HEARTS in the Americas: innovations for improving hypertension and cardiovascular disease risk management in primary care

Abstract

Global Hearts is the flagship initiative of the World Health Organization to reduce the burden of cardiovascular diseases, the leading cause of death and disability worldwide. HEARTS in the Americas Initiative is the regional adaptation that envisions HEARTS as the model for cardiovascular disease risk management, including hypertension and diabetes, in primary health care in the Americas by 2025. This initiative is entering its sixth year of implementation and now includes 22 countries and 1 380 primary health care centers. The objectives of this report are three-fold. First, it describes the emergence and the main elements of HEARTS in the Americas. Secondly, it summarizes the main innovations developed to catalyze and sustain implementation of the initiative. These innovations include: a) introduction of hypertension control drivers; b) development of a comprehensive and practical clinical pathway; c) development of a strategy to improve the accuracy of blood pressure measurement; d) creation of a monitoring and evaluation platform; and e) development of a standardized set of training and education resources. Thirdly, this report discusses future priorities of the initiative. The goal of implementing these innovative and pragmatic solutions is to create a more effective health system and shift the focus of cardiovascular and hypertension programs from the highly specialized care level to primary health care. In addition, HEARTS in the Americas can serve as a model for more comprehensive, effective, and sustainable noncommunicable disease prevention and treatment practices.

Association between population hypertension control and ischemic heart disease and stroke mortality in 36 countries of the Americas, 1990-2019: an ecological study

“…In 2017, the World Health Organization launched the Global HEARTS Initiative ( 9 ) to accelerate the reduction in burden of illness due to CVD. HEARTS in the Americas ( 10 ) is a regional adaptation of this initiative, which is being implemented in more than 1 300 primary health care centers in 22 countries. Its main purpose is to implement the best practices to improve the control of hypertension and other CVD risk factors, including diabetes, with the goal of reducing the burden of illness due to CVD.…”

Monitoring and evaluation platform for HEARTS in the Americas: improving population-based hypertension control programs in primary health care

“…Integrating HEARTS into existing health delivery services, particularly at the primary health care level, is critical to encouraging the adoption of global best practices in preventing and controlling CVD and other noncommunicable diseases. HEARTS is currently implemented in 23 Latin American and Caribbean countries, including more than 1300 primary health care facilities ( 2 , 3 ).…”

“…The lack of a quality improvement system, including insufficient data collection and timely reporting mechanisms to identify areas for potential improvement, particularly at the primary health care level ( 2 , 3 ), are significant challenges impeding a rapid scaling up of HEARTS. Therefore, developing a standardized, feasible, and responsive monitoring and evaluation (M&E) platform is vital for implementing HEARTS ( 4 ).…”

Scaling up cardiovascular disease management in primary care through HEARTS in the Americas

“…There are renewed global and regional commitments to improve the response to NCDs, with the recent World Health Assembly adoption of the NCD roadmap towards the achievement of the Sustainable Development Goal target 3.4, to reduce premature NCD mortality by one-third by 2030. For CVDs, PAHO adapted the WHO Global HEARTS initiative to the Region in 2017, and has provided technical guidance to Member States on standardized hypertension treatment as described in the article by Ordunez et al ( 3 ). Regional public goods have been created through training and education materials, resources to improve accuracy of blood pressure measurement, and a clinical pathway for hypertension control.…”