[Poor medication adherence and worsening of heart failure--a vicious circle]

Dtsch Med Wochenschr. 2014 Nov;139(47):2390-4. doi: 10.1055/s-0034-1387391. Epub 2014 Nov 12.
[Article in German]


Despite of markedly improved options for treatment, chronic heart failure is associated with recurrent worsening of symptoms. Poor medication adherence has adverse effects on frequency and progression of congestive heart failure. There are three relevant areas of problems that could be aggravated by each other:There is the problem of changes in pharmacokinetics in worsening heart failure. Proportional to the severity of heart failure, there is an existing intestinal edema and changes of intestinal bacterial colonization that may affect a drug's absorption and, hence, its efficacy.Depression and impaired cognitive function is quite common in patients with chronic heart failure. Depression both predicts hospitalization and mortality rate as well as poor medication adherence in CHF. Compared to stable CHF patients, cognitive function deteriorates significantly while decompensation leading to impaired medication adherence.Shown by recent studies, there is a higher risk for poor medication adherence after a cardiovascular event.Poor medication adherence is associated with an increased rate of cardiovascular events not only in heart failure, but also in all cardiovascular diseases. Hence, there is a need for specific and long term interventions to improve medication adherence at an early stage.

Publication types

  • English Abstract
  • Review

MeSH terms

  • Biological Availability
  • Cardiotonic Agents / administration & dosage*
  • Cardiotonic Agents / pharmacokinetics
  • Cognition Disorders / complications
  • Cognition Disorders / psychology
  • Depressive Disorder / complications
  • Depressive Disorder / psychology
  • Disease Progression
  • Heart Failure / drug therapy*
  • Heart Failure / psychology
  • Humans
  • Intestinal Absorption / drug effects
  • Medication Adherence* / psychology
  • Recurrence
  • Risk Factors
  • Treatment Outcome


  • Cardiotonic Agents