Notably, however, clinicians tend to over- estimate actual adherence, and no perfect measure of adherence exists. The past decade has seen a transition away from a hi- erarchical approach to medication adherence and more TABLE 8 Potential Infrastructure Components to Support Team-Based HF Care Modality Challenges Potential Bene ts Electronic health records n Ease of access n Interoperability with other electronic data repositories n Data accuracy including missing data n Reduction in errors n Decision support (e.g., ACC TreatHF mobile app) n Accurate medication reconciliation to facilitate guideline adherence n Patient portal to facilitate patient/caregiver engage- ment, including patient-reported outcomes and other patient-generated data (if available) Patient monitoring devices: (e.g., scales, implanted devices, bioimpedance devices, wearable hemodynamic sensors) n Accuracy n False alert n Cost-effectiveness n Infrastructure/resource needs, including accurate data management and triage n Early warning and a reduction in morbidity Wearable activity monitors n Accuracy n Physical activity coaching/adherence n Early detection of arrhythmias (e.g., AF) Smartphones or other mobile technologies n Need for more useful apps or other mobile tech- nologies, including support systems in place for providing equipment and training for use n Potential privacy issues n Activity tracking n Diet records n Weight management n Communication with HF team n Prompts for medication and lifestyle adherence ACC American College of Cardiology; AF atrial brillation; HF heart failure. Reasons for Nonadherence (World Health Organization) Patient n Perceived lack of effect n Poor health literacy n Physical impairment (vision, cognition) n Mental health conditions (depression, anxiety) n Social isolation n Cognitive impairment (dementia) Medical condition n High HF regimen complexity n Impact of comorbidities (e.g.