A Systematic Review of Medication Adherence Interventions for Patients with Heart Failure

Background: Heart failure (HF) is a leading cause of death in the United States (U. S.) and the world. HF is responsible for poor quality of life, frequent hospitalization, and increased health care costs. Although treatments are available, medication adherence is essential. Previous research has explored interventions to increase adherence for HF patients, yet barriers to medication adherence remain a challenge. This systematic review aims to examine the studies of adherence interventions among HF patients. The World Health Organization’s (WHO) model of Adherence to Long-Term Therapies, developed for patients with chronic illnesses, was the conceptual framework. The model groups barriers to adherence into five factors: patient-related factors, therapy-related factors, condition-related factors, social-economic factors, and health care team and health system factors. Methods: A search in databases CINAHL, PubMed, and Scopus identified intervention studies using the terms heart failure, medication adherence, and intervention. The inclusion criteria were that articles be the original reports of interventional studies exclusively with patients diagnosed with HF. Articles detailing only study protocols and interventions that did not measure medication adherence were excluded. Articles were categorized by setting, participant characteristics, adherence strategies, and design. Each article was evaluated using the Johns Hopkins guidelines for the level of evidence and quality. The WHO factor or factors addressed by each intervention and effectiveness in comparison to a control group were described. Results: A total of 40 articles met the inclusion criteria. All 40 addressed patient-related factors, 30 addressed therapy-related factors, 22 addressed condition-related factors, 26 addressed social-economic factors, and 22 addressed health care team and health system factors. Overall findings reinforced the WHO recommendation to support adherence by targeting the multiple factors at once. When examined individually, health care team and health system interventions had the greatest impact on increasing adherence. Limitations of this review include potential for bias, including the predominance of studies conducted in the U. S. and limited data collection by individual studies regarding race and ethnicity of the participants. Conclusions: Clinicians should incorporate a multidimensional approach when promoting adherence to medication regimens, with additional focus on the impact of the health care team and health system.