Intended for healthcare professionals

Clinical Review State of the Art Review

Medication adherence in cardiovascular medicine

BMJ 2021; 374 doi: (Published 11 August 2021) Cite this as: BMJ 2021;374:n1493
  1. Steven T Simon, assistant professor of medicine-cardiology1,
  2. Vinay Kini, assistant professor of medicine-cardiology1,
  3. Andrew E Levy, assistant professor of medicine-cardiology1 2,
  4. P Michael Ho, professor of medicine-cardiology3 4
  1. 1Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
  2. 2Division of Cardiology, Denver Health Medical Center, Denver, CO, USA
  3. 3Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
  4. 4Cardiology Section, VA Eastern Colorado Health Care System, Aurora, CO, USA
  1. Correspondence to S T Simon Steven.Simon{at}


Cardiovascular disease is the leading cause of death globally. While pharmacological advancements have improved the morbidity and mortality associated with cardiovascular disease, non-adherence to prescribed treatment remains a significant barrier to improved patient outcomes. A variety of strategies to improve medication adherence have been tested in clinical trials, and include the following categories: improving patient education, implementing medication reminders, testing cognitive behavioral interventions, reducing medication costs, utilizing healthcare team members, and streamlining medication dosing regimens. In this review, we describe specific trials within each of these categories and highlight the impact of each on medication adherence. We also examine ongoing trials and future lines of inquiry for improving medication adherence in patients with cardiovascular diseases.


  • Series explanation: State of the Art Reviews are commissioned on the basis of their relevance to academics and specialists in the US and internationally. For this reason they are written predominantly by US authors

  • Competing interests: We have read and understood the BMJ policy on declaration of interests and declare the following interests: STS reports none, AEL reports none, VK reports unrelated research grants from the NIH and Greenwall Foundation, PMH reports research grants from Department of Veterans Affairs, NHLBI, and University of Colorado School of Medicine. His NHLBI grant is focused on medication adherence. He has a research agreement with Bristol Myers Squibb unrelated to medication adherence. He serves as a deputy editor for Circulation: Cardiovascular Quality and Outcomes.

  • Contributors and guarantor: STS prepared the manuscript draft, performed literature review, and is the guarantor of the manuscript. AEL and VK contributed to the writing of the manuscript, selection of articles for inclusion, and reviewing the manuscript. PMH constructed the idea and framework of the manuscript, selection of articles for inclusion, contributed to writing of the manuscript, and reviewing the manuscript. STS is guarantor.

  • Provenance and peer review: commissioned; externally peer reviewed.

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