Issues in cardiovascular nursing| Volume 37, ISSUE 1, P8-16.e1, January 2008

Download started.


Factors influencing medication adherence in patients with heart failure


      The purpose of this study was to explore factors influencing adherence to the prescribed medical regimen in patients with heart failure (HF).


      A convenience sample of 7 women and 9 men with HF participated in in-depth interviews. The interviews were audio-taped, transcribed, and checked for accuracy. Content analysis strategies were used to analyze the data.


      The desire to be healthy was the primary motivator in the decision to take medications as prescribed. The process of making connections enhanced medication adherence. Participants connected knowledge of their illness and their symptoms with their medication’s effectiveness in decreasing these symptoms. Connections to a health care provider and family enhanced treatment adherence. Participants relied on environmental cues as reminders to take their medications, resulting in a habit of daily medication use.


      Education that helps clients understand their illness, particular symptoms and how medications help them may be beneficial in promoting adherence. A positive working relationship with the health care provider may result in improved adherence.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Heart & Lung: The Journal of Cardiopulmonary and Acute Care
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • American Heart Association
        Heart disease and stroke statistics—2005 update.
        American Heart Association, Dallas, TX2005
        • Stanley M.
        • Prasun M.
        Heart failure in older adults: keys to successful management.
        AACN Clin Issues. 2002; 13: 94-102
        • Rich M.W.
        • Gray D.B.
        • Beckham V.
        • Wittenberg C.
        • Luther P.
        Effect of a multidisciplinary intervention on medication compliance in elderly patients with congestive heart failure.
        Am J Med. 1996; 101: 270-276
        • Col N.
        • Fanale J.E.
        • Kronholm P.
        The role of medication noncompliance and adverse drug reactions in hospitalizations of the elderly.
        Arch Intern Med. 1990; 150: 841-845
        • Huang L.H.
        Medication-taking behavior of the elderly.
        Kaohsiung J Med Sci. 1996; 12: 423-433
        • Cline C.M.
        • Bjorck-Linne A.K.
        • Israelsson B.Y.
        • Willenheimer R.B.
        • Erhardt L.R.
        Non-compliance and knowledge of prescribed medication in elderly patients with heart failure.
        Eur J Heart Fail. 1999; 1: 145-149
        • Gonzalez B.
        • Lupon J.
        • Parajon T.
        • Urrutia A.
        • Altimir S.
        • Coll R.
        • et al.
        Nurse evaluation of patients in a new multidisciplinary heart failure unit in Spain.
        Eur J Cardiovasc Nurs. 2004; 3: 61-69
        • Blenkiron P.
        The elderly and their medication: understanding and compliance in a family practice.
        Postgrad Med J. 1996; 72: 671-676
        • Rodgers P.T.
        • Ruffin D.M.
        Medication nonadherence: part II–a pilot study in patients with congestive heart failure.
        Manag Care Interface. 1998; 11 (75): 67-69
        • Bonner C.J.
        • Carr B.
        Medication compliance problems in general practice: detection and intervention by pharmacists and doctors.
        Aust J Rural Health. 2002; 10: 33-38
        • Bhagat K.
        • Mazayi-Mupanemunda M.
        Compliance with medication in patients with heart failure in Zimbabwe.
        East Afr Med J. 2001; 78: 45-48
        • Bohachick P.
        • Burke L.E.
        • Sereika S.
        • Murali S.
        • Dunbar-Jacob J.
        Adherence to angiotensin-converting enzyme inhibitor therapy for heart failure.
        Prog Cardiovasc Nurs Fall. 2002; 17: 160-166
        • Graveley E.A.
        • Oseasohn C.S.
        Multiple drug regimens: medication compliance among veterans 65 years and older.
        Res Nurs Health. 1991; 14: 51-58
        • Monane M.
        • Bohn R.L.
        • Gurwitz J.H.
        • Glynn R.J.
        • Avorn J.
        Noncompliance with congestive heart failure therapy in the elderly.
        Arch Intern Med 28. 1994; 154: 433-437
        • Artinian N.T.
        • Harden J.K.
        • Kronenberg M.W.
        • Vander Wal J.S.
        • Daher E.
        • Stephens Q.
        • et al.
        Pilot study of a Web-based compliance monitoring device for patients with congestive heart failure.
        Heart Lung. 2003; 32: 226-233
        • Evangelista L.S.
        • Berg J.
        • Dracup K.
        Relationship between psychosocial variables and compliance in patients with heart failure.
        Heart Lung. 2001; 30: 294-301
        • Chin M.H.
        • Goldman L.
        Factors contributing to the hospitalization of patients with congestive heart failure.
        Am J Publ Health. 1997; 87: 643-648
        • Li H.
        • Morrow-Howell N.
        • Proctor E.K.
        Post-acute home care and hospital readmission of elderly patients with congestive heart failure.
        Health Soc Work. 2004; 29: 275-285
        • Miura T.
        • Kojima R.
        • Mizutani M.
        • Shiga Y.
        • Takatsu F.
        • Suzuki Y.
