Changing Hearts and Habits: A Review of Behavioral Interventions in Modern Cardiology and Interventional Cardiology

Advances in interventional cardiology, particularly percutaneous coronary intervention (PCI), have substantially improved survival following acute coronary syndromes. However, long term outcomes remain highly dependent on sustained adherence to secondary prevention therapies, lifestyle modification, and participation in cardiac rehabilitation. Despite strong guideline recommendations, medication nonadherence, premature discontinuation of dual antiplatelet therapy, and poor engagement in preventive care remain common, contributing to recurrent cardiovascular events. Behavioral interventions have therefore emerged as complementary strategies to improve implementation of evidence-based cardiovascular care. This review summarizes major behavioral intervention strategies evaluated over the past decade in both general cardiovascular and interventional cardiology, including patient-directed activation, mobile health (mHealth), gamification, financial incentives and copayment reduction, medication simplification through polypills, and physician-directed nudges. Across these approaches, the most consistent benefit is improvement in process measures, including medication adherence, guideline-directed medical therapy initiation, patient engagement, physical activity, and cardiovascular risk factor control. More intensive, integrated interventions that combine digital tools with clinician feedback or structured patient-clinician interactions generally demonstrate greater effectiveness than passive reminder-based approaches. In contrast, evidence demonstrating reductions in hard clinical endpoints, including myocardial infarction, hospitalization, and mortality, remains inconsistent, with only select high-intensity, multicomponent interventions showing meaningful clinical benefit. Current behavioral strategies also face important limitations, including digital divide, declining long term patient and clinician engagement, alert fatigue, scalability challenges, and reimbursement barriers that limit implementation in routine practice. Emerging approaches incorporating predictive analytics, wearable-derived digital biomarkers, just-in-time adaptive interventions, and learning health systems offer opportunities to deliver more personalized, scalable, and sustainable behavioral support. Overall, behavioral interventions are valuable adjuncts to cardiovascular care, but their greatest potential will likely be realized through integrated, adaptive care models that align patient engagement, clinician decision-making, and longitudinal care delivery to improve long term cardiovascular outcomes.