***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: R and omized clinical trials have shown that antihypertensive treatment reduces the risk of heart failure ( HF ) .  Limited evidence exists , however , on whether and to what extent this benefit is translated into real-life practice . A nested case – control study was carried out by including the cohort of 76 017 patients from Lombardy ( Italy ) , aged 40 to 80 years , who were newly treated with antihypertensive drugs during 2005 . Cases were the 622 patients who experienced hospitalization for HF from initial prescription until 2012 . Up to 5 controls were r and omly selected for each case . Logistic regression was used to model the HF risk associated with adherence to antihypertensive drugs , which was measured by the proportion of days covered by treatment ( PDC ) . Data were adjusted for several covariates . Sensitivity analyses were performed to account for possible sources of systematic uncertainty . Compared with patients with very low adherence ( PDC , ⩽25 % ) , low , intermediate , and high adherences were associated with progressively lower risk of HF , reduction in the high-adherence group ( > 75 % ) being 34 % ( 95 % confidence interval , 17%–48 % ) . Similar effects were observed in younger ( 40–70 years ) and older ( 71–80 years ) patients and between patients treated with angiotensin-converting enzyme inhibitors , angiotensin receptor blockers , and diuretics . There was no evidence that adherence with calcium-channel blockers  reduced the HF risk . Antihypertensive treatment lowers the HF risk in real-life practice , but adherence to treatment is necessary for a substantial benefit to take place . This is the case with a variety of antihypertensive drugs We determined the factors associated with exacerbation of heart failure , using a cohort ( n = 192 ) nested within a r and omized trial at a university‐affiliated ambulatory practice . Factors associated with emergency or hospital care included left ventricular ejection fraction , hematocrit and serum sodium levels , refill adherence , and the ability to read a prescription label . Refill adherence of < 40 % was associated with a threefold higher incidence of hospitalization for heart failure than a refill adherence of ≥80 % ( P = 0.002 ) . In multivariable analysis , prescription label reading skills were associated with a lower incidence of heart failure – specific emergency care ( incidence rate ratio , 0.76 ; 95 % confidence interval ( CI ) , 0.19–0.69 ) , and participants with adequate health literacy had a lower risk of hospitalization for heart failure ( incidence rate ratio , 0.34 ; 95 % CI , 0.15–0.76 ) . We conclude that inadequate treatment adherence and health literacy skills are key factors in the exacerbation of heart failure . These findings emphasize the need for careful instruction of patients about their medications BACKGROUND Poor medication adherence is associated with negative health outcomes . We investigated whether poor medication adherence increases the rate of falls as part of Maintenance of Balance , Independent Living , Intellect , and Zest in the Elderly of Boston ( MOBILIZE Boston ) , a prospect i ve , community-based cohort recruited for the purpose of study ing novel risk factors for falls . METHODS A total of 246 men and 408 women ( mean age , 78 years ) were followed for the occurrence of falls ( median follow-up , 1.8 years ) . Adherence was assessed by the Morisky scale based on the following four questions : whether an individual ever forgets , is careless at times , stops taking medications when feels better , or stops taking medications when feels worse . Low adherence was defined as a " yes " answer to one or more questions . High adherence was defined as a " no " answer to every question . RESULTS Forty-eight percent of subjects were classified as having low medication adherence . The rate of falls in the low adherence group was 1.1 falls/person-year ( 95 % confidence interval [ CI ] : 1.0 - 1.3 ) compared with 0.7 falls/person-year ( 95 % CI : 0.6 - 0.8 ) in the high adherence group . After adjusting for age , sex , race/ethnicity , education , alcohol use , cognitive measures , functional status , depression , and number of medications , low medication adherence was associated with a 50 % increased rate of falls compared with high medication adherence ( rate ratio = 1.5 , 95 % CI : 1.2 - 1.9 ; p < .001 ) . CONCLUSIONS Low medication adherence may be associated with an increased rate of falls among older adults . Future studies should confirm this association and explore whether interventions to improve medication adherence