028 , 95%CI 0.816 - 1.295 , P=0.816 ) , and all-cause death or rehospitalization ( adjusted HR 1.039 , 95%CI 0.842 - 1.281 , P=0.722 ) . CONCLUSIONS Among patients hospitalized for HF in Japan , AF was common , but was not an independent risk for long-term adverse outcomes , including death or rehospitalization , in routine clinical practice BACKGROUND Atrial fibrillation is the most common supraventricular arrhythmia in patients with acute myocardial infa rct ion . Recent advances in pharmacological treatment of myocardial infa rct ion may have changed the impact of this arrhythmia . OBJECTIVE To assess the incidence and prognosis of atrial fibrillation complicating myocardial infa rct ion in a large population of patients receiving optimal treatment , including angiotensin converting enzyme ( ACE ) inhibitors .  METHODS Data were derived from the GISSI-3 trial , which included 17 944 patients within the first 24 hours after acute myocardial infa rct ion . Atrial fibrillation was recorded during the hospital stay , and follow up visits were planned at six weeks and six months . Survival of the patients at four years was assessed through census offices . RESULTS The incidence of in-hospital atrial fibrillation or flutter was 7.8 % . Atrial fibrillation was associated with indicators of a worse prognosis ( age > 70 years , female sex , higher Killip class , previous myocardial infa rct ion , treated hypertension , high systolic blood pressure at entry , insulin dependent diabetes , signs or symptoms of heart failure ) and with some adverse clinical events ( reinfa rct ion , sustained ventricular tachycardia , ventricular fibrillation ) . After adjustment for other prognostic factors , atrial fibrillation remained an independent predictor of increased in-hospital mortality : 12.6%v 5 % , adjusted relative risk ( RR ) 1.98 , 95 % confidence interval ( CI ) 1.67 to 2.34 . Data on long term mortality ( four years after acute myocardial infa rct ion ) confirmed the persistent negative influence of atrial fibrillation ( RR 1.78 , 95 % CI 1.60 to 1.99 ) . CONCLUSIONS Atrial fibrillation is an indicator of worse prognosis after acute myocardial infa rct ion , both in the short term and in the long term , even in an unselected population OBJECTIVES Preoperative atrial fibrillation ( PAF )  has been associated with poorer early and mid-term outcomes after isolated valvular or coronary artery bypass graft surgery . Few studies , however , have evaluated the impact of PAF on early and mid-term outcomes after  concomitant aortic valve replacement and coronary aortic bypass graft ( AVR-CABG ) surgery . METHODS Data obtained prospect ively between June 2001 and December 2009 by the Australian and New Zeal and Society of Cardiac and Thoracic Surgeons National Cardiac Surgery Data base Program was retrospectively analysed . Patients who underwent concomitant atrial arrhythmia surgery/ablation were excluded . Demographic and operative data were compared between patients undergoing concomitant AVR-CABG  who presented with PAF and those who did not using chi-square and t-tests . The independent impact of PAF on 12 short-term complications and mid-term mortality was determined using binary logistic and Cox regression , respectively . RESULTS Concomitant AVR-CABG surgery was performed in 2563 patients ; 322 ( 12.6 % ) presented with PAF . PAF patients were generally older ( mean age 76 vs 74 years ; P < 0.001 ) and presented more often with comorbidities including congestive heart failure , chronic pulmonary disease and cerebrovascular disease ( all P < 0.05 ) . PAF was associated with 30-day mortality on univariate analysis ( P = 0.019 ) but not multivariate analysis ( P = 0.53 ) . The incidence of early complications was not significantly higher in the PAF group . PAF was independently associated with reduced mid-term survival ( HR , 1.58 ; 95 % CI , 1.14 - 2.19 ; P = 0.006 ) . CONCLUSIONS PAF is associated with reduced mid-term survival after concomitant AVR-CABG surgery .  Patients with PAF undergoing AVR-CABG  should be considered for a concomitant surgical ablation procedure Failure to expeditiously diagnose atrial fibrillation ( AF ) as the cause of ischemic stroke has unclear consequences . We 
    Output:
    
agent
Among the outcomes examined , the highest absolute risk increase was for heart failure .
