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: INTRODUCTION AND OBJECTIVES To assess the efficacy of cardiac rehabilitation with a mixed primary and cardiological care program in patients with low-risk myocardial infa rct ion . PATIENTS AND METHOD The participants in this 12-month prospect i ve study were 153 consecutive patients with low-risk myocardial infa rct ion ( MI ) referred to their primary care center for follow-up care . Of these patients , 113 were referred to a mixed primary and specialized care program that included physical exercise , cardiovascular risk control , an antismoking program , health education talks and psychological evaluation . The other 40 patients served as controls . We analyzed the results after 3 months and 1 year of follow-up . RESULTS There were no differences between the two groups at baseline . After 1 year , improvements were seen in smoking habit ( 4.6 % vs 15.6 % ; P<.05 ) and body mass index ( 26 [ 2 ] vs 29 [ 2 ] ; P<.05 ) . Dyslipidemia , glucose and blood pressure were similar in both groups after follow-up . Greater improvements in the group of patients who participated in the program were seen after 1 year in quality of life ( 78 [ 2 ] vs 91 [ 2 ] ; P<.05 ) , exercise capacity ( 10.3 [ 2 ] vs 8.4 [ 3 ] ; P<<.01 ) and return to active employment ( 84.6 % vs 53.3 % ; P<.05 ) . CONCLUSIONS After 1 year of follow-up , the cardiac rehabilitation program coordinated by cardiological and primary care services for low-risk post-MI patients improved quality of life , and increased exercise tolerance , active employment , and the number of participants who quit smoking . The mixed program also reduced body mass index . These results suggest the need for similar programs BACKGROUND Cardiac rehabilitation ( CR ) is well documented , in r and omised trials , to reduce mortality risk after myocardial infa rct ion ( MI ) . Selection of healthy patients for CR  is a relatively unexplored problem . Our aims were to identify predictors of CR-attendance and to describe the prognosis as concerns mortality , re-admission and invasive treatment among CR-attendees as compared to  CR-non-attendees  . METHODS From a cohort of 138 290 persons aged 30 - 69 years , we identified consecutive MI patients , between 1 April 2000 and 31 March 2002 . There were 206 MI patients , who survived until admission , and among the 200 who survived 30 days , 145 ( 72.5 % ) attended a comprehensive CR programme . Data were obtained from patient charts and from Danish population registers , and as a result we had no non-participation for the study . RESULTS The 2-year mortality proportions for patients surviving the first 30 days of admission were 2.8 and 21.8 % among CR-attendees and CR-non-attendees , respectively ( P < 0.0001 ) . Among CR-non-attendees , there was a smaller fraction having an invasive treatment performed as compared with CR-attendees . By multiple logistic regression controlling for age and sex , CR-attendance was associated with chest pain , whereas CR-non-attendance was associated with low gross income , single living and inverted T-wave in the electrocardiogram . CONCLUSION  CR attendance rate was 72.5 % . Non-attendees have a higher mortality risk , which in part may be attributed to selection of healthy patients . Non-attendees are older and more likely to have atypical symptoms at admission , a low socioeconomic status and to live alone . Special attention is needed to improve CR attendance among such patients Background The prognostic effect of early , comprehensive short-term cardiac rehabilitation on top of current , guideline -adjusted treatment of acute myocardial infa rct ion has not sufficiently been evaluated . Design Prospect i ve cohort study . Methods Within the OMEGA study population , the clinical course of 3560 patients still alive 3 months after acute myocardial infa rct ion were evaluated by comparing patients who had attended to cardiac rehabilitation ( 70.6 % ) with those who did not .  