Exploring medication adherence in heart failure from a patient perspective - a qualitative study
I Gunnthorsdottir, I J Ingimarsdottir, A I Gunnarsdottir, K Andersen, E Svansdottir, I S Thrainsdottir, P Forsyth, A B AlmardottirAbstract
Background
Medication adherence (MA) is essential for achieving the benefits of guideline-directed medical therapy in heart failure (HF). However it is seldom assessed systematically in practice. Understanding how patients perceive and manage treatment in everyday life is critical for designing effective, patient-centered adherence support.
Purpose
To explore HF patients’ perspectives on medication use and adherence, identify factors influencing long-term adherence, and characterize patients at risk of non-adherence to inform systematic assessment in clinical practice.
Methods
A qualitative study explored HF patients’ experiences of factors influencing MA. Data included four focus-group and twelve in-depth interviews (May 2022–Nov 2023) recruited from the National Heart Failure Registry and a cardiac rehabilitation program. Interviews were audio-recorded, transcribed verbatim, and analyzed inductively using reflexive thematic analysis. Coding and theme development were supported by field notes and multidisciplinary review.
Results
A total of 27 HF patients (12 women), aged 40–89 years, participated. Four interrelated themes influencing medication adherence were identified: (1) Practical aspects of medication use (daily routines, dose timing, adherence aids, formulation challenges, and polypharmacy); (2) Psychosocial influences (stress, mental health, illness acceptance, cognition, social support, and socioeconomic context); (3) Healthcare system and provider interactions (adherence assessment, education, follow up, access, costs, patient–provider relationships, and support at home); and (4) Disease- and medication-related factors (HF symptoms, physical limitations, diuretic burden affecting everyday life, and side effects). Participants consistently reported that medication adherence was rarely assessed or discussed in routine care. Adherence was most consistent when regimens aligned with daily routines and when tolerability, follow-up, psychosocial needs, and affordability were addressed proactively.
Conclusion
HF patients view adherence as a dynamic process of integrating medicines into daily life rather than a matter of motivation alone. Effective support requires regimen simplification, explicit diuretic planning, psychosocial and cost screening, and coordinated multidisciplinary follow-up including pharmacist involvement. Findings provide patient-derived evidence to guide HF-specific adherence assessment in routine clinical care.Thematic overview of main themesFor image description, please refer to the figure legend and surrounding text.