Associations between atrial fibrillation and included outcomes were broadly consistent across subgroups and in sensitivity analyses .
Atrial fibrillation is associated with an increased risk of death and an increased risk of cardiovascular and renal disease .
***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: Aims Multiple trials have shown that implantable cardioverter defibrillators ( ICDs ) prolong survival in secondary and primary prevention population s. However , in spite of the efficacy of these devices in terminating life-threatening arrhythmias , total mortality remains high . Methods and results We evaluated 1703 patients ( mean age : 67 ± 12 years , 82 % male ) with conventional ICD indications , who were enrolled and followed between 2001 and 2004 at 128 US centres . Patients were followed for up to a year , and vital status was obtained for 1655 patients ( 97 % , median follow-up : 377 days ) . There were 183 deaths within 1 year of ICD implantation ( 1-year mortality rate : 16 % ) . Predictors of mortality included a history of atrial fibrillation ( AF , P < 0.0001 ) , diabetes ( P = 0.0001 ) , failure to use cholesterol-lowering medications ( P < 0.001 ) , use of digitalis and derivatives ( P < 0.0001 ) , use of diuretics ( P < 0.0001 ) , low body mass index ( BMI , P < 0.0001 ) , increasing age ( P < 0.0001 ) , low left ventricular ejection fraction ( P < 0.0001 ) , low activity hours ( P < 0.0001 ) , elevated resting heart rate ( P = 0.014 ) , low mean arterial pressure ( MAP , P = 0.007 ) , and poor functional status ( New York Heart Association class , P < 0.0001 ) . In multivariate modelling , AF ( P ≤ 0.001 ) , diabetes ( P = 0.004 ) , BMI ( P = 0.001 ) , MAP ( P = 0.040 ) , and functional class ( P = 0.006 ) predicted mortality . Conclusion In this population undergoing ICD implantation , poor functional status , low MAP , diabetes , low BMI , and AF were strongly associated with death within a year Objective To develop and vali date a risk algorithm ( QStroke ) to estimate risk of stroke or transient ischaemic attack in patients without prior stroke or transient ischaemic attack at baseline ; to compare ( a ) QStroke with CHADS2 and CHA2DS2VASc scores in patients with atrial fibrillation and ( b ) the performance of QStroke with the Framingham stroke score in the full population free of stroke or transient ischaemic attack . Design Prospect i ve open cohort study using routinely collected data from general practice during the study period 1 January 1998 to 1 August 2012 . Setting 451 general practice s in Engl and and Wales contributing to the national Q Research data base to develop the algorithm and 225 different Q Research practice s to vali date the algorithm . Participants 3.5 million patients aged 25 - 84 years with 24.8 million person years in the derivation cohort who experienced 77 578 stroke events . For the validation cohort , we identified 1.9 million patients aged 25 - 84 years with 12.7 million person years who experienced 38 404 stroke events . We excluded patients with a prior diagnosis of stroke or transient ischaemic attack and those prescribed oral anticoagulants at study entry . Main outcome measures Incident diagnosis of stroke or transient ischaemic attack recorded in general practice records or linked death certificates during follow-up . Risk factors Self assigned ethnicity , age , sex , smoking status , systolic blood pressure , ratio of total serum cholesterol to high density lipoprotein cholesterol concentrations , body mass index , family history of coronary heart disease in first degree relative under 60 years , Townsend deprivation score , treated hypertension , type 1 diabetes , type 2 diabetes , renal disease , rheumatoid arthritis , coronary heart disease , congestive cardiac failure , valvular heart disease , and atrial fibrillation Results The QStroke algorithm explained 57 % of the variation in women and 55 % in men without a prior stroke . The D statistic for QStroke was 2.4 in women and 2.3 in men . QStroke had improved performance on all measures of