HEARTS in the Americas appraisal checklist and clinical pathway for comprehensive hypertension management in primary care

Rosende, Andrés; DiPette, Donald J.; Brettler, Jeffrey W.; Rodríguez, Gonzalo; Zúñiga, Eduardo Contreras; Connell, Kenneth; Ordúñez, Pedro

doi:10.26633/rpsp.2022.125

Cited by 7 publications

(8 citation statements)

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“…HEARTS in the Americas appraisal checklist and its Clinical Pathway ( Figure 1 ) has been published previously ( 12 ). Briefly, HEARTS in the Americas established a core advisory group from high and middle-income countries with proven clinical experience in hypertension management (internal medicine, cardiology, nephrology, and public health) and in-depth knowledge of the HEARTS model.…”

Section: Methodsmentioning

confidence: 99%

HEARTS in the Americas clinical pathway. Strengthening the decision support system to improve hypertension and cardiovascular disease risk management in primary care settings

Rosende

DiPette

Martínez

et al. 2023

Front. Cardiovasc. Med.

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BackgroundHEARTS in the Americas is the regional adaptation of the WHO Global HEARTS Initiative. It is implemented in 24 countries and over 2,000 primary healthcare facilities. This paper describes the results of a multicomponent, stepwise, quality improvement intervention designed by the HEARTS in the Americas to support advances in hypertension treatment protocols and evolution towards the Clinical Pathway.MethodsThe quality improvement intervention comprised: 1) the use of the appraisal checklist to evaluate the current hypertension treatment protocols, 2) a peer-to-peer review and consensus process to resolve discrepancies, 3) a proposal of a clinical pathway to be considered by the countries, and 4) a process of review, adopt/adapt, consensus and approval of the clinical pathway by the national HEARTS protocol committee. A year later, 16 participants countries (10 and 6 from each cohort, respectively) were included in a second evaluation using the HEARTS appraisal checklist. We used the median and interquartile scores range and the percentages of the maximum possible total score for each domain as a performance measure to compare the results pre and post-intervention.ResultsAmong the eleven protocols from the ten countries in the first cohort, the baseline assessment achieved a median overall score of 22 points (ICR 18 −23.5; 65% yield). After the intervention, the overall score reached a median of 31.5 (ICR 28.5 −31.5; 93% yield). The second cohort of countries developed seven new clinical pathways with a median score of 31.5 (ICR 31.5 −32.5; 93% yield). The intervention was effective in three domains: 1. implementation (clinical follow-up intervals, frequency of drug refills, routine repeat blood pressure measurement when the first reading is off-target, and a straightforward course of action). 2. treatment (grouping all medications in a single daily intake and using a combination of two antihypertensive medications for all patients in the first treatment step upon the initial diagnosis of hypertension) and 3. management of cardiovascular risk (lower BP thresholds and targets based on CVD risk level, and the use of aspirin and statins in high-risk patients).ConclusionThis study confirms that this intervention was feasible, acceptable, and instrumental in achieving progress in all countries and all three domains of improvement: implementation, blood pressure treatment, and cardiovascular risk management. It also highlights the challenges that prevent a more rapid expansion of HEARTS in the Americas and confirms that the main barriers are in the organization of health services: drug titration by non-physician health workers, the lack of long-acting antihypertensive medications, lack of availability of fixed-doses combination in a single pill and cannot use high-intensity statins in patients with established cardiovascular diseases. Adopting and implementing the HEARTS Clinical Pathway can improve the efficiency and effectiveness of hypertension and cardiovascular disease risk management programs.

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Section: Methodsmentioning

confidence: 99%

HEARTS in the Americas clinical pathway. Strengthening the decision support system to improve hypertension and cardiovascular disease risk management in primary care settings

Rosende

DiPette

Martínez

et al. 2023

Front. Cardiovasc. Med.

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“…Estos factores impulsores y las recomendaciones específicas para su implementación se tradujeron en medidas con respecto a los procesos, lo que llevó a dos índices interconectados (índices de madurez y de desempeño). Por último, estos índices se integraron a la vía clínica de HEARTS ( 24 ) y al sistema de seguimiento y evaluación de HEARTS ( 25 ). Se espera que el centrarse en estos impulsores clave durante la implementación mejore el proceso de mejora de la calidad y el control de la hipertensión en la APS.…”

Section: Innovar Con Hearts En Las Américasunclassified

“…Tras la publicación de las directrices de la OMS del 2021 sobre el tratamiento farmacológico de la hipertensión en personas adultas ( 16 , 31 ), HEARTS en las Américas elaboró una vía clínica ( 24 ). Esta nueva herramienta, diseñada para ser utilizada por todo el equipo de atención médica, armoniza todas las recomendaciones de las directrices sobre hipertensión de la OMS, incluidas las relativas a la medición de la presión arterial, la evaluación del riesgo de ECV y el manejo de la prevención primaria y secundaria (diabetes, enfermedad renal crónica y ECV establecida), pero conserva el algoritmo de tratamiento estandarizado de la hipertensión de HEARTS como elemento esencial.…”

