Candidate Interventions for Integrating Hypertension and Cardiovascular-Kidney-Metabolic Care in Primary Health Settings: HEARTS 2.0 Phase 1

Background: HEARTS in the Americas is the regional adaptation of the WHO Global HEARTS Initiative, aimed at helping countries enhance hypertension and cardiovascular disease (CVD) risk management in primary care settings. Its core implementation tool, the HEARTS Clinical Pathway, has been adopted by 28 countries. To improve the care of hypertension, diabetes, and chronic kidney disease (CKD), HEARTS 2.0 was developed as a three-phase process to integrate evidence-based interventions into a unified care pathway, ensuring consistency across fragmented guidelines. This paper focuses on Phase 1, highlighting targeted interventions to improve and update the HEARTS Clinical Pathway. Methods: First, the coordinating group defined the project’s scope, objectives, principles, methodological framework, and tools. Second, international experts from different disciplines proposed interventions to enhance the HEARTS Clinical Pathway. Third, the coordinating group harmonized these proposals into unique interventions. Fourth, experts appraised the appropriateness of the proposed interventions on a 1-to 9 scale using the adapted RAND/UCLA Appropriateness Method. Finally, interventions with a median score above 6 were deemed appropriate and selected as candidates to enhance the HEARTS Clinical Pathway. Results: Building on the existing HEARTS Clinical Pathway, 45 unique interventions were selected, including community-based screening, early detection and management of risk factors, lower blood pressure thresholds for diagnosing hypertension in high CVD-risk patients, reinforcement of single-pill combination therapy, inclusion of sodium-glucose cotransporter-2 inhibitors for patients with diabetes, CKD, or heart failure, expanded roles for non-physician health workers in team-based care, and strengthened clinical documentation, monitoring, and evaluation.

• Autores: Rosende, Andres; Romero, Cesar; DiPette, Donald; Brettler, Jeffrey; Van der Stuyft, Patrick; Satheesh, Gautam; Perel, Pablo; Chapman, Niamh; Moran, Andrew; Schutte, Aletta; Sharman, James; IRAZOLA, VILMA; Huffman, Mark; Campbell, Norm; Abdul Salam, Mohammad; Lanas, Fernando; Coca, Antonio; Garcia-Zamora, Sebastian; FERREIRO, ALEJANDRO; Lopez-Jaramillo, Patricio; Rico-Fontalvo, Jorge; Ridley, Emily; Picone, Dean; Flood, David; Piñeiro, Daniel José; Neira Ojeda, Carolina; Rodriguez, Gonzalo; Wellmann, Irmgardt A.; Orias, Marcelo; Rivera, Marcela; Villatoro, Matías; Onuma, Oyere; RAMROOP, SHAUN; Khan, Taskeen; Valdés González, Yamilé; Sebba Barroso Souza, Weimar Kunz; Plavnik, Frida; Zúñiga, Eric; Grassani, Ana María; Tajer, Carlos; Zaidel, Ezequiel J; MARIN, MARCOS; Cyr Philbert, Shana; amorin, ignacio; Diaz-Aguilera, Miguel Angel; Bortolotto, Luiz; AVEZUM, ALVARO; Ribeiro, Antonio; Tobe, Sheldon; Aumala Viscarra, Teresa Natalia; Angell, Sonia; Lavados, Pablo; Martins, Sheila; Munera, Ana; Jaffe, Marc; Prabhakaran, Dorairaj; Parati, Gianfranco; Zhang, Xin-Hua; Rodgers, Anthony; Yusuf, Salim; Whelton, Paul; Ordunez, Pedro
• Fecha de publicación: 2025
• Institución: Universidad Simón Bolívar
• Repositorio: Repositorio Digital USB
• Idioma: eng
• OAI Identifier: oai:bonga.unisimon.edu.co:20.500.12442/16630
• Acceso en línea: https://hdl.handle.net/20.500.12442/16630; https://doi.org/10.5334/gh.1428; https://globalheartjournal.com/articles/1428/files/683599615fc84.pdf
• Palabra clave: Hypertension; Primary Health Care; Cardiovascular Diseases; Diabetes mellitus; Renal Insufficiency; Chronic; Stroke
• Rights: openAccess
• License: Attribution-NonCommercial-NoDerivatives 4.0 International