Total mortality and major adverse cerebrovascular and cardiovascular events , as well as non-fatal events , were evaluated within the time period of 4–12 months after hospital admission for acute myocardial infa rct ion . The effect of cardiac rehabilitation on clinical events was estimated by using the propensity score method to adjust for confounding parameters in multivariate analysis . Results Patients participating in cardiac rehabilitation  were younger , more often had acute revascularization  , less often experienced non-ST-elevation myocardial infa rct ion , and less often had a history of diabetes or cardiovascular events . Total mortality ( OR 0.46 , 95 % CI 0.27–0.77 ) and major adverse cerebrovascular and cardiovascular events ( OR 0.53 , 95 % CI 0.38–0.75 ) were significantly lower in the rehabilitation group . Subgroup analysis including major clinical characteristics also revealed significantly reduced rates of total death and major adverse cerebrovascular and cardiovascular events in the rehabilitation group . Conclusions Attendance to early , comprehensive short-term cardiac rehabilitation programmes on top of current guideline -adjusted treatment of acute myocardial infa rct ion is associated with a significantly improved 1-year prognosis Background It is widely believed that cardiac rehabilitation following acute myocardial infa rct ion ( MI ) reduces mortality by approximately 20 % . This belief is based on systematic review s and meta-analyses of mostly small trials undertaken many years ago . Clinical management has been transformed in the past 30–40 years and the findings of historical trials may have little relevance now . Objectives The principal objective was to determine the effect of cardiac rehabilitation , as currently provided , on mortality , morbidity and health-related quality of life in patients following MI . The secondary objectives included seeking programmes that may be more effective and characteristics of patients who may benefit more . Design , setting , patients , outcome measures A multi-centre r and omised controlled trial in representative hospitals in Engl and and Wales compared 1813 patients referred to comprehensive cardiac rehabilitation programmes or discharged to ‘ usual care ’ ( without referral to rehabilitation ) .  The primary outcome measure was all-cause mortality at 2 years . The secondary measures were morbidity , health service use , health-related quality of life , psychological general well-being and lifestyle cardiovascular risk factors at 1 year . Patient entry ran from 1997 to 2000 , follow-up of secondary outcomes to 2001 and of vital status to 2006 . A parallel study compared 331 patients in matched ‘ elective ’ rehabilitation and ‘ elective ’ usual care ( without rehabilitation ) hospitals . Results There were no significant differences between patients referred to rehabilitation and controls in mortality at 2 years ( RR 0.98 , 95 % CI 0.74 to 1.30 ) or after 7–9 years ( 0.99 , 95 % CI 0.85 to 1.15 ) , cardiac events , seven of eight domains of the health-related quality of life scale ( ‘ Short Form 36 ’ , SF36 ) or the psychological general well-being scale . Rehabilitation patients reported slightly less physical activity . No differences between groups were reported in perceived overall quality of cardiac aftercare . Data from the ‘ elective ’ hospitals comparison concurred with these findings . Conclusion In this trial , comprehensive rehabilitation following MI had no important effect on mortality , cardiac or psychological morbidity , risk factors , health-related quality of life or activity . This finding is consistent with systematic review s of all trials reported since 1983 . The value of cardiac rehabilitation as practised in the UK is open to question Objective To observe the prognostic influences of the cardiac rehabilitation ( CR ) program in Korean acute myocardial infa rct ion ( AMI ) patients during the first year after an occurrence of the disease . Method A total of 141 AMI patients who underwent percutaneous coronary intervention ( PCI )  were recruited consecutively for this study and divided into the CR group and the control group . The CR group completed the phase 2 CR program in the hospital for a period of 6 - 8 weeks and maintained self-exercise in their community by exercise prescription for a year after AMI . We performed a prospect i ve comparison of the patients ' demographic data , high sensitive C-reactive protein ( hs-CRP ) level after the 4-month CR program , and the rate of recurrence ( AMI , re-hospitalization , positive coronary angiogram , needed revascularization procedure , or death ) between the two groups . Results Compared to the control