discrimination and calibration compared with the Framingham score in patients without a prior stroke . Among patients with atrial fibrillation , levels of discrimination were lower , but QStroke had some improved performance on all measures of discrimination compared with CHADS2 and CHA2DS2VASc . Conclusion QStroke provides a valid measure of absolute stroke risk in the general population of patients free of stroke or transient ischaemic attack as shown by its performance in a separate validation cohort . QStroke also shows some improvement on current risk scoring methods , CHADS2 and CHA2DS2VASc , for the subset of patients with atrial fibrillation for whom anticoagulation may be required . Further research is needed to evaluate the cost effectiveness of using these algorithms in primary care Atrial fibrillation ( AF ) has been established as an independent predictor of long-term mortality after acute myocardial infa rct ion . However , this is less well defined across the whole spectrum of acute coronary syndromes ( ACSs ) . The Acute Coronary Syndrome Prospect i ve Audit is a prospect i ve multicenter registry with 12-month outcome data for 3,393 patients ( 755 with ST-segment elevation myocardial infa rct ion , 1942 with high-risk non-ST-segment elevation ACS [ NSTE-ACS ] , and 696 with intermediate-risk NSTE-ACS ) . A total of 149 patients ( 4.4 % ) had new-onset AF and 387 ( 11.4 % ) had previous AF .  New-onset AF was more , and previous AF was less frequent in those with ST-segment elevation myocardial infa rct ion than in those with high-risk NSTE-ACS or intermediate-risk NSTE-ACS ( p < 0.001 ) . Compared to patients without arrhythmia , patients with new-onset AF and previous AF were significantly older and had more high-risk features at presentation ( p < 0.004 ) . Patients with new-onset AF more often had left main coronary artery disease , result ing in a greater rate of surgical revascularization ( p < 0.001 ) . Only new-onset AF result ed in adverse in-hospital outcomes ( p < 0.001 ) . Only patients with previous AF had greater long-term mortality ( hazard ratio 1.42 , p < 0.05 ) . New-onset AF was only associated with a worse long-term composite outcome ( hazard ratio 1.66 , p = 0.004 ) . However , the odds ratio for the composite outcome was greatest for patients with new-onset AF with intermediate-risk NSTE-ACS ( odds ratio 3.9 , p = 0.02 ) than for those with high-risk NSTE-ACS ( odds ratio 2.0 , p = 0.01 ) or ST-segment elevation myocardial infa rct ion ( odds ratio 1.4 , p = 0.4 ) . In conclusion , new-onset AF was associated with worse short-term outcomes and previous AF was associated with greater mortality even at long-term follow-up . The prognostic burden of new-onset AF differed with the type of ACS presentation BACKGROUND Atrial fibrillation ( AF ) is a common arrhythmia in patients with heart failure ( HF ) , but its prognostic importance is controversial . The effect of AF on long-term outcomes , including mortality and rehospitalization , among unselected HF patients hospitalized with HF in routine clinical practice in Japan was assessed in the present study . METHODS AND RESULTS The Japanese Cardiac Registry of Heart Failure in Cardiology ( JCARE-CARD ) prospect ively studied the characteristics and treatment strategies of a broad sample of patients hospitalized with worsening HF and the outcomes were followed with an average of 2.4 years of follow-up . The study cohort ( n=2,659 ) was grouped according to the presence ( n=937 ; 35.2 % ) or absence ( n=1,722 ; 64.8 % ) of AF at baseline . After multivariable adjustment , patients with and without AF had a comparable risk for all-cause death ( adjusted hazard ratio ( HR ) 0.931 , 95 % confidence interval ( CI ) 0.690 - 1.258 , P=0.643 ) , cardiac death ( adjusted HR 0.949 , 95%CI 0.655 - 1.377 , P=0.784 ) , rehospitalization because of the worsening HF ( adjusted HR 1.028 , 95%CI 0.816 - 1.295 , P=0.816 ) , and all-cause death or rehospitalization ( adjusted HR 1.039 , 95%CI 0.842 - 1.281 , P=0.722 ) . CONCLUSIONS Among patients hospitalized