{
  "abstract": "Background and Importance Sustained adherence to guideline-directed medical therapy (GDMT) in heart failure (HF) management is essential, with non-adherence being associated with worse clinical outcomes–including increased hospitalisations, readmissions, and mortality.Aim and Objectives To synthesize evidence on the association between adherence and/or persistence to HF GDMT and clinical outcomes.Material and Methods A systematic review was conducted in September 2024, following PRISMA guidelines. The literature was searched across PubMed, Embase, CINAHL, Web of Science, and Scopus databases using terms related to medication adherence, persistence, HF, and electronic health databases (EHDs). Observational studies of adults with HF using EHDs that assessed medication adherence or persistence and their association with clinical outcomes were included.Collected variables included study characteristics, adherence/persistence measures, and clinical outcomes related to adherence/persistence.Results A total of 14 studies were identified: 13 measuring adherence and one measuring persistence to GDMT. Among the 13 adherence studies, 11 used threshold-based definitions; good adherence was commonly defined as proportion of days covered (PDC) ≥80% (n=6), ≥75% (n=1), or ≥90% (n=1); other definitions included medication possession ratio (MPR) >80%, fill frequency ≥80%, and Patient Adherence Index ≥50%. Two studies evaluated adherence as a continuous variable using PDC (n=1) or MPR (n=1). Across studies, higher adherence was associated with improved outcomes, including lower all-cause mortality (9/13), fewer cardiovascular and HF hospitalisations (7/13), and fewer readmissions (3/13). Effect estimates for adherent versus non-adherent patients ranged from HR 0.72 to 0.85; conversely, non-adherence was associated with increased risk (HR 1.8–3.0). The single persistence study found that non-persistence–defined as a ≥90-day gap between refills–was associated with higher mortality for renin–angiotensin–aldosterone system inhibitors (HR 1.37; 95% CI 1.31–1.42) and β-blockers (HR 1.25; 95% CI 1.19–1.32).Conclusion and Relevance In real-world HF cohorts, better adherence to GDMT is consistently associated with improved clinical outcomes. Hospital pharmacists should prioritise adherence-supportive strategies (medication review, counselling, discharge reconciliation, early follow-up and refill coordination) and implement routine real-world monitoring to identify early declines and target support to high-risk patients.Conflict of Interest No conflict of interest",
  "authors": [
    {
      "affiliations": [
        "Hospital Universitario Jerez De La Frontera, Pharmacy, Jerez-Cádiz, Spain"
      ],
      "name": "N Báez Gutiérrez"
    },
    {
      "affiliations": [
        "Hospital Universitario Jerez De La Frontera, Pharmacy, Jerez-Cádiz, Spain"
      ],
      "name": "H Rodríguez Ramallo"
    },
    {
      "affiliations": [
        "Hospital Universitario Jerez De La Frontera, Pharmacy, Jerez-Cádiz, Spain"
      ],
      "name": "M González Martínez"
    },
    {
      "affiliations": [
        "Hospital Universitario Nuestra Señora De Valme, Pharmacy, Seville, Spain"
      ],
      "name": "C Galindo García"
    },
    {
      "affiliations": [
        "Hospital Universitario Jerez De La Frontera, Pharmacy, Jerez-Cádiz, Spain"
      ],
      "name": "JF Sierra Sánchez"
    },
    {
      "affiliations": [
        "Universidad De Sevilla, Preventive Medicine and Public Health Department, Seville, Spain"
      ],
      "name": "S Sánchez Fidalgo"
    }
  ],
  "title": "6ER-045 Adherence and persistence to heart failure guideline-directed medical therapy and their link to clinical outcomes",
  "uid": "61cc3e63-6b79-5916-a9bc-6fcc9c5fc9ae"
}