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Improving medication adherence in cardiovascular disease

Nature Reviews Cardiology (2024)Cite this article

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Abstract

Non-adherence to medication is a global health problem with far-reaching individual-level and population-level consequences but remains unappreciated and under-addressed in the clinical setting. With increasing comorbidity and polypharmacy as well as an ageing population, cardiovascular disease and medication non-adherence are likely to become increasingly prevalent. Multiple methods for detecting non-adherence exist but are imperfect, and, despite emerging technology, a gold standard remains elusive. Non-adherence to medication is dynamic and often has multiple causes, particularly in the context of cardiovascular disease, which tends to require lifelong medication to control symptoms and risk factors in order to prevent disease progression. In this Review, we identify the causes of medication non-adherence and summarize interventions that have been proven in randomized clinical trials to be effective in improving adherence. Practical solutions and areas for future research are also proposed.

Key points

  • Medication non-adherence remains a global health problem that is not fully appreciated and is under-addressed in the clinic.

  • The label of being ‘non-adherent to medications’ is often considered in a binary (and pejorative) manner; however, medication-taking behaviour is a complicated process with multiple phases and potential barriers.

  • Several methods for detecting non-adherence exist, with many providing complementary rather than gold-standard information.

  • Clinicians need to understand the importance of simplifying medication regimens and encouraging the use of blister packs, whereas health systems need to explore multifaceted, multidisciplinary interventions for complex non-adherence.

  • Multiple interventions for improving medication adherence have proven efficacy, but a one-size-fits-all solution is unlikely to be successful; both precision and population approaches are required and need further evaluation.

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Fig. 1: Tension between the complexity of an intervention and patient versus population target.

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Authors and Affiliations

  1. Victorian Heart Institute, Melbourne, Victoria, Australia

    Adam J. Nelson

  2. Duke Clinical Research Institute, Duke University, Durham, NC, USA

    Adam J. Nelson, Neha J. Pagidipati & Hayden B. Bosworth

  3. Population Health Sciences, Duke University, Durham, NC, USA

    Hayden B. Bosworth

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A.J.N. and N.J.P. researched data for the article. All the authors discussed its content, wrote the manuscript, and reviewed and edited it before submission.

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Correspondence to Hayden B. Bosworth.

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A.J.N. declares research grants from Amgen, AstraZeneca, Boehringer Ingelheim, Eli Lilly & Company and Novartis Pharmaceuticals and consulting fees from AstraZeneca, Boehringer Ingelheim, Eli Lilly & Company and Novartis. N.J.P. declares research grants from Amgen, AstraZeneca, Boehringer Ingelheim, Duke Clinical Research Institute, Eli Lilly & Company, Novartis Pharmaceuticals, Novo Nordisk Pharmaceutical Company and Verily Sciences Research Company and consulting fees from AstraZeneca, Boehringer Ingelheim, CRISPR Therapeutics, Eli Lilly & Company, Merck, Novo Nordisk Pharmaceutical Company and Novartis. H.B.B. declares research grants from BeBetter Therapeutics, Boehringer Ingelheim, the Elton John AIDS Foundation, the Hilton Foundation, Improved Patient Outcomes, Merck, NHLBI, Novo Nordisk, Otsuka, Pfizer, Sanofi and Veterans Affairs and consulting fees from Abbott, Imatar, Novartis, Sanofi, Vidya, Walmart and Webmed. H.B.B. is on the Board of Directors of Preventric Diagnostics.

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Nelson, A.J., Pagidipati, N.J. & Bosworth, H.B. Improving medication adherence in cardiovascular disease. Nat Rev Cardiol (2024). https://doi.org/10.1038/s41569-023-00972-1

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