group ( 0.33±0.48 mg/dl ) , the hs-CRP level was lower in the CR group ( 0.18±0.32 mg/dl ) after 4 months of exercise . The recurrence rate was lower ( 10 % , 7/69 ) in the CR group , compared to the control group ( 24 % , 17/72 , p<0.05 ) . The number of disease-free days was larger in the CR group ( 354±38.34 ) , compared to the control group ( 316±99.96 , p<0.05 ) . In a comparison of statistical methods used for testing the e quality of two survivor distributions , the CR group showed a lower recurrence rate than the control group ( p<0.05 ) . Conclusion Participation in the CR program design ed for AMI patients who underwent PCI-induced normalization of the serum hs-CRP level and lowering of the recurrence rate by 14 % during the first year Abstract Objectives : The aim was to evaluate the effect of short-term cardiac rehabilitation ( CR ) on clinical events during a 1-year follow-up after acute myocardial infa rct ion . Methods : From the observational , prospect i ve Acute COronary Syndromes ( ACOS ) registry , 4547 consecutive patients after ST-elevation ( STEMI : n = 2432 ) or non-ST-elevation myocardial infa rct ion ( NSTEMI : n = 2115 ) , recruited between June 2000 and December 2002 , were characterised and evaluated for clinical outcomes during a 1-year follow-up . From the STEMI group 67.8 % and from the NSTEMI group 52.3 % participated in cardiac rehabilitation ( CR+ ) . Results : Age > 70 years and previous myocardial infa rct ion were independent predictors not to attend CR in STEMI and NSTEMI patients , whereas early revascularisation ( < 48 hours after hospital admission ) was associated with increased likelihood to undergo CR . Multivariable analysis adjusting for propensity score shows that CR+ was independently associated with a significant reduction of all-cause mortality ( STEMI : OR 0.41 , 95 % CI 0.28–0.60 ; NSTEMI : OR 0.53 , 95 % CI 0.38–0.76 ) and major adverse cardiac and cerebrovascular events ( MACCE ; STEMI : OR 0.66 , 95 % CI 0.49–0.89 ; NSTEMI : OR 0.73 , 95 % CI 0.55–0.98 ) during a 1-year follow-up . Conclusion : The study shows an independent and strong association of CR+ with markedly reduced total mortality and MACCE during a 1-year follow-up after STEMI or NSTEMI . The limitation of the study is that it is not a prospect i ve r and omised trial . Furthermore , unequal distribution of risk factors relevant for long-term prognosis had to be corrected by multivariable analysis adjusting for propensity score BACKGROUND There is increasing interest from review authors about including  non-r and omized studies  ( NRS ) in their systematic review s of health care interventions . This series from the Ottawa Non-R and omized Studies Workshop consists of six papers identifying method ological issues when doing this . AIM To format the guidance from the preceding papers on study design and bias , confounding and meta- analysis , selective reporting , and applicability/directness into checklists of issues for review authors to consider when including NRS in a systematic review . CHECKLISTS Checklists were devised providing frameworks to describe/assess : ( 1 ) study design s based on study design features ; ( 2 ) risk of residual confounding and when to consider meta-analysing data from NRS ; ( 3 ) risk of selective reporting based on the Cochrane framework for detecting selective outcome reporting in trials but extended to selective reporting of analyses ; and ( 4 ) directness of evidence contributed by a study to aid integration of NRS findings into summary of findings tables . SUMMARY The checklists described will allow review groups to operationalize the inclusion of NRS in systematic review s in a more consistent way . The next major step is extending the existing Cochrane Risk of Bias tool so that it can assess the risk of bias to NRS included in a review . Copyright © 2013 John Wiley & Sons , This study examined the effect of the Ornish Program for Reversing Heart Disease and cardiac rehabilitation(CR )  on psychosocialrisk factors and quality of life in patients with confirmedcoronary artery disease . Participants had previously undergone a revascularization procedure . The 84 patients self-selected to participate in the Ornish Program for Reversing Heart Disease ( n = 507 28 ) , CR ( n = 28 ) , or a control group ( n = 28 ) . Twelve psych 
    Output:
    
agent
