American Heart Month

February is American Heart Month. 

In the 1970s, nearly all deaths (an estimated 91%) caused by heart disease were attributable to heart attacks.¹  Despite modern advances resulting in a significant increase in the likelihood of survival after a heart attack, mortality rates associated with other forms of heart disease have increased.¹ Now, heart failure, arrhythmias, and hypertension are responsible for over 50% of heart-disease related deaths.¹

While significant progress has been made in drastically reducing heart attack mortality rates within the past 50 years, heart disease remains the leading cause of death from men, women, and most racial and ethnic groups in the United States.^{1, 2} In 2023, 1 in every 5 deaths was attributable to heart disease, which includes all heart disease, making prevention and proactive treatment to prevent further complications of utmost importance.³

Types of Heart Disease

While heart disease is often automatically associated with heart attacks, it encompasses a broad range of conditions that affect the function and structure of the heart.³ In order to effectively diagnose and treat each condition, understanding and distinguishing between them is essential.³

Coronary Artery Disease (CAD)

Coronary artery disease, more commonly referred to as CAD, occurs when an individual’s coronary arteries experience blockages.³ When blockages occur in the coronary arteries, this reduces the flow of blood to the heart, limiting the amount of oxygen the heart receives. CAD is the most common heart disease condition with the highest death toll.³

Notably, this condition is progressive, with deposits, commonly referred to as “plaque” gradually accumulating in the coronary arteries and reducing blood flow to the heart over extended periods of time.³ If CAD goes unnoticed or untreated it can lead to chest pains, or in clinical terms, angina.³ Additional complications can include an individual experiencing abnormal heart rhythms, heart failure, and/or a heart attack.³

A series of factors can influence and increase one’s risk of developing CAD. These include the following …³

• Age: Men’s risk of CAD increases significantly after the age of 55, while women’s risk rises after menopause.
• Sedentary lifestyle
• Genetic factors
• Family history of CAD
• Chronic conditions: Individuals living with diabetes, metabolic syndrome, and/or high blood pressure may be at an increased risk for developing CAD.³
• High LDL levels: Low-density lipoprotein (LDL) levels are commonly referred to as one’s levels of “bad” cholesterol, as it is associated with an increased risk of plaque buildup within the arteries.³
• Low HDL levels: High-density lipoprotein (HDL) levels measure one’s “good” cholesterol, as it enables the removal of bad cholesterol; having low levels may increase the risk of plaque buildup in the arteries.³
• Obesity 
• Smoking 
• Chronic stress

Heart Arrhythmias 

A heart arrhythmia is typically defined as an individual’s heart beating too fast, too slow, or in an uneven, irregular rhythm.³ While some arrhythmias can be harmless, others can significantly increase the risk of cardiac arrest or stroke.³ While serious arrhythmias can occur independently, more often than not, they develop due to other heart-related problems.³

Key risk factors for developing a heart arrhythmia include the following …³

• Smoking 
• Alcohol consumption 
• Additional health-related conditions: Including obesity, sleep apnea, or high blood sugar levels. 

Heart Failure

Heart failure occurs when one’s heart begins failing to pump blood as effectively as a healthy, normal functioning heart would to ensure that all bodily needs are met.³ Heart failure is most commonly caused by CAD, but can also occur due to thyroid disease, high blood pressure, heart disease (cardiomyopathy), and other conditions.³

Heart Valve Disease

Heart valve disease occurs when an individual experiences an abnormality in one of their heart’s four valves. Under normal circumstances, the heart valves open and close to direct blood flow between each of the heart’s four chambers, the lungs, and blood vessels.³ An abnormality can result in valve dysfunction, leading to blood flow blockages or leakages.³

There are two types of heart valve disease, including endocarditis and rheumatic heart disease. ³

Endocarditis is most commonly caused by a bacterial infection entering the bloodstream and manifesting in the heart.³ This can occur during illness, after surgery, or after one receives intravenous drugs. Notably, the risk of endocarditis is greater if an individual already has issues with their heart valves, and if left untreated, endocarditis can further damage the valves, leading to life threatening complications.³ When provided in a timely manner, antibiotics can be utilized to cure endocarditis, but serious damage may necessitate heart replacement surgery. ³

Rheumatic heart disease occurs when rheumatic fever, connected to strep throat and scarlet fever, damages one’s heart muscles and valves.³ In the modern day, rheumatic heart disease is less common due to antibiotics being utilized proactively to treat the conditions that can lead to rheumatic fever.³

Pericardial Disease 

The pericardium refers to the sac surrounding the heart. Any disease involving the pericardium is referred to as pericardial disease, with common conditions including those that cause inflammation of the pericardium (clinically referred to as pericarditis).³

Pericardial disease is often a result of a viral infection, inflammatory disease, or injury directly to the pericardium.³ It is especially common after undergoing open heart surgery. 

Cardiomyopathy (Heart Muscle Disease)

Cardiomyopathy is a disease of the heart muscle, also referred to as the myocardium, which can become stretched, thickened, or stiff.³ If this occurs, one’s heart may become too weak to pump blood efficiently.³

Cardiomyopathy has numerous potential causes including the following …³

• Genetic heart conditions 
• Reactions to certain drugs or toxins (this includes alcohol) 
• Viral infections 
• In some cases, chemotherapy for cancer can lead to cardiomyopathy. 

