Medication adherence in heart failure is especially complex due to the nature of the syndrome. Heart failure develops secondary to a wide variety of etiologies and covers a broad spectrum of symptom severity. Heart failure is commonly accompanied by coronary artery disease, hypertension, dyslipidemia, atrial fibrillation, and diabetes mellitus. As a result, patients with heart failure take medications not only for heart failure, but also for a number of other medical conditions. Hence, polypharmacy is common in heart failure patients. Reported medication adherence rates in patients with heart failure have ranged from 2% to 90% reflecting the broad range of types of patients who have heart failure and the differing methods used to assess adherence. A number of barriers to good adherence have been identified in patients with heart failure. Strategies to overcome these barriers have been described, but are often focused on single aspects of improving adherence, which tend to produce relatively small improvements in overall medication adherence. The most productive strategies to improve adherence typically involve multifactorial, multidisciplinary interventions. Disease management programs for heart failure, although not specifically designed to focus only on medication adherence, have been shown to improve adherence to a number of treatments including medications, diet, and exercise. Disease management programs have also been shown to favorably impact the frequency of heart failure hospitalizations and mortality in selected populations of heart failure patients. Efforts continue to define the most appropriate strategies to produce improvements in medication adherence in patients with heart failure.
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