Improving medication adherence of patients with chronic heart failure: challenges and solutions

Deval Shah,¹ Kim Simms,² Debra J Barksdale,³ Jia-Rong Wu<sup>3

1</sup>Internal Medicine, Wake Forest Baptist Hospital, Winston-Salem, ²Duke University Hospital, Durham, ³School of Nursing, University of North Carolina, Chapel Hill, NC, USA

Abstract: Heart failure is a chronic debilitating illness that affects 5.7 million Americans. The financial burden of heart failure in the US toppled $31 billion in 2012, which is one of the highest among all chronic medical conditions. Medication adherence is a major component of heart failure self-care behaviors. Therefore, medication non-adherence is associated with more emergency department visits, frequent rehospitalizations, and higher medical cost. Medication adherence rates have varied from 10% to 98% depending on the definition and measurement used to assess and analyze adherence. Many factors contribute to medication non-adherence such as lack of support, finances, absent of symptoms, cognitive decline, adverse reactions, depression, poor attention span, poor knowledge about medication, multiple medications, difficulty swallowing large pills, and inconveniences of urinary frequency with diuretics. Researchers have explored various strategies such as the use of pharmacists, nurses, telemedicine, and interdisciplinary teams to provide interventions to improve medication adherence in heart failure. Health care providers should continue to provide education, constantly reinforce the importance of taking medication as prescribed, and when feasible, utilize one of the successful evidence-based strategies to increase adherence.

Keywords: pharmacy, tele-health, interdisciplinary, registered nurse, interventions