might decrease the frequency of falls and other serious health-related outcomes Background Despite a higher risk for medication nonadherence among older adults residing in the community , few prospect i ve studies have investigated the health outcomes associated with nonadherence in this population or the possible variations in risk in urban versus rural residents . Objectives The primary objective of this study was to examine , in a prospect i ve manner , the risk for hospitalisation ( including an emergency department visit ) and /or mortality associated with medication nonadherence in older , at-risk adults residing in the community . A secondary objective was to examine differences in the prevalence , determinants and consequences of medication nonadherence between rural and urban home care clients . Methods Data were derived from a 1-year prospect i ve study of home care clients aged ≥65 years ( n = 319 ) r and omly selected from urban and rural setting s in southern Alberta , Canada . Trained nurses conducted in-home assessment s including a comprehensive medication review , self-report measures of adherence and the Minimum Data Set for Home Care ( MDS-HC ) tool . Hospitalisation and mortality data during 12-month follow-up were obtained via linkages with regional administrative and vital statistics data bases . Results Nonadherent clients showed an increased but nonsignificant risk for an adverse health outcome ( hospitalisation , emergency department visit or death ) during follow-up ( hazard ratio [ adjusted for relevant covariates ] = 1.24 , 95 % CI 0.93 , 1.65 ) . Subgroup analyses suggested this risk may be higher for unintentional nonadherence ( unadjusted hazard ratio = 1.55 , 95 % CI 0.97 , 2.48 ) . The prevalence of nonadherence was similar among rural ( 38.2 % ) and urban ( 38.9 % ) clients and was associated with the presence of vision problems , a history of smoking , depressive symptoms , a high drug regimen complexity score , residence in a private home ( vs assisted-living setting ) and absence of assistance with medication administration . In both setting s , approximately 20 % of clients received one or more inappropriate medications . Conclusions Although not associated with rural/urban residence , medication nonadherence was common in our study population , particularly among those with depressive symptoms and complex medication regimens . The absence of a significant association between overall medication nonadherence and health outcomes may reflect study limitations and /or the need to differentiate among types of nonadherent behaviours Introduction Adherence to treatment in osteoporosis remains poor . The aim of this study was to evaluate the effects of an educational leaflet on adherence to medication and to assess the association between adherence and health-related quality of life ( HRQOL ) . Methods A naturalistic , observational , multi-center , prospect i ve study of 12 months ’ follow-up was performed . Consecutive post-menopausal women aged 50 years to 86 years starting treatment with raloxifene according to daily practice were enrolled from 126 primary care offices in Spain . The women were assigned to two study groups . Group A received an educational leaflet with general information about osteoporosis ; group B followed current practice . To assess adherence to medication and HRQOL , the Morisky test and the EuroQoL question naire were administered . A total of 745 post-menopausal women ( group A , n=366 ; group B n=379 ) , with a mean age of 62 years , were included . Results Most patients in both study groups showed high adherence to raloxifene at the 3-month visit : 56.3 % vs 62.7 % for groups A and B , respectively ; this proportion at the 12-month visit was 47.4 % ( P=0.15 ) and 52.5 % ( P=0.02 ) , respectively . At baseline , “ pain/discomfort ” was the dimension showing the highest percentage of women reporting problems : 86.4 % vs 83.2 % in groups A and B , respectively ( P=0.22 ) . HRQOL improved in both groups throughout the study , with an overall mean increment in the EuroQoL visual analog scale ( EQ VAS ) of 9.2 at 12 months ( P<0.01 ) . Correlations between adherence and HRQOL were weak . After receiving an educational leaflet , young post-menopausal women suffering osteoporosis did not show improvement in adherence to therapy . HRQOL improved at 12-month follow-up under treatment . Conclusion No consistent correlation between adherence and HRQOL was found Data from electronic dosing monitors and published pharmacokinetic parameters were used to derive medication adherence measures for immediate‐release metoprolol and examine their