Medication adherence and associated factors among heart failure patients: a systematic review and meta-analysis of observational studies

Background: Non-adherence to heart failure medications significantly increases the risk of hospital readmission and mortality. Because comprehensive pooled estimates of adherence levels and their determinants are sparse in the existing literature, this review was designed to determine the global pooled adherence rate and to identify the factors that influence it. Methods: This systematic review and meta-analysis adhered to PRISMA guidelines, with a comprehensive search carried out across PubMed, ScienceDirect, Scopus, and Google Scholar. The search process spanned from June 29 to 28 July 2025, and the final query was performed on 27 July 2025. A total of 19 studies meeting the predetermined inclusion criteria were incorporated into the review. Data were collected via a standardized extraction checklist and subsequently analyzed using Stata version 14. A random-effects model was employed to conduct the meta-analysis. Publication bias was examined through visual inspection of the funnel plot, complemented by Egger’s and Begg’s tests set at a 5% significance level. The funnel plot exhibited symmetry, and the P -values for both the Egger and Begg tests exceeded 0.05, collectively indicating that publication bias was unlikely. Finally, the Cochrane Q test and I 2 statistic were utilized to evaluate the heterogeneity among the included studies. Results: Among patients with heart failure, the pooled adherence rate to medication was 53.07% (95% CI: 40.54–65.60). Adherence was significantly higher among those who followed a low-salt diet (AOR = 2.01; 95% CI: 1.35–3.0), had health insurance (AOR = 4.35; 95% CI: 1.36–13.93), and had higher education (AOR = 2.33; 95% CI: 1.47–3.69). Conclusion: Nineteen studies, including 5265 patients with heart failure, show that global medication adherence in heart failure exceeds 50%. Pharmacist-led consultation efforts should therefore pinpoint patients prone to non-adherence. Crucially, when delivered via a multidisciplinary framework, this intervention has been proven to effectively boost adherence.