***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: INTRODUCTION AND OBJECTIVES To assess the efficacy of cardiac rehabilitation with a mixed primary and cardiological care program in patients with low-risk myocardial infa rct ion . PATIENTS AND METHOD The participants in this 12-month prospect i ve study were 153 consecutive patients with low-risk myocardial infa rct ion ( MI ) referred to their primary care center for follow-up care . Of these patients , 113 were referred to a mixed primary and specialized care program that included physical exercise , cardiovascular risk control , an antismoking program , health education talks and psychological evaluation . The other 40 patients served as controls . We analyzed the results after 3 months and 1 year of follow-up . RESULTS There were no differences between the two groups at baseline . After 1 year , improvements were seen in smoking habit ( 4.6 % vs 15.6 % ; P<.05 ) and body mass index ( 26 [ 2 ] vs 29 [ 2 ] ; P<.05 ) . Dyslipidemia , glucose and blood pressure were similar in both groups after follow-up . Greater improvements in the group of patients who participated in the program were seen after 1 year in quality of life ( 78 [ 2 ] vs 91 [ 2 ] ; P<.05 ) , exercise capacity ( 10.3 [ 2 ] vs 8.4 [ 3 ] ; P<<.01 ) and return to active employment ( 84.6 % vs 53.3 % ; P<.05 ) . CONCLUSIONS After 1 year of follow-up , the cardiac rehabilitation program coordinated by cardiological and primary care services for low-risk post-MI patients improved quality of life , and increased exercise tolerance , active employment , and the number of participants who quit smoking . The mixed program also reduced body mass index . These results suggest the need for similar programs BACKGROUND Cardiac rehabilitation ( CR ) is well documented , in r and omised trials , to reduce mortality risk after myocardial infa rct ion ( MI ) . Selection of healthy patients for CR  is a relatively unexplored problem . Our aims were to identify predictors of CR-attendance and to describe the prognosis as concerns mortality , re-admission and invasive treatment among CR-attendees as compared to  CR-non-attendees  . METHODS From a cohort of 138 290 persons aged 30 - 69 years , we identified consecutive MI patients , between 1 April 2000 and 31 March 2002 . There were 206 MI patients , who survived until admission , and among the 200 who survived 30 days , 145 ( 72.5 % ) attended a comprehensive CR programme . Data were obtained from patient charts and from Danish population registers , and as a result we had no non-participation for the study . RESULTS The 2-year mortality proportions for patients surviving the first 30 days of admission were 2.8 and 21.8 % among CR-attendees and CR-non-attendees , respectively ( P < 0.0001 ) . Among CR-non-attendees , there was a smaller fraction having an invasive treatment performed as compared with CR-attendees . By multiple logistic regression controlling for age and sex , CR-attendance was associated with chest pain , whereas CR-non-attendance was associated with low gross income , single living and inverted T-wave in the electrocardiogram . CONCLUSION  CR attendance rate was 72.5 % . Non-attendees have a higher mortality risk , which in part may be attributed to selection of healthy patients . Non-attendees are older and more likely to have atypical symptoms at admission , a low socioeconomic status and to live alone . Special attention is needed to improve CR attendance among such patients Background The prognostic effect of early , comprehensive short-term cardiac rehabilitation on top of current , guideline -adjusted treatment of acute myocardial infa rct ion has not sufficiently been evaluated . Design Prospect i ve cohort study . Methods Within the OMEGA study population , the clinical course of 3560 patients still alive 3 months after acute myocardial infa rct ion were evaluated by comparing patients who had attended to cardiac rehabilitation ( 70.6 % ) with those who did not .  