association with health care utilization of out patients aged 50 years or older with heart failure Background : Little is known about adherence to inhaled medication in chronic obstructive pulmonary disease ( COPD ) and the impact on mortality and morbidity . Methods : Data on drug adherence from a r and omised double-blind trial comparing inhaled salmeterol 50 μg + fluticasone propionate 500 μg twice daily with placebo and each drug individually in 6112 patients with moderate to severe COPD over 3 years in the TORCH study were used  . All-cause mortality and exacerbations leading to hospital admission were primary and secondary end points . The study of adherence was not specified a priori as an ancillary study . Results : Of the 4880 patients ( 79.8 % ) with good adherence defined as > 80 % use of study medication  , 11.3 % died compared with 26.4 % of the 1232 patients ( 20.2 % ) with poor adherence .  The annual rates of hospital admission for exacerbations were 0.15 and 0.27 , respectively . The association between adherence and mortality remained unchanged and statistically significant after adjusting for other factors related to prognosis ( hazard ratio 0.40 ( 95 % CI 0.35 to 0.46 ) , p<0.001 ) . The association was even stronger when analysing on-treatment deaths only . Similarly , the association between adherence and hospital admission remained unchanged and significant in a multivariate analysis ( rate ratio 0.58 ( 95 % CI 0.44 to 0.73 , p<0.001 ) . The association between increased adherence and improved mortality and reduction in hospital admission was independent of study treatment . The effect of treatment was more pronounced in patients with good adherence than in those with poor adherence . Conclusion : Adherence to inhaled medication is significantly associated with reduced risk of death and admission to hospital due to exacerbations in COPD . Further research is needed to underst and these strong associations OBJECTIVE To examine the contribution of medication adherence to 12-month depression scores in the context of other psychosocial and clinical predictors of depression in a sample of older adults treated for depression . METHODS Secondary analysis of a prospect i ve cohort study involving 241 older patients undergoing depression treatment using a st and ardized algorithm .  Depression was measured at baseline and 12-months post-baseline . Baseline predictor variables included antidepressant adherence , barriers to antidepressant adherence , four domains of social support , basic and instrumental activities of daily living ( BADLs and IADLs ) , and clinical factors including past history of depression and medical comorbidities . RESULTS Nearly 28 % of patients reported being nonadherent with their antidepressant medication . In bivariate analyses , greater  antidepressant medication nonadherence , more medication barriers , poorer subjective social support , less non-family interaction , greater BADL and IADL limitations , poor self-rated health , higher baseline depression scores , and not having diabetes were related to higher 12-month depression scores . In multivariable analyses , greater medication nonadherence , not having diabetes , poorer subjective social support , greater BADL limitations , and higher baseline depression scores were related to higher 12-month depression scores . CONCLUSION Interventions should be directed toward improving antidepressant adherence and modifiable psychosocial variables OBJECTIVE Depression is a significant comorbidity in patients with chronic obstructive pulmonary disease ( COPD ) . Although comorbid depression is associated with low use and poor adherence to medications treating other chronic conditions , evidence of the relationship between depression and COPD management is limited . This study estimated the association between depression and COPD maintenance medication ( MM ) adherence among patients with COPD . METHODS This cross-sectional study used a 5 % r and om sample of 2006 - 2007 Chronic Condition Warehouse data . Medicare beneficiaries enrolled in Parts A , B , and D plans with diagnosed COPD who survived through 2006 were included ( n = 74,863 ) .  COPD MM adherence was measured as medication discontinuation and proportion of days covered ( PDC ) . Depression was identified through the International Classification of Diseases , Ninth Revision , Clinical Modification diagnosis codes . Multivariable models with modified generalized estimating equations were used to estimate adjust 
    Output:
    
Medication non-adherence may be significantly associated with all-cause hospitalisation and mortality in older people .