Review of Patient Charts Reveals Suboptimal Adherence to Heart Failure Therapies

Polypharmacy and medication class may influence adherence to the medications prescribed for heart failure, which remains generally inadequate, according to a retrospective review presented at the 2026 Annual Meeting of the American Association of Heart Failure Nurses in San Diego, California. 

Heart failure is a progressive disease associated with high mortality and morbidity rates and a major driver of healthcare costs in the United States. While adherence to guideline-directed medical therapies (GDMTs) is essential to maintain physiologic function, slow disease progression, and extend life expectancy in this population, inadequate adherence to treatment regimens has been documented in approximately half of patients with heart failure globally [Jarrah M et al. Medicina (Kaunas). 2023; 59:960]. 

A retrospective chart review of randomly selected patients admitted with a diagnosis of heart failure at one of three midwestern hospitals between January 1 and December 31, 2024 showed that the self-reported adherence to prescribed medications varied widely, ranging from 33% adherence rates to loop diuretics to 68% adherence rates to sodium-glucose cotransporter 2 (SGLT2) inhibitors. Prescribed medications also included angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), angiotensin receptor-neprilysin inhibitors (ARNIs), beta blockers, and aldosterone antagonists. The reviewers looked at charts from 210 patients with a mean age of 71 years, with about half of the cohort presenting with preserved ejection fraction (>50%). No differences in adherence rates were observed based on ejection fraction range. The research team at Illinois State University also assessed the effects of multiple factors related to social and economic aspects, healthcare systems, providers, type of medication, and type of diagnosis, and found that polypharmacy had a statistically significant influence on adherence to medications. The multivariable logistic regression analysis showed that the total number of heart failure medications taken daily decreased adherence upon admission to the hospital by 47.7% for each medication added to the regimen. Overall, patients had a 30-day hospital readmission rate of 22%. 

While a retrospective review of patient charts from a limited number of hospitals may paint an incomplete picture regarding adherence to prescribed GDMTs, the real-world data captured by the review raise signals regarding the need to escalate interventions and up-titrate life-saving therapies in this vulnerable population.