Exploring Medication Adherence in Heart Failure From a Patient Perspective: A Qualitative Study

Medication adherence (MA) is essential for achieving the benefits of guideline-directed medical therapy in heart failure, yet it is seldom assessed systematically in routine care. Understanding how patients experience and manage long-term medication use in everyday life is critical for designing effective, patient-centered MA support.

A qualitative study explored the experiences of patients with heart failure of factors influencing MA. Data were derived from 4 focus groups and 12 in-depth interviews with 27 participants (May 2022-November 2023) recruited from the Icelandic Heart Failure Registry and a cardiac rehabilitation program. Data were analyzed using inductive thematic analysis, supported by field notes and multidisciplinary review.

Four interdependent themes emerged: (1) practical aspects of medication use, including daily routines, dose timing, MA aids, formulation challenges, and polypharmacy; (2) psychosocial influences, such as stress, mood, cognition, social support, and socioeconomic context; (3) interactions with the health care system and providers, including education, follow-up, access, costs, patient-provider relationships, and home support; and (4) disease- and medication-related factors, including symptoms, physical limitations, diuretic burden, and side effects. MA was most consistent when regimens aligned with daily life and when tolerability, follow-up, psychosocial needs, and costs were addressed proactively.

Patients with heart failure experience MA as a dynamic process of integrating treatment into daily life rather than a matter of motivation alone. Effective MA support requires regimen simplification, explicit diuretic planning, psychosocial and cost screening, and coordinated multidisciplinary follow-up, including pharmacist involvement. These findings provide patient-derived evidence to inform heart failure-specific MA assessment in routine clinical practice.