for HF in Japan , AF was common , but was not an independent risk for long-term adverse outcomes , including death or rehospitalization , in routine clinical practice BACKGROUND Atrial fibrillation is the most common supraventricular arrhythmia in patients with acute myocardial infa rct ion . Recent advances in pharmacological treatment of myocardial infa rct ion may have changed the impact of this arrhythmia . OBJECTIVE To assess the incidence and prognosis of atrial fibrillation complicating myocardial infa rct ion in a large population of patients receiving optimal treatment , including angiotensin converting enzyme ( ACE ) inhibitors .  METHODS Data were derived from the GISSI-3 trial , which included 17 944 patients within the first 24 hours after acute myocardial infa rct ion . Atrial fibrillation was recorded during the hospital stay , and follow up visits were planned at six weeks and six months . Survival of the patients at four years was assessed through census offices . RESULTS The incidence of in-hospital atrial fibrillation or flutter was 7.8 % . Atrial fibrillation was associated with indicators of a worse prognosis ( age > 70 years , female sex , higher Killip class , previous myocardial infa rct ion , treated hypertension , high systolic blood pressure at entry , insulin dependent diabetes , signs or symptoms of heart failure ) and with some adverse clinical events ( reinfa rct ion , sustained ventricular tachycardia , ventricular fibrillation ) . After adjustment for other prognostic factors , atrial fibrillation remained an independent predictor of increased in-hospital mortality : 12.6%v 5 % , adjusted relative risk ( RR ) 1.98 , 95 % confidence interval ( CI ) 1.67 to 2.34 . Data on long term mortality ( four years after acute myocardial infa rct ion ) confirmed the persistent negative influence of atrial fibrillation ( RR 1.78 , 95 % CI 1.60 to 1.99 ) . CONCLUSIONS Atrial fibrillation is an indicator of worse prognosis after acute myocardial infa rct ion , both in the short term and in the long term , even in an unselected population OBJECTIVES Preoperative atrial fibrillation ( PAF )  has been associated with poorer early and mid-term outcomes after isolated valvular or coronary artery bypass graft surgery . Few studies , however , have evaluated the impact of PAF on early and mid-term outcomes after  concomitant aortic valve replacement and coronary aortic bypass graft ( AVR-CABG ) surgery . METHODS Data obtained prospect ively between June 2001 and December 2009 by the Australian and New Zeal and Society of Cardiac and Thoracic Surgeons National Cardiac Surgery Data base Program was retrospectively analysed . Patients who underwent concomitant atrial arrhythmia surgery/ablation were excluded . Demographic and operative data were compared between patients undergoing concomitant AVR-CABG  who presented with PAF and those who did not using chi-square and t-tests . The independent impact of PAF on 12 short-term complications and mid-term mortality was determined using binary logistic and Cox regression , respectively . RESULTS Concomitant AVR-CABG surgery was performed in 2563 patients ; 322 ( 12.6 % ) presented with PAF . PAF patients were generally older ( mean age 76 vs 74 years ; P < 0.001 ) and presented more often with comorbidities including congestive heart failure , chronic pulmonary disease and cerebrovascular disease ( all P < 0.05 ) . PAF was associated with 30-day mortality on univariate analysis ( P = 0.019 ) but not multivariate analysis ( P = 0.53 ) . The incidence of early complications was not significantly higher in the PAF group . PAF was independently associated with reduced mid-term survival ( HR , 1.58 ; 95 % CI , 1.14 - 2.19 ; P = 0.006 ) . CONCLUSIONS PAF is associated with reduced mid-term survival after concomitant AVR-CABG surgery .  Patients with PAF undergoing AVR-CABG  should be considered for a concomitant surgical ablation procedure Failure to expeditiously diagnose atrial fibrillation ( AF ) as the cause of ischemic stroke has unclear consequences . We 
    Output:
    