Total mortality and major adverse cerebrovascular and cardiovascular events , as well as non-fatal events , were evaluated within the time period of 4–12 months after hospital admission for acute myocardial infa rct ion . The effect of cardiac rehabilitation on clinical events was estimated by using the propensity score method to adjust for confounding parameters in multivariate analysis . Results Patients participating in cardiac rehabilitation  were younger , more often had acute revascularization  , less often experienced non-ST-elevation myocardial infa rct ion , and less often had a history of diabetes or cardiovascular events . Total mortality ( OR 0.46 , 95 % CI 0.27–0.77 ) and major adverse cerebrovascular and cardiovascular events ( OR 0.53 , 95 % CI 0.38–0.75 ) were significantly lower in the rehabilitation group . Subgroup analysis including major clinical characteristics also revealed significantly reduced rates of total death and major adverse cerebrovascular and cardiovascular events in the rehabilitation group . Conclusions Attendance to early , comprehensive short-term cardiac rehabilitation programmes on top of current guideline -adjusted treatment of acute myocardial infa rct ion is associated with a significantly improved 1-year prognosis Background It is widely believed that cardiac rehabilitation following acute myocardial infa rct ion ( MI ) reduces mortality by approximately 20 % . This belief is based on systematic review s and meta-analyses of mostly small trials undertaken many years ago . Clinical management has been transformed in the past 30–40 years and the findings of historical trials may have little relevance now . Objectives The principal objective was to determine the effect of cardiac rehabilitation , as currently provided , on mortality , morbidity and health-related quality of life in patients following MI . The secondary objectives included seeking programmes that may be more effective and characteristics of patients who may benefit more . Design , setting , patients , outcome measures A multi-centre r and omised controlled trial in representative hospitals in Engl and and Wales compared 1813 patients referred to comprehensive cardiac rehabilitation programmes or discharged to ‘ usual care ’ ( without referral to rehabilitation ) .  The primary outcome measure was all-cause mortality at 2 years . The secondary measures were morbidity , health service use , health-related quality of life , psychological general well-being and lifestyle cardiovascular risk factors at 1 year . Patient entry ran from 1997 to 2000 , follow-up of secondary outcomes to 2001 and of vital status to 2006 . A parallel study compared 331 patients in matched ‘ elective ’ rehabilitation and ‘ elective ’ usual care ( without rehabilitation ) hospitals . Results There were no significant differences between patients referred to rehabilitation and controls in mortality at 2 years ( RR 0.98 , 95 % CI 0.74 to 1.30 ) or after 7–9 years ( 0.99 , 95 % CI 0.85 to 1.15 ) , cardiac events , seven of eight domains of the health-related quality of life scale ( ‘ Short Form 36 ’ , SF36 ) or the psychological general well-being scale . Rehabilitation patients reported slightly less physical activity . No differences between groups were reported in perceived overall quality of cardiac aftercare . Data from the ‘ elective ’ hospitals comparison concurred with these findings . Conclusion In this trial , comprehensive rehabilitation following MI had no important effect on mortality , cardiac or psychological morbidity , risk factors , health-related quality of life or activity . This finding is consistent with systematic review s of all trials reported since 1983 . The value of cardiac rehabilitation as practised in the UK is open to question Objective To observe the prognostic influences of the cardiac rehabilitation ( CR ) program in Korean acute myocardial infa rct ion ( AMI ) patients during the first year after an occurrence of the disease . Method A total of 141 AMI patients who underwent percutaneous coronary intervention ( PCI )  were recruited consecutively for this study and divided into the CR group and the control group . The CR group completed the phase 2 CR program in the hospital for a period of 6 - 8 weeks and maintained self-exercise in their community by exercise prescription for a year after AMI . We performed a prospect i ve comparison of the patients ' demographic data , high sensitive C-reactive protein ( hs-CRP ) level after the 4-month CR program , and the rate of recurrence ( AMI , re-hospitalization , positive coronary angiogram , needed revascularization procedure , or death ) between the two groups . Results Compared to the control