Therapeutic Adherence in Cardiovascular Diseases: Insights from the Patient and Physician-A Narrative Review

Therapeutic adherence is defined as the extent to which patients' medication-taking behaviour corresponds with agreed recommendations from a clinician. Adherence to cardiovascular therapies significantly improves outcomes and improves patient quality of life. However, adherence is often suboptimal in patients with cardiovascular disease. This narrative review aims to describe key barriers to adherence and identify practical actions that can be undertaken by all stakeholders to improve treatment adherence. Key barriers fall into categories related to the patient, medication, healthcare system, disease and society. These include, but are not limited to, logistical challenges faced by patients incorporating medication into their daily lives, fragmented care, the patient-physician relationship, the complexity of the regimen and medication costs. While macro-initiatives to remove health system and societal barriers are encouraged, there are many practical ways in which patients can also be supported to adhere to medication. These include improving communication techniques to build a trusting physician-patient relationship, engaging other healthcare professionals (e.g. nurses and pharmacists), referral to patient advocacy groups for reliable information and peer support, simplifying treatment regimens where safe and appropriate, the use of digital tools or devices (e.g. pill boxes and symptom trackers) that help patients to take their medication in the right dose and at the right time and consideration of the patient's budgetary constraints when prescribing. Prescribing formulations for once-daily administration and single-pill combinations can also help to simplify treatment regimens. No single solution will fit all patients, and initiatives to enhance adherence must also be tailored wherever possible to the individual patient's abilities, circumstances, values and beliefs.