Background <p>Patients with heart failure often face individual context-dependent challenges that affect their ability to follow a treatment plan. How hospital doctors recognize and respond to such contextual factors (CF) may influence health outcomes. This study aims to identify adherence related CF disclosed by older patients with heart failure during hospital interactions and to examine how doctors respond to them.</p> Methods <p>Audio-recordings from two key hospital interactions were collected from 42 older patients with heart failure. Occurrences of CF were identified based on a previously developed coding scheme and followed during the hospital interactions. We then analysed doctor’s responses to patient’s CF and categorized them as: (1) Solution-oriented, (2) Exploring (3) No follow-up.</p> Results <p>We identified 58 CF across 113 occurrences in 27 (64%) patients. Medication-related CF (47%) were the most frequently disclosed, followed by patient-specific (34%), condition-related (12%), and healthcare system-related factors (7%). Doctors’ responses varied: 26% (<i>n</i> = 15) of CF received no follow-up, 21% (<i>n</i> = 12) were only explored, 24% (<i>n</i> = 14) were explored and met with a solution-oriented action, and 29% (<i>n</i> = 17) were met with solution-oriented actions without any exploration from the doctor.</p> Conclusions <p>Older patients with heart failure often disclose important CF relevant to adherence during hospital interactions. Roughly half of these factors are not met with a solution-oriented response, with a substantial portion not being followed up by the doctors at all. Future research should explore how to better improve doctors’ ability to recognize and appropriately respond to CF disclosed by patients.</p>