It is recognized that the irregularity in therapeutic compliance is one of the main unstabilizing factors leading to hospitalization in patients with heart failure (HF). In this review, we specifically deal with the Pharmacological Therapeutic Adherence (PTA) in HF patients, and especially with the adherence problems related to those drugs which have been shown to improve the prognosis of the disease. The impact of a deficient PTA (DPTA) jeopardizes the efficiency of the new neurohormonal inhibitor drugs which have proven benefit in wide and expensive clinical trials. It is necessary to have more information about PTA, to develop skills and methods to identify noncompliant patients and to practically improve those actions which have shown some positive effect on DPTA. Some DPTA-related problems owe to inappropriate therapeutic schemes, adverse effects, social deprivation, scarce interaction with the physician and an inadequate health education. Uninformed patients use to believe that they must take the medicines only when they feel sick and have symptoms, yet they believe that drugs can be withdrawn when they feel better. Different pharmacological groups may have different adherence problems in HF. It is estimated that those interventions aimed at improving adherence are useful for the reduction of health costs are they are likely more effective than the effects caused by choosing a given drug. The choosing method to assess PTA in practice with reliability is the counting of pills combined with a compliance survey. Time spent to improve adherence not only can improve it but also it can diminish the total time spent by the physician in the follow-up of these patients.