Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Opinion
  • Published:

'Take as directed'—strategies to improve adherence to cardiac medication

Nature Reviews Cardiology volume 11, pages 304–307 (2014)Cite this article

Subjects

Abstract

In patients with cardiovascular diseases, adherence to medication is a fundamental prerequisite for pharmacological therapy to be effective. Nonadherence to medication is a major public health problem that compromises the effectiveness of therapies and results in suboptimal clinical outcomes. The behaviour of nonadherence is complex and is strongly influenced by an interaction between various factors, such as patient education, communication between patients and physicians, drug dosing schedules, and access to health care. Interventions have been implemented to target these barriers to adherence; however, individual interventions have generally been associated with fairly modest improvements in adherence. Financial incentive schemes and modern technology, such as mobile telephone applications, are being harnessed as novel strategies to improve adherence. Ultimately, multifaceted strategies tailored to individual patients are likely to be required to improve long-term adherence to medication and consequently enhance patient health.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  1. Lozano, R. et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 380, 2095–2128 (2012).

    Article  Google Scholar 

  2. Haynes, R. B. in Compliance in Health Care (eds Haynes, R. B., Taylor, D. W. & Sackett, D. L.) 46–62 (The Johns Hopkins University Press, 1979).

    Google Scholar 

  3. Rand, C. S. Measuring adherence with therapy for chronic disease: implications for the treatment of heterozygous familial hypercholesterolemia. Am. J. Cardiol. 72, 68D–74D (1993).

    Article  CAS  Google Scholar 

  4. WHO. Adherence to long-term therapies: evidence for action [online], (2003).

  5. Vrijens, B. et al. A new taxonomy for describing and defining adherence to medications. Brit. J. Clin. Pharmacol. 73, 691–705 (2012).

    Article  Google Scholar 

  6. Benner, J. S. et al. Long-term persistence in use of statin therapy in elderly patients. JAMA 288, 455–461 (2002).

    Article  Google Scholar 

  7. Monane, M. et al. Compliance with antihypertensive therapy among elderly Medicaid enrollees: the roles of age, gender, and race. Am. J. Public Health 86, 1805–1808 (1996).

    Article  CAS  Google Scholar 

  8. Choudhry, N. K., Setoguchi, S., Levin, R., Winkelmayer, W. C. & Shrank, W. H. Trends in adherence to secondary prevention medications in elderly post-myocardial infarction patients. Pharmacoepidemiol. Drug Saf. 17, 1189–1196 (2008).

    Article  Google Scholar 

  9. Choudhry, N. K. & Winkelmayer, W. C. Medication adherence after myocardial infarction: a long way left to go. J. Gen. Intern. Med. 23, 216–218 (2008).

    Article  Google Scholar 

  10. Osterberg, L. & Blaschke, T. Adherence to medication. N. Engl. J. Med. 353, 487–497 (2005).

    Article  CAS  Google Scholar 

  11. Marshall, I. J., Wolfe, C. D. & McKevitt, C. Lay perspectives on hypertension and drug adherence: systematic review of qualitative research. BMJ 344, e3953 (2012).

    Article  Google Scholar 

  12. Viswanathan, M. et al. Interventions to improve adherence to self-administered medications for chronic diseases in the United States: a systematic review. Ann. Intern. Med. 157, 785–795 (2012).

    Article  Google Scholar 

  13. Nielsen-Bohlman, L., Panzer, A. M. & Kindig, D. A. (eds) Health Literacy: a Prescription to End the Confusion (National Academies Press, 2004).

    Google Scholar 

  14. King, A. Poor health literacy: a 'hidden' risk factor. Nat. Rev. Cardiol. 7, 473–474 (2010).

    Article  Google Scholar 

  15. Miller, W. R. Motivational interviewing: research, practice, and puzzles. Addict. Behav. 21, 835–842 (1996).

    Article  CAS  Google Scholar 

  16. Lavoie, K. et al. The efficacy of brief motivational interviewing to improve medication adherence in poorly controlled, nonadherent asthmatics: results from a randomized controlled pilot study [abstract]. Chest 140, 915A (2011).

    Article  Google Scholar 

  17. Ogedegbe, G. et al. A practice-based trial of motivational interviewing and adherence in hypertensive African Americans. Am. J. Hypertens. 21, 1137–1143 (2008).