However, oftentimes, doctors are unable to pinpoint an exact cause for cardiomyopathy.³

Congenital Heart Disease 

Congenital heart disease occurs when a heart abnormality occurs while the heart is forming before an individual is born.³ While this condition can result in immediate issues upon birth, some individuals may not experience any symptoms until they reach adulthood.³

Septal abnormalities are the most common form of congenital heart issues, in which there are holes in the wall separating the left and right sides of the heart.³ Procedures to patch these holes may be performed to fix septal abnormalities.³

Another abnormality that is classified as a congenital heart issue includes pulmonary stenosis, in which a narrow valve minimizes the amount of blood flowing to the lungs.³ Proper treatment often involves a procedure or surgery to open or replace the valve.³

In some newborns, the ductus arteriosus may not close at birth as is intended, causing blood to leak back into the pulmonary artery, which puts an increased strain on the heart. This can be treated with surgery, procedures, or, in some instances, medication.³

Symptoms of Heart Disease 

The symptoms of heart disease can present in varying ways depending on the condition a person has and the progression of heart disease.^3,4 In many cases, symptoms across conditions may overlap.^{3, 4} Below is an overview of some of the most common symptoms associated with various types of heart disease.

• Coronary Artery Disease (CAD) → Common symptoms include chest pain, chest tightness, chest pressure, shortness of breath, severe pain in the neck/jaw/throat/upper back or belly, and feelings of pain, numbness, weakness, or coldness in the legs or arms (if blood vessels in these areas become too narrow).⁴ 
• Arrhythmias → Symptoms often include chest pain, dizziness, fainting spells, fluttering in the chest, light-headedness, shortness of breath, and a racing or slow heart rate.⁴
• Heart failure → Patients may experience shortness of breath (this may occur even when lying down), fatigue/weakness, a persistent cough, and/or swelling in the ankles/legs/feet.⁴
• Heart valve disease → Frequently reported symptoms of heart valve disease include chest pain, fainting, shortness of breath, fatigue, irregular heartbeat, shortness of breath, and/or swollen feet/ankles. ⁴
• Cardiomyopathy → Individuals with cardiomyopathy may experience dizziness, fatigue, shortness of breath during activity/rest/sleep, rapid heartbeat or fluttering heartbeats, and/or swollen ankles/feet/legs.⁴
• Congenital heart disease → Common symptoms associated with congenital heart disease are as follows: blue or grey colored skin due to low oxygen levels, swelling in the legs/belly/around the eyes, and shortness of breath during feeding, which can lead to difficulties with weight gain.⁴  

Evidently, symptoms across conditions significantly overlap, making professional evaluation and diagnosis essential for proper treatment. 

How is Heart Disease Diagnosed? 

There are a variety of different tests that can be used to diagnose heart disease.⁵ Notably, heart disease is the leading cause of death in the United States, responsible for an estimated one in five deaths every year.¹ If you or a loved one experience symptoms of heart disease, seeking a screening with a healthcare provider is imperative for improving long-term outcomes and reducing the risk of mortality.³ Those predisposed to developing heart disease conditions, such as those with genetic risk factors, certain chronic conditions, and/or additional health issues, should proactively seek screening to protect their health and well-being.³ 

A typical heart disease diagnosis will entail an appointment with a healthcare professional who will examine the patient’s heart.³ One can expect to be asked questions about their symptoms, personal history, and family medical history.³ If deemed necessary, professionals use a variety of mechanisms to examine the heart and aid professionals in diagnosing heart disease.³ These methods include …

• Blood tests: When an individual experiences a heart attack, the damage induced by the heart attack results in certain proteins from the heart slowly leaking into their blood.⁵ Healthcare professionals can run blood tests to check for these proteins.⁵ For instance, a high-sensitivity C-reactive protein (CPR) test may be ordered to check for a protein that is associated with inflammation of the arteries.⁵ Additional tests may entail checking cholesterol or blood sugar levels.
• Chest X-ray: A chest X-ray allows professionals to determine the condition of a patient’s lungs and whether their heart appears enlarged.⁵
• Electrocardiogram (EKG): An EKG is a quick, painless test that records the electrical signals within the heart to determine if one’s heart is beating too quickly or slowly.⁵  
• Holter monitoring: A holter monitor is a portable EKG device that is often utilized for periods of 24+ hours to provide a comprehensive picture of the heart’s activity during daily activities. This enables for detection of irregularities in an individual’s heart rhythm that may go missed during a regular EKG examination.⁵ 
• Echocardiogram: An echocardiogram is a noninvasive exam in which sound waves produce detailed images of the heart, showing how blood flows through the heart and heart valves. This test is commonly performed to determine if a valve in the heart is leaking or blocked.⁵
• Exercise test/Stress test: During an exercise or stress test patients are asked to engage in some form of exercise, often walking on a treadmill or riding a stationary bike, while a healthcare professional monitors their heart.⁵ These tests help to reveal how an individual’s heart responds to physical activity and whether symptoms of heart disease occur when they are engaging in exercise.⁵
  • For those who are unable to engage in physical exercise, medication can be administered that affects the heart in a similar manner to physical activity.⁵
• Cardiac catheterization: With cardiac catheterization, professionals insert a long, thin flexible tube (known as a catheter) into a patient’s blood vessel in their groin or wrist, gradually guiding it to the heart.⁵ Dye flows through the catheter to the heart’s arteries, allowing for clearer images of the arteries when X-ray images are taken.⁵
• Heart CT scan (Cardiac CT scan): During a heart CT scan, patients lie on a table inside of a doughnut-shaped machine.⁵ An X-ray tube inside of the machine rotates around the patient’s body, producing numerous images of the heart and chest from various angles.⁵ 
• Heart magnetic resonance imaging (MRI) scan: An MRI scan utilizes a magnetic field and computer-generated radio waves that allow for detailed images of the heart.⁵

