Physicians' Academy for Cardiovascular Education

Low adherence and persistence with HF therapies in new-onset HF

Adherence and persistence to pharmacotherapy in patients with heart failure: a nationwide cohort study, 2014-2020

Literature - Ødegaard KM, Lirhus SS, Melberg HO, et al. - ESC Heart Fail. 2022 Oct 20 [Online ahead of print]. doi: 10.1002/ehf2.14206

Introduction and methods


Despite the availability of several HF therapies, morbidity and mortality in patients with HF remain high [1-3]. One of the reasons could be low adherence to or non-persistence with medication [4-7].

Aim of the study

The authors aimed to study initiation, adherence, and long-term persistence for 3 HF drug classes (beta-blocker (BB ), RAASi, and MRA) in a Norwegian nationwide cohort of HF patients.


Data of 54,899 patients aged 18–79 years who were newly diagnosed with HF from 2014 through 2020 and who survived ≥30 days were collected from the Norwegian Patient Registry. These data were then linked to the Norwegian Prescription Database, which contains information about prescription drugs dispensed from pharmacies. Patients were followed to the outcome of interest (death) or until December 2020.

Initiation (time to drug initiation), adherence, and long-term persistence (no treatment break >30 days) were calculated for the prescription of a BB, a RAASi (ACEi, ARB, or ARNI), and an MRA, as well as for dual and triple HF therapy. One-year adherence was measured as proportion of days covered (i.e., number of days on medication divided by number of days under observation) and adherence was defined as ≥80%. Because of local reimbursement criteria for prescription of ARNIs, the group of patients initiating an ARNI was studied separately. To evaluate the robustness of the findings, sensitivity analyses were performed.

Main results



Long-term persistence


This Norwegian nationwide cohort study with longitudinal follow-up showed that 1-year adherence to dual or triple HF therapies was low in newly diagnosed HF patients (42% and 5%, respectively). In addition, 2- to 5 -year persistence was inadequate, with almost half of the patients discontinuing a RAASi or BB and two-thirds discontinuing an MRA within 2 years.

Although the authors did not investigate the reasons for non-prescription or non-adherence, they believe “[u]rgent efforts are needed to improve implementation of HF drug treatment with decision support to clinicians and patients and ensure broader access to structured multidisciplinary care, particularly addressing adherence of multiple drug therapies.”


Show references

Find this article online at ESC Heart Fail.

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