    Article  Google Scholar 

  18. Golin, C. E. et al. A 2-arm, randomized, controlled trial of a motivational interviewing-based intervention to improve adherence to antiretroviral therapy (ART) among patients failing or initiating ART. J. Acquir. Immune Defic. Syndr. 42, 42–51 (2006).

    Article  Google Scholar 

  19. Derose, S. F. et al. Automated outreach to increase primary adherence to cholesterol-lowering medications. JAMA Intern. Med. 173, 38–43 (2013).

    Article  Google Scholar 

  20. Fischer, M. A. et al. Trouble getting started: predictors of primary medication nonadherence. Am. J. Med. 124, 1081.e9–e22 (2011).

    Article  Google Scholar 

  21. Choudhry, N. K. et al. Full coverage for preventative medications after myocardial infarction. N. Engl. J. Med. 365, 2088–2097 (2011).

    Article  CAS  Google Scholar 

  22. Chernew, M. E., Rosen, A. B. & Fendrick, A. R. Value-based insurance design. Health Aff. (Millwood) 26, w195–w203 (2007).

    Article  Google Scholar 

  23. The Holy Bible: International Standard Version. Romans 7:15 (Davidson Press, 2008).

  24. Bobonich, C. & Destrée, P. Akrasia in Greek Philosophy: from Socrates to Plotinus (Brill, 2007).

  25. DeFulio, A. & Silverman, K. The use of incentives to reinforce medication adherence. Prev. Med. 55 (Suppl.), S86–S94 (2012).

    Article  Google Scholar 

  26. Volpp, K. G. et al. A test of financial incentives to improve warfarin adherence. BMC Health Serv. Res. 8, 272 (2008).

    Article  Google Scholar 

  27. Kimmel, S. E. et al. Randomized trial of lottery-based incentives to improve warfarin adherence. Am. Heart J. 164, 268–274 (2012).

    Article  Google Scholar 

  28. Volpp, K. G. et al. Financial incentive-based approaches for weight loss: a randomized trial. JAMA 300, 2631–2637 (2008).

    Article  CAS  Google Scholar 

  29. John, L. K. et al. Financial incentives for extended weight loss: a randomized, controlled trial. J. Gen. Intern. Med. 26, 621–626 (2011).

    Article  Google Scholar 

  30. Aetna News Hub. Aetna launches CarePass Developers Challenge with $100,000 in prizes for top apps encouraging medication compliance [online], (2012).

  31. US Department of Health & Human Services. Health Data Initiative. HHS.gov/Open [online], (2010).

  32. Aetna. Health data initiative by HHS [online], (2012).

  33. Aetna. CarePass® platform and medication reminder developer challenge webinar [online], (2012).

  34. US National Library of Medicine. ClinicalTrials.gov [online], (2013).

  35. GoodRx. Stop paying too much for your prescriptions! [online], (2013).

  36. Health 2.0. Aetna's CarePass platform and medication reminder developer challenge [online], (2012).

  37. FDA. Mobile medical applications: guidance for industry and Food and Drug Administration staff [online], (2013).

  38. Timimi, F. K. Medicine, morality and health care social media. BMC Medicine 10, 83 (2012).

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, 55905, MN, USA

    Tanya H. Tajouri & David R. Holmes Jr

  2. Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 North Lake Shore Drive, Suite 1400, Chicago, 60611, IL, USA

    Steven L. Driver

Authors
  1. Tanya H. Tajouri
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Steven L. Driver
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. David R. Holmes Jr
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

T. H. Tajouri and S. L. Driver researched data for the article. All the authors contributed substantially to discussion of its content and wrote the manuscript. T. H. Tajouri and D. R. Holmes Jr reviewed/edited the article before submission.

Corresponding author

Correspondence to David R. Holmes Jr.

Ethics declarations

Competing interests

The authors declare no competing financial interests.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Tajouri, T., Driver, S. & Holmes, D. 'Take as directed'—strategies to improve adherence to cardiac medication. Nat Rev Cardiol 11, 304–307 (2014). https://doi.org/10.1038/nrcardio.2013.208

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/nrcardio.2013.208

This article is cited by

Search

Advanced search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing