Cardiovascular diseases (CVD) remain among the leading causes of death and disability globally, despite the availability of effective treatments. The cornerstone of successful long-term management of CVD often involves adherence to prescribed medications. Yet, medication nonadherence persists as a significant barrier, exacerbating morbidity, increasing mortality, and inflating healthcare costs.
Nonadherence to medication in CVD patients is alarmingly common, with adherence rates dropping dramatically even within weeks of prescription initiation. For example, nearly a third of acute coronary syndrome (ACS) patients are nonadherent within the first week of discharge, and over half discontinue medications within two years. This suboptimal adherence leads directly to adverse clinical outcomes, including higher risks of major cardiovascular events, hospitalizations, and death.
Factors influencing medication adherence are multidimensional, encompassing patient-specific attributes such as:
- age, education level, forgetfulness, and personal beliefs;
- socioeconomic aspects including financial barriers, access to healthcare, and social support;
- healthcare system-related issues like patient-provider communication and insurance coverage;
- therapy-related elements such as drug side effects and complex dosing regimens;
- condition-related factors including comorbidities.
Interventions aimed at improving adherence have shown promise, particularly when combining educational initiatives, behavioral counseling, technological reminders, financial incentives, healthcare team engagement, and simplifying medication regimens. Educational programs that actively involve patients and utilize regular follow-ups have been notably effective, as have technological interventions such as smartphone reminders and telemedicine consultations. Financial assistance, including reduced medication costs or copayment coverage, also significantly enhances adherence rates.
Evidence clearly demonstrates that improved adherence translates directly to improved clinical outcomes. High adherence levels correlate with substantial reductions in cardiovascular events, stroke, hospitalizations, and mortality. Furthermore, enhanced adherence is economically advantageous, decreasing overall healthcare expenditures despite increased medication costs by significantly reducing hospital admissions and emergency care needs.
Clinicians play a critical role in enhancing medication adherence by routinely assessing adherence nonjudgmentally, understanding and addressing underlying causes of nonadherence, and individualizing interventions. Multifaceted approaches tailored to specific patient needs and circumstances appear most effective, highlighting the importance of personalized healthcare.
Ultimately, improving adherence to cardiovascular medications is essential for optimizing patient outcomes, enhancing the quality of life, and achieving cost-effective healthcare. Healthcare systems, providers, and policymakers should prioritize adherence interventions as critical components of cardiovascular care, ensuring sustainable and effective long-term disease management.
References
- Nelson, A.J., Pagidipati, N.J. & Bosworth, H.B. Improving medication adherence in cardiovascular disease. Nat Rev Cardiol 21, 417–429 (2024). https://doi.org/10.1038/s41569-023-00972-1
- Berra, E. et al. Evaluation of adherence should become an integral part of assessment of patients with apparently treatment-resistant hypertension. Hypertension 68, 297–306 (2016).
- Tegegn, H. G., Wark, S., Tursan d’Espaignet, E. & Spark, M. J. Measurement properties of patient-reported outcome measures for medication adherence in cardiovascular disease: a COSMIN systematic review. Clin. Drug Investig. 42, 879–908 (2022)
