Values Affirmation Boosts Medication Adherence in Heart Failure Patients
A pilot RCT tests whether a values-based psychological intervention can improve medication adherence in heart failure patients undergoing cardiac rehab.
Summary
Sticking to medication regimens is one of the biggest challenges in managing heart failure, yet many patients fall short. This pilot randomized controlled trial, conducted at The Miriam Hospital, tested whether a values affirmation intervention — a technique that helps people reconnect with what matters most to them — could improve medication adherence when added to standard cardiac rehabilitation. Forty-three adults with heart failure were enrolled and randomly assigned to either values affirmation plus usual care or usual care alone. The primary goals were to assess whether the study procedures were feasible and acceptable to participants rather than to measure clinical outcomes definitively. Completed in early 2025, this small but meaningful study lays groundwork for larger trials exploring how psychological tools can complement traditional heart failure management and improve long-term health outcomes.
Detailed Summary
Heart failure affects millions of older adults worldwide and demands strict adherence to complex medication regimens. Yet non-adherence remains alarmingly common, contributing to preventable hospitalizations, disease progression, and premature death. Behavioral interventions that address the psychological barriers to adherence represent a promising but underexplored frontier in cardiac care.
This pilot randomized controlled trial, sponsored by The Miriam Hospital, enrolled 43 adults with heart failure who were concurrently participating in cardiac rehabilitation. Participants were randomly assigned to receive either a values affirmation intervention layered on top of usual care, or usual care alone. Values affirmation is a brief psychological technique — often involving writing exercises — designed to help individuals reflect on their core personal values, reinforcing a sense of identity and self-integrity that may motivate health-promoting behaviors.
The trial's primary objectives were feasibility and acceptability rather than definitive efficacy. Researchers sought to determine whether the study procedures could be successfully implemented, whether participants found them tolerable and meaningful, and whether the design merited scaling to a larger confirmatory trial. The study ran from September 2022 through January 2025 and was completed as planned.
If the intervention proves acceptable and scalable, it could offer clinicians a low-cost, non-pharmacological tool to bolster medication adherence — potentially reducing hospitalization rates and improving quality of life in a vulnerable population. Values-based approaches are already used in behavioral medicine and have shown promise in other chronic disease contexts.
Several important caveats apply. With only 43 participants, the trial was not powered to detect statistically significant differences in adherence outcomes. The summary here is based on the abstract only, as the full results have not been reviewed. Definitive conclusions must await larger, adequately powered trials.
Key Findings
- Pilot RCT tested values affirmation added to cardiac rehab to improve medication adherence in heart failure patients.
- Primary outcomes were feasibility and acceptability, not clinical efficacy — appropriate for a phase NA pilot design.
- 43 adults with heart failure were enrolled across a roughly two-year study period.
- Values affirmation is a brief, low-cost psychological technique with potential to scale in cardiac rehab settings.
- Completion of the trial signals readiness to evaluate full efficacy in a larger, powered RCT.
Methodology
Pilot randomized controlled trial with 43 participants assigned to values affirmation plus usual care versus usual care alone. The study was phase-undesignated (Phase NA), consistent with a feasibility and acceptability focus rather than efficacy testing. Conducted within a cardiac rehabilitation setting at The Miriam Hospital, with enrollment from September 2022 to January 2025.
Study Limitations
The summary is based on the abstract only; full results, adherence outcomes, and statistical findings were not available for review. The small sample size (n=43) means the trial was not powered to detect efficacy differences, limiting generalizability. Findings are preliminary and require replication in a larger, adequately powered randomized trial before clinical recommendations can be made.
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