Section: Innovar Con Hearts En Las Américasunclassified

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HEARTS en las Américas: innovaciones para mejorar el manejo de la hipertensión y del riesgo cardiovascular en la atención primaria

Ordúñez

Campbell

Arcila

et al. 2022

Revista Panamericana De Salud Pública

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La Iniciativa Mundial HEARTS. es la iniciativa emblemática de la Organización Mundial de la Salud para reducir la carga de las enfermedades cardiovasculares, la principal causa de muerte y discapacidad en todo el mundo. La Iniciativa HEARTS en las Américas es la adaptación regional que propone usar HEARTS como modelo para el manejo del riesgo de enfermedades cardiovasculares, incluida la hipertensión, y la diabetes en la atención primaria de salud en la Región de las Américas para el año 2025. Esta iniciativa está iniciando su sexto año de aplicación y ya incluye a 22 países y 1 380 centros de atención primaria de salud. Este informe tiene tres objetivos. En primer lugar, describir cómo surgió la Iniciativa HEARTS en las Américas y cuáles son sus principales elementos. En segundo lugar, resumir las principales innovaciones logradas para catalizar la iniciativa y mantener su aplicación. Entre estas innovaciones se encuentran: a) la introducción de factores impulsores del control de la hipertensión; b) el desarrollo de una vía clínica integral y práctica; c) la elaboración de una estrategia para mejorar la precisión de la medición de la presión arterial; d) la creación de un marco de seguimiento y evaluación; y e) la elaboración de un conjunto estandarizado de recursos de capacitación y formación. En tercer lugar, en este informe se examinan las futuras prioridades de la iniciativa. El objetivo de poner en marcha estas soluciones innovadoras y pragmáticas es crear un sistema de salud más efectivo y trasladar el enfoque de los programas cardiovasculares y de hipertensión del nivel de atención altamente especializada a la atención primaria de salud. Además, HEARTS en las Américas puede servir como modelo para unas prácticas más integrales, efectivas y sostenibles en la prevención y el tratamiento de las enfermedades no transmisibles.

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“…It defined the attributes and components of a preferred STPs and developed the 'HEARTS in the Americas appraisal checklist and its Clinical Pathway' (HEARTS in the Americas Checklist) [13]. This checklist has been used previously to appraise hypertension treatment STPs from 16 countries in the PAHO region [14]. Outside the PAHO, there has been no review of the availability and quality of the hypertension STPs (hereafter referred to as STPs).…”

Section: Introductionmentioning

confidence: 99%

Standardized treatment protocols for hypertension: global availability, characteristics, and alignment with the hypertension guideline recommendations

Satheesh,

Dhurjati,

Huffman

et al. 2023

Journal of Hypertension

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Background: Hypertension control is suboptimal globally. Implementing evidence-based, simple, standardized treatment protocols (STPs) has been instrumental in effectively and efficiently improving treatment and control of hypertension. We aimed to identify, characterize, and critically appraise hypertension STPs. Methods: We defined STP as a series of steps for the pharmacological treatment of primary hypertension, with information on target population, BP threshold for treatment initiation, target BP, specific drugs/classes/doses, and follow-up frequency. STPs for adult patients were identified from the websites of relevant health organizations, Google search, and through expert consultations (until July 2023). STPs for secondary, gestational, or malignant hypertension or those that were templates/samples were excluded. Included STPs were critically appraised using HEARTS in the Americas Checklist for hypertension management in primary care and compared with the 2021 WHO hypertension management guideline recommendations. Results: Fifty STPs were identified. All STPs had a stepwise treatment approach, involved guideline-recommended first-line drugs, and 98% consisted of at least four steps. Majority (54%) recommended monotherapy with calcium channel blockers as first-line treatment. Only 44% STPs recommended treatment initiation with combination therapy, and 16% recommended single-pill combinations. Most (62%) had dose-intensification as the second step. Most (74%) STPs did not provide complete dosing information. Only one STP mentioned a target time for achieving BP control. On average, STPs scored a performance of 68% on the HEARTS Checklist. Conclusion: Several STPs are available globally; however, most of them have enormous scope for improvement through interventions aimed at alignment with the latest evidence-based guidelines and multistakeholder engagement.

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HEARTS in the Americas appraisal checklist and clinical pathway for comprehensive hypertension management in primary care

Cited by 7 publications

References 14 publications

HEARTS in the Americas clinical pathway. Strengthening the decision support system to improve hypertension and cardiovascular disease risk management in primary care settings

HEARTS in the Americas clinical pathway. Strengthening the decision support system to improve hypertension and cardiovascular disease risk management in primary care settings

HEARTS en las Américas: innovaciones para mejorar el manejo de la hipertensión y del riesgo cardiovascular en la atención primaria

Standardized treatment protocols for hypertension: global availability, characteristics, and alignment with the hypertension guideline recommendations

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