More than 40 medical entities and experts linked to health institutions across Latin America, including Brazil, are advocating for the recognition of non-adherence to treatment for chronic diseases like diabetes and hypertension as a modifiable risk factor for cardiovascular events, such as heart attack and stroke – collectively known as cardiovascular disease, the leading cause of death globally.
The proposal is detailed in the document “Recommendations of Latin American Experts on Adherence and Therapeutic Inertia in Cardiovascular Disease, and its Impact on Public Health,” which represents a consensus among 43 regional specialists and is supported by 275 scientific references, including cohort studies, clinical trials, systematic reviews, and meta-analyses. The document primarily addresses cardiovascular and metabolic conditions with high prevalence rates, such as arterial hypertension, type 2 diabetes, dyslipidemia (high cholesterol), coronary artery disease, heart failure, and chronic kidney disease – diagnoses that require continuous treatment and strict control of risk factors.
According to the authors, failing to adhere to treatment for these diseases reduces the effectiveness of medical interventions and allows the condition to run its natural course, potentially leading to preventable complications. Because this behavior can be modified, similar to sedentary lifestyles, obesity, and smoking, experts argue it should be treated as a modifiable risk factor.
Published last September by the Colombian Society of Cardiology and Cardiovascular Surgery, with support from the Inter-American Society of Cardiology and the Brazilian Society of Hypertension, the technical book aims to provide tools for healthcare professionals, particularly those in primary care, to improve care and address the impact of low adherence on public health in Latin America.
The document estimates that non-compliance with treatments for chronic diseases generates additional costs exceeding US$2 billion annually in Latin America, due to hospitalizations, emergency care, and avoidable complications.
In addition to low patient adherence, experts highlight what is known as clinical inertia – when treatment is not adjusted even when clinical targets are not met. Eduardo Barbosa, a Brazilian contributor to the publication and head of the Department of Hypertension and Vascular Dynamics at Santa Casa de Porto Alegre, states that both low adherence and therapeutic inertia are major obstacles to controlling chronic diseases associated with cardiovascular risk.
Non-adherence to hypertension treatment is cited as a frequent example contributing to cardiovascular events, due to its high global prevalence and the need for continuous monitoring and regular therapeutic adjustments. Barbosa explains that adherence refers to the extent to which a patient follows medical recommendations and maintains treatment over time. Inertia, occurs when treatment is not adjusted even when established clinical goals are not achieved.
“Sometimes the patient is very close to the target, and the doctor chooses to reinforce guidance on diet and exercise, but does not adjust the medication,” he explains.
Barbosa believes that formally recognizing poor adherence and therapeutic inertia as risk factors could lead to their inclusion in future guidelines from organizations such as the Brazilian Society of Cardiology, the Brazilian Society of Nephrology, and the Brazilian Society of Hypertension.
The main reasons for abandoning treatment include a lack of understanding of the disease, distrust of the physician, the use of multiple pills per day, and complex regimens. The greater the number of medications and daily doses, the worse adherence tends to be.
The book outlines strategies to address the problem, such as simplifying treatment with single-dose daily combinations of drugs, establishing clear goals with the patient, avoiding technical jargon, and strengthening empathetic communication. The involvement of family members and the use of digital tools are also identified as allies.
“The more the patient understands the disease and trusts the doctor, the greater the adherence. And improving adherence is fundamental to reducing heart attacks, strokes, costs, and loss of quality of life,” he states.
Cardiologist Eduardo Lima, from Hospital Nove de Julho and leader of cardiology at Rede Américas, says the document aims “to shed light on a very old problem” and to clarify responsibilities in the relationship between doctor and patient.
“Non-adherence is not solely the patient’s responsibility; It’s also the doctor’s responsibility,” he asserts. He emphasizes that it is the professional’s responsibility to explain the severity of the disease, the consequences of interrupting treatment, and potential side effects.
Lima reports that some patients with hypertension, for example, suspend their medication on warmer days or when recording temporarily lower blood pressure readings.
“They need to understand that the medication they take in the morning actually works for 24 hours,” he explains.
Last year, the World Heart Federation (WHF) launched a global movement to raise awareness about non-adherence to treatments and lifestyle changes. The alert revealed that the problem affects more than half of patients with chronic diseases and has worsened health outcomes. According to web search results, the WHF estimates that non-adherence in Europe is associated with 200,000 deaths annually and could generate savings of more than €330 million over ten years if adherence reached 70%. In the United States, non-adherence increases annual costs per patient to as much as US$52,000, due to increased hospitalizations and emergency care.
At the time, a report in Folha de S.Paulo showed that non-adherence to treatments for chronic diseases is around 50% in Brazil, a figure similar to that observed globally.