Prevention & Treatment for Heart Disease

Heart disease treatment varies depending on one’s diagnosis, but one theme remains consistent: early prevention and timely care can significantly reduce the risk of further complications and improve long-term outcomes.⁵ While some forms of heart disease require procedures or surgery, many can be prevented, or at the least managed effectively, through lifestyle changes, consistent monitoring, and adherence to medications.^{3, 4, 5} 

Prevention: How to Reduce the Risk? 

While some heart disease conditions can occur due to factors out of an individual’s control, many of the risk factors are modifiable. This means that by taking active steps to improve other areas of one’s health, individuals can lower their chances of developing heart-related conditions. Commonly recommended prevention strategies entail the following … .^{3, 5}

1. Diet: Consuming heart-healthy foods such as fruits, vegetables, lean proteins, whole grains, and healthy fats like those found in salmon, avocado, and olive oil.^{3, 5} One should seek to limit their consumption of salt, sugar, alcohol, and highly processed foods.^{3, 5}
2. Activity Levels: Movement and activity helps to maintain the health of the heart.³ Professionals typically recommend engaging in moderate activity for a minimum of 150 minutes (walking at a brisk pace) or 75 minutes of vigorous activity (running) per week.^{3, 5}
   1. However, more recent research suggests that 30 minutes of exercise every day may be more beneficial.³ Exercise recommendations vary from person to person, speaking with healthcare professionals is essential to determine the appropriate amount and type of exercise to meet one’s specific needs.
3. Sleep: Failure to get enough sleep has been associated with an increased risk of heart disease and additional chronic health conditions. It is estimated that adults should aim for an average of 7 to 9 hours of sleep per night.^{3, 5}
   1. For those who have difficulty with sleep, contacting a healthcare professional can help them determine strategies to ensure they get adequate sleep. 
4. Stress: Stress can increase the risk of heart disease, making it critical for individuals to find ways to alleviate or minimize the emotional stress they experience. Exercise, mindfulness, meditation, and connecting with others via support groups are all common strategies recommended to help individuals minimize their stress.^{3, 5}
5. Weight: There is a strong association between obesity and heart disease.^{3, 5} Engaging in moderate physical activity and working to actively make healthy dietary choices can play a large role in ensuring an individual maintains a weight deemed optimal for them based on their providers’ recommendations.⁵
6. Smoking: Smoking is a larger risk factor for heart disease, making actively seeking to quit imperative.^{3, 5} For those struggling to quit, healthcare professionals can provide recommendations for programs or treatments to ensure patients receive the necessary support they deserve.
7. Managing Co-Morbid Conditions 

Blood Pressure: Individuals with high, uncontrolled blood pressure are at greater risk of serious health conditions. Those over the age of 18 should seek to have their blood pressure checked, at minimum, every two years to determine if their blood pressure is within optimal range or not.⁵ It is important to note that high blood pressure often does not have any symptoms, making regular treatment imperative.⁶ A blood pressure of 120 mm Hg / 80 mm Hg is typically considered the gold standard, or the optimal reading for one’s blood pressure.⁶ A normal blood pressure will vary from person to person, making it critical to see a doctor so they can determine what is healthy based on that individual’s medical history.⁶ 

Cholesterol: It is recommended that all individuals get a cholesterol test when they are in their 20s, then, go for re-testing every 4 to 6 years, decreasing the amount of time between visits with age progression.⁵ High cholesterol often has no symptoms, making more frequent check-ups for those with a family history of high cholesterol, or non-optimal levels, necessary.⁷

The following cholesterol levels place individuals at an increased risk of heart disease:⁷ 

Total cholesterol: 200+ 

HDL cholesterol: Below 40 (in men), below 50 (in women)

LDL cholesterol: 100+ 

The following cholesterol levels are considered heart-healthy levels that can help reduce one’s risk of heart disease:⁷ 

Total cholesterol: Below 200

HDL cholesterol: 40-80 (in men), 50-80 (in women)

LDL cholesterol: Below 100 (lower is better)

Diabetes: For individuals living with diabetes, controlling blood sugar levels is essential for minimizing the risk of developing heart disease.⁵ 

It is important for individuals with diabetes to control their blood sugar levels to reduce their risk of heart disease.⁵ Ranges for fasted blood glucose levels are as follows:

Healthy blood glucose level for someone without diabetes: 70 – 90 mg/dL.⁸ Values between 50 – 70 mg/dL can be normal for people without diabetes as well.⁸

Pre-diabetic blood glucose levels: 100 – 125 mg/dL. People with prediabetes have a 50% chance of developing Type 2 diabetes within the next 5-10 years, but steps can be taken to reverse prediabetes.⁸

Diabetic blood glucose levels: 126 mg/dL or higher for Type 2, 200 mg/dL or higher for Type 1 diabetes.⁸

