Intentional and Unintentional Medication Nonadherence in Adults With Chronic HF

Study Questions:

What factors contribute to intentional and unintentional medication nonadherence in adults with heart failure (HF)?


This is a secondary analysis of qualitative data from 4 previous studies that evaluated HF self-care that included 125 participants, with 112 patients discussing medication adherence.


The sample consisted of a diverse group of 112 patients (63% male, 58% white, 39% black, 3% Asian, 6% Hispanic) with an age range of 25-98 years (mean age 59 ± 15). Four interconnected themes were identified: rarely nonadherent (n = 25; 22%), frequently nonadherent (n = 57; 51%), intentionally nonadherent (n = 21; 19%), and reformed nonadherent (n = 9; 8%). The patients who reported frequent nonadherence identified events that caused them to frequently forget to get medications refilled, did not know how to manage missed doses, and lacked knowledge or effective support to improve adherence. Twenty-one patients (19%) who were intentionally nonadherent purposefully did not take their medications because they did not like the idea of taking medications or the actual or perceived side effects. Patients perceived lack of benefits from the medications. Patients did not recognize fatigue as a symptom of HF and attributed it to normal aging. Misconception that HF was not a life-threatening condition resulted in at least intermediate nonadherence until a hospitalization occurred. Nine patients (8%) who had previously been nonadherent suffered a negative event that scared them. Through education, patients changed their perception of HF. Patients recognized HF “would be with them for a long time,” “could kill them,” and “learned that I have to take my medication.” Once symptoms reached the level that required hospitalization, patients recognized a link between medication adherence and symptoms.


In this secondary analysis, medication nonadherence occurred at some level in 90% of the patients due to misconceptions about HF, beliefs, concerns, and contextual factors. The most common cause of unintentional medication nonadherence was forgetfulness (60%). There was a significant number of patients (27%) who reported intentional nonadherence, but after a negative event, adherence improved.


Medication nonadherence is a complicated problem that requires patient education about HF symptoms, the benefits of medications, and how to manage missed doses. Assessment of the frequency and causes of medication nonadherence will help guide education.

Clinical Topics: Congenital Heart Disease and Pediatric Cardiology, Geriatric Cardiology, Heart Failure and Cardiomyopathies, Congenital Heart Disease, Acute Heart Failure

Keywords: Heart Defects, Congenital, Geriatrics, Heart Failure

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