        Effect of digoxin noncompliance on hospitalization and mortality in patients with heart failure in long-term therapy: a prospective cohort study.
        Eur J Clin Pharmacol. 2001; 57: 77-83
        • Hope C.J.
        • Wu J.
        • Tu W.
        • Young J.
        • Murray M.D.
        Association of medication adherence, knowledge, and skills with emergency department visits by adults 50 years or older with congestive heart failure.
        Am J Health Syst Pharm. 2004; 61: 2043-2049
        • Chapman P.J.
        A case report of acute heart failure caused by a patient delaying taking his diuretic medication.
        Aust Dent J. 2002; 47 (75 [quiz]): 66-67
        • Happ M.B.
        • Naylor M.D.
        • Roe-Prior P.
        Factors contributing to rehospitalization of elderly patients with heart failure.
        J Cardiovasc Nurs. 1997; 11: 75-84
        • Sandelowski M.
        Whatever happened to qualitative description?.
        Res Nurs Health. 2000; 23: 334-340
        • Stromberg A.
        • Brostrom A.
        • Dahlstrom U.
        • Fridlund B.
        Factors influencing patient compliance with therapeutic regimens in chronic heart failure: a critical incident technique analysis.
        Heart Lung. 1999; 28: 334-341
        • Riegel B.
        • Carlson B.
        Facilitators and barriers to heart failure self-care.
        Patient Educ Couns. 2002; 46: 287-295
        • Russell J.
        • Krantz S.
        • Neville S.
        The patient-provider relationship and adherence to highly active antiretroviral therapy.
        J Assoc Nurses AIDS Care. 2004; 15: 40-47
        • Kerse N.
        • Buetow S.
        • Mainous 3rd, A.G.
        • Young G.
        • Coster G.
        • Arroll B.
        Physician-patient relationship and medication compliance: a primary care investigation.
        Ann Fam Med. 2004; 2: 455-461
        • Conn V.
        • Taylor S.
        • Miller R.
        Cognitive impairment and medication adherence.
        J Gerontol Nurs. 1994; 20: 41-47
        • Simpson S.H.
        • Johnson J.A.
        • Farris K.B.
        • Tsuyuki R.T.
        Development and validation of a survey to assess barriers to drug use in patients with chronic heart failure.
        Pharmacotherapy. 2002; 22: 1163-1172
        • Evangelista L.
        • Doering L.V.
        • Dracup K.
        • Westlake C.
        • Hamilton M.
        • Fonarow G.C.
        Compliance behaviors of elderly patients with advanced heart failure.
        J Cardiovasc Nurs. 2003; 18 (207–198 [quiz]): 197-206
        • Nikolaus T.
        • Kruse W.
        • Bach M.
        • Specht-Leible N.
        • Oster P.
        • Schlierf G.
        Elderly patients’ problems with medication.
        Eur J Clin Pharmacol. 1996; 49: 255-259
        • Murray M.D.
        • Birt J.A.
        • Manatunga A.K.
        • Darnell J.C.
        Medication compliance in elderly outpatients using twice-daily dosing and unit-of-use packaging.
        Ann Pharmacother May. 1993; 27: 616-621
        • Dunbar-Jacob J.
        • Bohachick P.
        • Mortimer M.K.
        • Sereika S.M.
        • Foley S.M.
        Medication adherence in persons with cardiovascular disease.
        J Cardiovasc Nurs. 2003; 18: 209-218
        • Sung J.C.
        • Nichol M.B.
        • Venturini F.
        • Bailey K.L.
        • McCombs J.S.
        • Cody M.
        Factors affecting patient compliance with antihyperlipidemic medications in an HMO population.
        Am J Manag Care. 1998; 4: 1421-1430
        • DiMatteo M.R.
        • Sherbourne C.D.
        • Hays R.D.
        • Ordway L.
        • Kravitz R.L.
        • McGlynn E.A.
        • et al.
        Physicians’ characteristics influence patients’ adherence to medical treatment: results from the Medical Outcomes Study.
        Health Psychol. 1993; 12: 93-102
        • Rockwell J.M.
        • Riegel B.
        Predictors of self-care in persons with heart failure.
        Heart Lung. 2001; 30: 18-25
        • Hicks F.D.
        • Holm K.
        Self-management decision influences in heart failure: a preliminary investigation.
        Clin Nurs Res. 2003; 12: 69-84
        • Schulz R.M.
        • Lingle E.W.
        • Chubon S.J.
        • Coster-Schulz M.A.
        Drug use behavior under the constraints of a Medicaid prescription cap.
        Clin Ther. 1995; 17: 330-340
        • Welsh J.D.
        • Heiser R.M.
        • Schooler M.P.
        • Brockopp D.Y.
        • Parshall M.B.
        • Cassidy K.B.
        • et al.
        Characteristics and treatment of patients with heart failure in the emergency department.
        J Emerg Nurs. 2002; 28: 126-131
        • Johnson M.J.
        • Williams M.
        • Marshall E.S.
        Adherent and nonadherent medication-taking in elderly hypertensive patients.
        Clin Nurs Res. 1999; 8: 318-335
        • DiMatteo M.R.
        Social support and patient adherence to medical treatment: a meta-analysis.
        Health Psychol. 2004; 23: 207-218
        • Lainscak M.
        • Keber I.
        Patient’s view of heart failure: from the understanding to the quality of life.
        Eur J Cardiovasc Nurs. 2003; 2: 275-281
        • Jackson J.E.
        • Doescher M.P.
        • Saver B.G.
        • Fishman P.
        Prescription drug coverage, health, and medication acquisition among seniors with one or more chronic conditions.
        Med Care. 2004; 42: 1056-1065