Treatment

Once individuals receive a professional diagnosis, heart disease treatment can then be tailored to meet their specific needs. Oftentimes, lifestyle modifications are recommended to improve existing symptoms and slow the progression of heart disease.⁵ These lifestyle changes include all of those outlined earlier when reviewing prevention strategies, such as an emphasis on dietary modifications, increases in physical activity, stress management, and smoking cessation.^{3, 5} 

While lifestyle modifications are often recommended, medications are often necessary in addition for effective symptom control and to prevent disease progression.³ The type of medication an individual is prescribed will vary based on the type of heart disease the individual is diagnosed with. Common medications include the following … 

1. Anticoagulants (“blood thinners”): Although anticoagulants are frequently referred to as “blood thinners,” anticoagulants do not actually “thin” the blood.⁹ Rather, anticoagulants decrease the blood’s clotting abilities, which in turn, helps to prevent blood clot formation and/or existing blood clots from growing in size.⁹ Anticoagulants are most commonly prescribed to proactively prevent strokes/heart attacks from occurring, although they may also be used to reduce the likelihood of recurrent strokes/heart attacks.⁹
2. Antiplatelet Agents: Antiplatelet agents are medications that work by preventing blood platelets from sticking to one another, helping to minimize the likelihood of blood clot formation.⁹ Antiplatelet agents can be used as treatment for a variety of different purposes in relation to heart disease.⁹ For instance, they may be prescribed as a preventative strategy for those who exhibit evidence of plaque build-up but have yet to experience a major blockage within their artery. In contrast, they may be given retrospectively, helping to prevent blood clotting in individuals who have already experienced a heart attack, unstable angina, ischemic strokes, and other forms of cardiovascular disease.⁹ 
3. Dual Antiplatelet Therapy (DAPT): DATP refers to dual antiplatelet therapy, which is when individuals are prescribed two forms of antiplatelet medication, most commonly including aspirin, plus another agent, which is oftentimes a P2Y12 inhibitor.⁹ The most common DAPT entails individuals being prescribed aspirin on a life-long basis in addition to a second antiplatelet agent (ex: P2Y12 inhibitor) which may be prescribed for months or years.⁹ The specific dual antiplatelet combination and length of treatment an individual receives on DAPT will vary based on their condition and risk factors.⁹ However, DAPT is most commonly used among individuals who have experienced a heart attack/stroke/transient ischemic attack, have had a stent placed in their coronary arteries, have had an angioplasty, or have had coronary artery bypass graft (CABG) surgery.⁹
4. Angiotensin-Converting Enzyme (ACE) Inhibitors: ACE inhibitors work by relaxing and widening blood vessels, lowering blood pressure, and making it easier for the heart to pump blood.⁹ These medications are commonly prescribed for treating or improving the symptoms of high blood pressure and/or heart failure.⁹ Research has also found that prescribing ACE inhibitors may prove beneficial for individuals who have had a heart attack.⁹
5. Angiotensin II Receptor Blockers/Inhibitors (ARBs): Similar to ACE inhibitors, ARBs are also utilized to relax and widen blood vessels, lower blood pressure, and make it easier for the heart to pump blood.⁹ They are also commonly used to treat or improve the symptoms associated with high blood pressure and heart failure.⁹ The distinguishing difference between ACE inhibitors and ARBs is that ACE inhibitors reduce the production of angiotensin II, while ARBs prevent angiotensin from binding to its intended receptors.¹⁰ For heart failure specifically, ACE inhibitors are typically the first line of treatment, but due to better toleration, ARBs may be used in place if an individual is experiencing unpleasant or distressing side effects associated with an ACE inhibitor.¹⁰ 
6. Beta-Adrenergic Blocking Agents (Beta Blockers): Beta blockers offer a series of benefits including slowing the heart rate, making it easier for the heart to pump blood, and potential blood pressure benefits via reductions in elevated blood pressure.⁹ Beta blockers are commonly used to treat high blood pressure, chest pain due to reduced blood supply to the heart, in addition to some types of arrhythmias and heart attacks.⁹ They may also be used to proactively prevent additional heart attacks in individuals who have already experienced a heart attack.⁹
7. Calcium Channel Blocks (Calcium Antagonists/Blockers): Calcium blockers can be prescribed to help relax blood vessels and decrease the heart’s pumping strength.⁹ These medications can be used to treat high blood pressure, chest pain caused by reduced blood flow to the heart, and some arrhythmias.⁹
8. Cholesterol-Lowering Medications (These include … statins, nicotinic acids, cholesterol absorption inhibitors, bile acid sequestrants, and PCSK9 inhibitors): While different cholesterol-medications impact the body in varying ways, they typically are all utilized to lower LDL, or “bad,” cholesterol levels.⁹ Numerous cholesterol-lowering medications exist, but statins are typically used as the first line of treatment.⁹ Alternative medications may be used if an individual experiences severe, distressing side effects or does not respond to statins.⁹
9. Diuretics (“water pills”): Diuretics help the body remove excess fluid and sodium through urination while simultaneously helping to reduce the workload placed on the heart.⁹ Diuretics are commonly prescribed to lower blood pressure and alleviate swelling, also clinically referred to as edema, which occurs due to excess fluid buildup in the body.⁹