group ( 0.33±0.48 mg/dl ) , the hs-CRP level was lower in the CR group ( 0.18±0.32 mg/dl ) after 4 months of exercise . The recurrence rate was lower ( 10 % , 7/69 ) in the CR group , compared to the control group ( 24 % , 17/72 , p<0.05 ) . The number of disease-free days was larger in the CR group ( 354±38.34 ) , compared to the control group ( 316±99.96 , p<0.05 ) . In a comparison of statistical methods used for testing the e quality of two survivor distributions , the CR group showed a lower recurrence rate than the control group ( p<0.05 ) . Conclusion Participation in the CR program design ed for AMI patients who underwent PCI-induced normalization of the serum hs-CRP level and lowering of the recurrence rate by 14 % during the first year Abstract Objectives : The aim was to evaluate the effect of short-term cardiac rehabilitation ( CR ) on clinical events during a 1-year follow-up after acute myocardial infa rct ion . Methods : From the observational , prospect i ve Acute COronary Syndromes ( ACOS ) registry , 4547 consecutive patients after ST-elevation ( STEMI : n = 2432 ) or non-ST-elevation myocardial infa rct ion ( NSTEMI : n = 2115 ) , recruited between June 2000 and December 2002 , were characterised and evaluated for clinical outcomes during a 1-year follow-up . From the STEMI group 67.8 % and from the NSTEMI group 52.3 % participated in cardiac rehabilitation ( CR+ ) . Results : Age > 70 years and previous myocardial infa rct ion were independent predictors not to attend CR in STEMI and NSTEMI patients , whereas early revascularisation ( < 48 hours after hospital admission ) was associated with increased likelihood to undergo CR . Multivariable analysis adjusting for propensity score shows that CR+ was independently associated with a significant reduction of all-cause mortality ( STEMI : OR 0.41 , 95 % CI 0.28–0.60 ; NSTEMI : OR 0.53 , 95 % CI 0.38–0.76 ) and major adverse cardiac and cerebrovascular events ( MACCE ; STEMI : OR 0.66 , 95 % CI 0.49–0.89 ; NSTEMI : OR 0.73 , 95 % CI 0.55–0.98 ) during a 1-year follow-up . Conclusion : The study shows an independent and strong association of CR+ with markedly reduced total mortality and MACCE during a 1-year follow-up after STEMI or NSTEMI . The limitation of the study is that it is not a prospect i ve r and omised trial . Furthermore , unequal distribution of risk factors relevant for long-term prognosis had to be corrected by multivariable analysis adjusting for propensity score BACKGROUND There is increasing interest from review authors about including  non-r and omized studies  ( NRS ) in their systematic review s of health care interventions . This series from the Ottawa Non-R and omized Studies Workshop consists of six papers identifying method ological issues when doing this . AIM To format the guidance from the preceding papers on study design and bias , confounding and meta- analysis , selective reporting , and applicability/directness into checklists of issues for review authors to consider when including NRS in a systematic review . CHECKLISTS Checklists were devised providing frameworks to describe/assess : ( 1 ) study design s based on study design features ; ( 2 ) risk of residual confounding and when to consider meta-analysing data from NRS ; ( 3 ) risk of selective reporting based on the Cochrane framework for detecting selective outcome reporting in trials but extended to selective reporting of analyses ; and ( 4 ) directness of evidence contributed by a study to aid integration of NRS findings into summary of findings tables . SUMMARY The checklists described will allow review groups to operationalize the inclusion of NRS in systematic review s in a more consistent way . The next major step is extending the existing Cochrane Risk of Bias tool so that it can assess the risk of bias to NRS included in a review . Copyright © 2013 John Wiley & Sons , This study examined the effect of the Ornish Program for Reversing Heart Disease and cardiac rehabilitation(CR )  on psychosocialrisk factors and quality of life in patients with confirmedcoronary artery disease . Participants had previously undergone a revascularization procedure . The 84 patients self-selected to participate in the Ornish Program for Reversing Heart Disease ( n = 507 28 ) , CR ( n = 28 ) , or a control group ( n = 28 ) . Twelve psych 
    Output:
    