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., depression) n Polypharmacy due to multiple comorbidities Therapy n Frequency of dosing n Polypharmacy n Side effects Socioeconomic n Out-of-pocket cost n Dif cult access to pharmacy n Lack of social support n Homelessness Health system n Poor communication n Silos of care n No automatic re lls n Dif culty navigating patient assistance programs HF heart failure. Maddox et al. J toward a shared approach, with greater focus on systems solutions (Table 10). As such, the language has shifted from patient compliance to adherence and now to activation, engagement, and empowerment (115). Within this new paradigm, patients are seen as needing support, whereas blame is counterproductive. Shared decision- making, holistic approaches to multiple chronic condi- tions, cost transparency, personal responsibility, and behavioral theories underlie many of the evolving ap- proaches to enhancing medication adherence (116,117). Six categories of interventions have been identi ed: pa- tient education; medication regimen management; clin- ical pharmacist consultation for chronic disease comanagement; cognitive behavioral therapies; medication-taking reminders; and incentives to promote adherence (102). A systematic review and meta-analysis of 771 intervention trials on medication adherence TABLE 10 Ten Considerations to Improve Adherence 1. Capitalize on opportunities when patients are most predisposed to adherence n In-hospital/pre-discharge initiation following decompensation 2. 