While medications can be extremely effective in preventing the progression and controlling the symptoms of heart disease, more extreme cases, depending on the type of heart disease and damage caused by the disease, may require heart procedures or surgery.^{3, 5} Coronary angioplasties may be performed to widen arteries and place stents.³ Heart valve surgery may be required to repair or replace faulty valves in the heart.³ If an individual has a blocked artery, bypass surgery may be needed to reroute blood flow around the blocked artery to maintain optimal flow from the heart. For those with exceptional damage to their heart, a heart transplant may be recommended, in which case an individual receives a completely new heart from a deceased donor.³

Adherence to Prescription Medications for Heart Disease 

Despite the prevalence and efficacy of medications for preventing further complications and relieving the symptoms associated with various types of heart disease, adherence remains a critical challenge. The following studies help to outline the prevalence of non-adherence among patients prescribed medication for heart disease … 

1. Anticoagulants (“blood thinners”): It is estimated that 33-50% of patients are nonadherent to their oral anticoagulant medications.¹¹ On average, those who are nonadherent miss 30%, nearly ⅓, of their prescribed doses.¹¹
2. Antiplatelet Agents: A cross-sectional survey found that adherence to antiplatelet therapy substantially declined with increasing time on treatment.¹² After less than 1 month on treatment adherence was estimated to be around 90%, declining to 88% after 1-6 months, further reduced to 75% after 6-12 months, and finally, plummeting to 46% after 12 months on treatment.¹²
3. Dual Antiplatelet Therapy (DAPT): A systematic review of 34 studies found that adherence to DAPT was high at 1 month, but declined significantly after 12 months on treatment.¹³ While adherence to aspirin remained at over 90% after one year, adherence to thienopyridine (a P2Y12 receptor inhibitor) reduced from the time between 1 month on treatment to 12 months across numerous trials.¹³
4. Angiotensin-Converting Enzyme (ACE) Inhibitors: A meta-analysis conducted on 17 observational studies of different classes of antihypertensive medications reported a pooled estimate of adherence to ACE inhibitors of 57.6%.¹⁴
5. Angiotensin II Receptor Blockers/Inhibitors (ARBs) → A meta-analysis conducted on 17 observational studies of different classes of antihypertensive medications reported a pooled estimate of adherence to ARBs of 64.9%.¹⁴
6. Beta-Adrenergic Blocking Agents (Beta Blockers) →  A meta-analysis conducted on 17 observational studies of different classes of antihypertensive medications reported a pooled estimate of adherence to beta blockers of 28.4%, which was significantly lower than adherence rates for comparable medications such as ARBs, ACEIs, calcium channel blockers, and diuretics.¹⁴
7. Calcium Channel Blocks (Calcium Antagonists/Blockers): A meta-analysis conducted on 17 observational studies of different classes of antihypertensive medications reported a pooled estimate of adherence to calcium channel blockers of 52%.¹⁴
8. Cholesterol-Lowering Medications (These include … statins, nicotinic acids, cholesterol absorption inhibitors, bile acid sequestrants, and PCSK9 inhibitors): In real-world clinical registries, reported adherence to statins, the first line of treatment for cholesterol-lowering medications, is below 50% after one year on treatment, with adherence rates dropping below 30% after two years.¹⁵
9. Diuretics (“water pills”): A meta-analysis conducted on 17 observational studies of different classes of antihypertensive medications reported a pooled estimate of adherence to diuretics of 51%.¹⁴

The implications of nonadherence for patients taking medications for heart disease are severe. For patients on oral anticoagulants, each 10% decrease in adherence is associated with a 14% increased hazard of SSE (stroke and systemic embolism) and a 5% increased hazard of SSE, transient ischemic attack, and death.¹¹ Among patients prescribed antiplatelet therapies, non-adherence has been associated with over a two-fold increase in critical cardiac events (HR: 2.50, p < 0.001).¹⁶ 

Optimal adherence to numerous heart disease medications, including ACEIs, ARBs, calcium channel blockers, diuretics, and beta-blockers, can lower blood pressure, consequently reducing the likelihood of adverse coronary events, strokes, and mortality.¹⁴ Yet, low levels of adherence can increase the risk of uncontrolled/poorly controlled blood pressure, increasing one’s risk of each of these adverse outcomes.¹⁴ 

While the outcomes resulting from low levels of adherence vary slightly across different medication classes for heart disease, common themes persist: poorer health outcomes and an increased risk of mortality. Consequently, implementing strategies to enhance adherence to prescribed treatments for patients living with heart disease is imperative. 

AdhereTech: Supporting Adherence to Heart Disease Medications 

For patients living with heart disease, maintaining consistent medication adherence is critical for managing side effects, improving long-term health outcomes, and increasing longevity. Yet, patients are often left to navigate complex routines, side effects, lifestyle challenges, and the day-to-day challenges of daily life, all of which make achieving optimal adherence exceptionally challenging. Treatment plans often require multiple medications, variable dosing schedules, unpleasant side effects, and pharmacy access issues, in addition to the emotional stress of managing a chronic condition. Hence, real-world barriers, not a lack of willingness, are among the most common reasons for patients failing to follow their treatment plans as prescribed. 

AdhereTech’s Aidia System was purpose-built to close this gap, transforming adherence support from a reactive, patient-burdened model into a proactive, fully automated patient-centric experience.

AdhereTech works to eliminate patient burden from the moment patients receive their devices. Devices arrive directly at the patient’s doors fully-charged and pre-programmed to their individualized dosing schedule. Built to resemble standard pill bottles and caps, adherence monitoring simply requires patients to engage in a familiar behavior: taking medication from a pill bottle. 

