Abstract: Objective To explore the key influencing factors of the medication adherence of patients with chronic heart failure (CHF) to oral sacubitril valsartan sodium tablets, and to construct an intelligent intervention strategy based on this, and evaluate its clinical application effect. Methods 260 CHF patients admitted to Hengshui Second People's Hospital from October 2022 to February 2024 were selected as the study subjects, all of whom were treated with oral sacubitril valsartan sodium tablets. A cross-sectional survey was conducted using a general information questionnaire and an 8-Item Morisky Medication Adherence Scale (MMAS-8). The MMAS-8 score was used to determine medication adherence, and patients were divided into a good adherence group (n = 66) and a poor adherence group (n = 194). Univariate analysis and multivariate logistic regression analysis were used to screen independent influencing factors of medication adherence. Patients with poor adherence were randomly divided into a control group and an observation group, with 97 cases in each group. The control group received routine medication guidance, while the observation group received a 3-month intelligent intervention on the basis of the control group's routine guidance. At 1 and 3 months of intervention, MMAS-8 score was used to compare medication adherence between the two groups of patients; patients were followed up for 3 months, and the incidence of adverse reactions was observed and recorded. Results The good adherence group and the poor adherence group showed statistically significant differences in terms of living status, educational level, per capita monthly household income, adverse drug reactions, disease awareness score, Self-Rating Anxiety Scale (SAS) score, Self-Rating Depression Scale (SDS) score, Social Support Rating Scale (SSRS) score, and other aspects (P < 0.05); Multivariate logistic regression analysis showed that living alone, education level of primary school or below, per capita monthly household income ≤ 3 000 yuan, adverse drug reactions, disease awareness score ≤ 15.5 points, SAS score > 53 points, SDS score > 54 points, SSRS score ≤ 34.5 points were all independent risk factors affecting the medication adherence of CHF patients to sacubitril valsartan sodium tablets (P < 0.05). After intervention for 1 month and 3 months, the observation group had a higher MMAS-8 score than the control group (P < 0.05). The incidence of adverse reactions such as hypotension, hyperkalemia, elevated serum creatinine, dizziness/fatigue and cough in the observation group was lower than that in the control group (P < 0.05). Conclusion The medication adherence of CHF patients taking sacubitril valsartan sodium tablets is influenced by factors such as living status, educational level, per capita monthly household income, adverse drug reactions, disease awareness score, anxiety and depression. Based on these factors, intelligent and personalized intervention measures can effectively improve patients' medication adherence, reduce adverse reactions, and have clinical promotion value.