Each time patients take their medication, embedded smart technology automatically records and transmits each bottle opening to a secure network with down-to-the-second precision. Monitoring, data capture, and transmission all occur passively via 4G cellular functionality, eliminating the burden imposed by existing digital adherence monitoring methods, which often require patients to engage in new behaviors, set-up devices, install and upload information via mobile applications, or have consistent WiFi connectivity.  

AdhereTech’s design, seamlessly integrating into patients existing routines, is essential for heart disease patient populations, which includes larger numbers of older adults, individuals experiencing cognitive impairments or decline, or those managing multiple comorbid conditions, all of whom may struggle with new habit adoption and complex digital technology. By eliminating the need for advanced technological literacy and complex behavioral engagement, AdhereTech removes the barriers that frequently prevent digital adherence tools from supporting long-term adherence.

Beyond passive data capture, AdhereTech’s Aidia system includes the capability for fully customizable, real-time reminders. Universal reminder features include the emission of a gentle glow before one’s dosing window and a chime every 15 minutes within a patient’s dosing window. Meanwhile, SMS messages are delivered in the patient’s primary language when a dose is missed or delayed. These reminders are customizable, meaning patients can choose as many or few as they would like, and the devices will be tailored accordingly to align with their dosing schedule.  

In a digital landscape where adherence is key to heart disease treatment success, Aidia’s passive, automated, and patient-centered design ensures the highest levels of accuracy and engagement without adding burden to complicated medication regimens. Patients can continue living their daily lives without their medication plans causing unnecessary disruptions, while Aidia handles the rest. 

Timely and Personalized Support When Doses Are Missed

For cardiac patients, the burden and confusion associated with multi-drug regimens, treatment fatigue, fear regarding side effects, and general human forgetfulness can all prevent them from taking their medications as prescribed. Aidia’s real-time detection allows for immediate support and proactive outreach, preventing nonadherence from escalating via … 

• Customizable reminders, including a gentle glow, a subtle chime, and SMS reminders, all of which remove the cognitive burden associated with remembering to follow stringent medication regimens. Furthermore, the SMS reminders allow patients to respond, explaining their reason(s) for nonadherence, providing healthcare professionals with invaluable insights in real-time. Professionals can reach out to support patients proactively, tailor treatment regimens, or walk patients through their concerns to ensure their treatment plans are individualized to optimize adherence. 
• Aidia’s escalation protocol balances patient autonomy with support. Real-time monitoring enables patients to have control over their medication-taking behaviors from the comfort of their own home, while allowing their care teams to passively monitor adherence behaviors and intervene as needed to prevent complications. 

Unlike existing solutions, which retrospectively offer adherence data, Aidia proactively uncovers the root cause of nonadherence before it leads to dangerous lapses in treatment. For instance, if a patient reports experiencing distressing or unpleasant effects while taking an ACE inhibitor, their care team can evaluate whether switching to an ARB is appropriate due to the lower risk of adverse drug reactions and unpleasant side effects.¹⁰

Given that every 10% decline in nonadherence to oral anticoagulants has been associated with a 14% increased risk of stroke or death,¹¹ early intervention is not merely a suggestion; it is essential for increasing longevity. Aidia’s approach combines real-time adherence support with compassion and personalization, turning a missed dose into an actionable insight. 

Integrated Pharmacy and Access Support

One of the leading causes for patients becoming nonadherent is a simple one: they run out of medication. In a meta-analysis measuring adherence to seven cardiovascular drug classes, including those used for heart disease treatment, pharmacy refill data found a nonadherence rate of 43%.¹⁷ Insurance issues, transportation barriers, and cost concerns may all prevent or delay timely medication refills, disrupting consistent cardiac medication usage.¹⁸ 

AdhereTech is specifically designed to help minimize these gaps in treatment.   

• AdhereTech’s smart pill bottles include an electronic magnetic field that can detect when a patient is running low on their medication, proactively alerting the patient’s care team that a refill is needed before their medication runs out. Furthermore, this electronic magnetic field has the capability to detect when inappropriate amounts of medication are removed, flagging this to the patient’s providers. This feature can alert professionals to patients who may be engaging in pill splitting, in which they are reducing the amount of medication they take below the level it is prescribed due to cost-related barriers. 
• The Aidia system’s escalation protocols alert specialty pharmacies and healthcare professions when patients require a refill, preventing unnecessary lapses in treatment.
• AdhereTech’s care team operates 7 days a week and can connect patients with financial resources to ensure that the cost of their medication does not compromise their health. The care team can also escalate questions regarding refills or access barriers to the patient’s care team, enabling for timely, proactive support.

For heart disease patients, particularly those with elevated blood pressure, uninterrupted treatment is essential for reducing the likelihood of adverse coronary events, stroke, and mortality.¹⁴ Aidia ensures that medication access issues are identified early and resolved quickly, preventing avoidable interruptions in care.

Actionable, Real-Time Data for Clinicians and Care Teams

Traditionally, clinicians have had little visibility into whether a patient is taking their medication as prescribed. For instance, many professionals have relied upon and continue to utilize self-report tools, pill counts, pharmacy claims data, and/or retrospective lab values.¹⁹ Each of these adherence monitoring methods are subject to biases, providing retrospective data that may result in nonadherence going undetected for extended periods of time, compromising patients’ long-term health outcomes.^{.19, 20} Aidia changes this, replacing retrospective insights with real-time accuracy. 

The Aidia system offers:

• Escalation protocols that alert professionals in real-time of missed or skipped doses. 
• Longitudinal data on adherence patterns for each patient. 
• Population-level insights that allow professionals to identify high-risk groups and develop interventions accordingly. 

This level of insight allows professionals to intervene – adjusting treatment plans, addressing side effects, and/or providing targeted education – long before a missed dose leads to serious consequences. For health systems and care management programs, Aidia creates a scalable, data-driven approach to improving outcomes, one that supports both individual patient care and population health strategies.

Technology that Supports All Patients

Heart disease disproportionately impacts adults over the age of 50, individuals living with multiple chronic conditions – such as diabetes, hypertension, metabolic syndrome – and populations facing socioeconomic barriers.^{21, 22, 23} Many existing digital health tools fail to effectively support these groups due to technical complexity, heavy reliance on smartphones, or added patient burden.

Aidia was intentionally built to mitigate these existing barriers. 

• Aidia eliminates the need for app installation, WiFi connectivity, and frequent device charging. Functioning via the 4G cellular network with an up to 10-month battery life, patients simply take their medication as they would from a regular pill bottle. 
• Aidia devices arrive at patients pre-programmed to their personal dosing schedule and fully charged, working to minimize patient burden the moment they arrive. 
• AdhereTech’s Aidia system leverages principles of behaviorism to further mitigate patient burden. The system integrates seamlessly into a patient’s existing routines, while the device uses nudges to promote daily adherence, leading to long-term habit formation of adherence behaviors.
• The Aidia system is scalable across diverse settings, ranging from outpatient programs to clinical trials. The devices’ 4G cellular connectivity and Aidia’s translation capabilities that deliver SMS messaging in a patient’s preferred language ensure that patients, regardless of their geographical location or native language, have access to the consistent support they deserve.

This makes Aidia uniquely positioned to support patients who are traditionally underserved and who stand to benefit the most from improved adherence due to existing health disparities. For patients living with heart disease, this inclusivity isn’t just a design preference; it’s a public health imperative for reducing adverse health outcomes and increasing longevity.

Why AdhereTech Represents a Breakthrough for Heart Disease Treatment

Heart disease medications can save patients lives, but only when they are taken consistently. Real-world adherence remains alarmingly low despite the life-saving capabilities of heart medications.^11-15 Clinical evidence backs Aidia’s promise in preventing non-adherence, with over 92% adherence achieved by the end of week in 8 in two clinical trials within cardiology.²⁴ The following features are key attributes of Aidia’s system that result in enhanced adherence … 

• Escalation protocols that alert patients’ care teams when non-adherence occurs, allowing them to intervene pro-actively before nonadherence escalates. 
• SMS capabilities that allow patients to report their reasons for non-adherence, enabling care teams to tailor treatment and interventions accordingly. 
• Timely reminders which serve as a source of support for patients. 
• Offers researchers, pharmacists, and clinicians with real-time insights, allowing for early intervention. 
• Reduces cognitive burden for patients, leveraging principles of Nudge Theory to support sustained adherence. 
• Caregiver features that, when enabled, provide caregivers with notification of their loved one’s adherence behaviors, serving as an additional layer of support to enhance adherence. 

According to a recent report from the American Heart Association, within the next thirty years, at least 60% of American adults may be affected by cardiovascular disease, which encompasses all forms of heart disease.²⁵ Models indicate that the economic consequences of the projected rise in heart disease and stroke is expected to triple the current associated costs, reaching $1.8 trillion by 2050.²⁵ The report highlights that any reduction in disease rates could help to reduce the economic strain imposed by heart disease and related conditions.²⁵ 

Hence, Aidia’s system offers a practical and scalable way to address one of the most persistent and costly drivers of poor outcomes in heart disease: medication non-adherence. By providing objective, real-time adherence data without requiring changes to patient behavior, Aidia enables earlier intervention, more informed clinical decision-making, and better long-term disease management. In a healthcare landscape facing rapidly rising rates of heart disease prevalence and unsustainable costs, solutions that improve adherence represent a tangible opportunity to reduce preventable events, improve patient outcomes, and help offset the projected economic burden of heart disease.

References 

¹ Bai, N. (2025, June 25). As fewer Americans die from heart attacks, more succumb to chronic heart disease. Stanford Medicine. https://med.stanford.edu/news/all-news/2025/06/heart-attack.html 

² Centers for Disease Control and Prevention. (2024, October 24). Heart disease facts | Heart disease | CDC. U.S. Department of Health & Human Services. https://www.cdc.gov/heart-disease/data-research/facts-stats/index.html 

³ Painter, K. (2024, December 10). Heart disease: Types, causes, and symptoms. WebMD. https://www.webmd.com/heart-disease/heart-disease-types-causes-symptoms 

⁴ Mayo Clinic Staff. (2023). Heart disease: Symptoms & causes. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/heart-disease/symptoms-causes/syc-20353118

⁵ Mayo Clinic Staff. (2024, August 13). Heart disease: Diagnosis & treatment. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/heart-disease/diagnosis-treatment/drc-20353124 

⁶ Heart Research Institute. (n.d.). What is normal blood pressure by age? https://www.hri.org.au/health/learn/risk-factors/what-is-normal-blood-pressure-by-age

⁷ Cleveland Clinic. (2025, October 13). Cholesterol: Understanding levels & numbers. https://my.clevelandclinic.org/health/articles/11920-cholesterol-numbers-what-do-they-mean

⁸ Cleveland Clinic. (2025, February 5). Blood Glucose (Sugar) Test.  https://my.clevelandclinic.org/health/diagnostics/12363-blood-glucose-test 

⁹ American Heart Association. (2025, February 27). Cardiac medications (Heart attack treatment). https://www.heart.org/en/health-topics/heart-attack/treatment-of-a-heart-attack/cardiac-medications 

¹⁰ National Kidney Foundation. (2023, May 4). ACE inhibitors and ARBs. https://www.kidney.org/kidney-topics/ace-inhibitors-and-arbs 

¹¹ Safari, A., Helisaz, H., Salmasi, S., Adelakun, A., De Vera, M. A., Andrade, J. G., … & Loewen, P. (2024). Association Between Oral Anticoagulant Adherence and Serious Clinical Outcomes in Patients With Atrial Fibrillation: A Long‐Term Retrospective Cohort Study. Journal of the American Heart Association, 13(18), e035639. 

¹² Luu, N. M., Dinh, A. T., Nguyen, T. T. H., & Nguyen, V. H. (2019). Adherence to antiplatelet therapy after coronary intervention among patients with myocardial infarction attending Vietnam National Heart Institute. BioMed research international, 2019(1), 6585040. 

¹³ Czarny, M. J., Nathan, A. S., Yeh, R. W., & Mauri, L. (2014). Adherence to dual antiplatelet therapy after coronary stenting: a systematic review. Clinical cardiology, 37(8), 505–513. https://doi.org/10.1002/clc.22289 

¹⁴ Kronish, I. M., Woodward, M., Sergie, Z., Ogedegbe, G., Falzon, L., & Mann, D. M. (2011). Meta-analysis: impact of drug class on adherence to antihypertensives. Circulation, 123(15), 1611–1621. https://doi.org/10.1161/CIRCULATIONAHA.110.983874 

¹⁵ Rodriguez, F., Maron, D. J., Knowles, J. W., Virani, S. S., Lin, S., & Heidenreich, P. A. (2019). Association of statin adherence with mortality in patients with atherosclerotic cardiovascular disease. JAMA cardiology, 4(3), 206-213. 

¹⁶ Mori, Y., Friede, T., Hattori, S., Yamaji, K., & Fukuma, S. (2025). Impact of Nonadherence to Any Antiplatelet Therapy After PCI With Drug-Eluting Stents on Critical Outcomes. JACC. Asia, 5(6), 758–768. https://doi.org/10.1016/j.jacasi.2025.03.008 

¹⁷ van der Laan, D. M., Elders, P. J. M., Boons, C. C. L. M., Nijpels, G., & Hugtenburg, J. G. (2019). Factors Associated With Nonadherence to Cardiovascular Medications: A Cross-sectional Study. The Journal of cardiovascular nursing, 34(4), 344–352. https://doi.org/10.1097/JCN.0000000000000582 

¹⁸ Pharmacy Quality Alliance & National Pharmaceutical Council. (2019). Access to care: Development of a medication access framework for quality measurement (Research report). Pharmacy Quality Alliance. https://www.pqaalliance.org/assets/Research/PQA-Access-to-Care-Report.pdf 

¹⁹ Eliasson, L., Clifford, S., Mulick, A., Jackson, C., & Vrijens, B. (2020). How the EMERGE guideline on medication adherence can improve the quality of clinical trials. British journal of clinical pharmacology, 86(4), 687–697. https://doi.org/10.1111/bcp.14240 

²⁰ Dockendorf, M. F., Hansen, B. J., Bateman, K. P., Moyer, M., Shah, J. K., & Shipley, L. A. (2021). Digitally enabled, patient‐centric clinical trials: shifting the drug development paradigm. Clinical and translational science, 14(2), 445-459.

²¹ Dumitrescu, A., Vitcu, G. M., Stoica, S., Susa, S. R., & Stoicescu, E. R. (2024). Cardiovascular Risk Factors in Socioeconomically Disadvantaged Populations in a Suburb of the Largest City in Western Romania. Biomedicines, 12(9), 1989. https://doi.org/10.3390/biomedicines12091989

²² National Institute of Diabetes and Digestive and Kidney Diseases. (n.d.). Diabetes, heart disease, & stroke. U.S. Department of Health and Human Services. https://www.niddk.nih.gov/health-information/diabetes/overview/preventing-problems/heart-disease-stroke 

²³ Kim K. I. (2023). Risk Stratification of Cardiovascular Disease according to Age Groups in New Prevention Guidelines: A Review. Journal of lipid and atherosclerosis, 12(2), 96–105. https://doi.org/10.12997/jla.2023.12.2.96 

²⁴ AdhereTech. (2025, October). AdhereTech Clinical Trials 2025-10-08 [Unpublished presentation]. GoogleSlides. 

²⁵ American Heart Association News. (2024, June 4). Heart disease and stroke could affect at least 60% of adults in U.S. by 2050. American Heart Association. https://www.heart.org/en/news/2024/06/04/heart-disease-and-stroke-could-affect-at-least-60-percent-of-adults-in-us-by-2050