Candidate Interventions for Integrating Hypertension and Cardiovascular-Kidney-Metabolic Care in Primary Health Settings: HEARTS 2.0 Phase 1
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Fecha
2025
Autores
Rosende, Andres
Romero, Cesar
DiPette, Donald
Brettler, Jeffrey
Van der Stuyft, Patrick
Satheesh, Gautam
Perel, Pablo
Chapman, Niamh
Moran, Andrew
Schutte, Aletta
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Ubiquity Press
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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.
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Rosende A, Romero C, DiPette DJ, Brettler J, Van der Stuyft P, Satheesh G, Perel P, Chapman N, Moran AE, Schutte AE, Sharman JE, Irazola V, Huffman MD, Campbell NRC, Salam A, Lanas F, Coca A, Garcia-Zamora S, Ferreiro A, Lopez-Jaramillo P, Rico-Fontalvo J, Ridley E, Picone D, Flood D, Piñeiro DJ, Ojeda CN, Rodriguez G, Wellmann IA, Orias M, Rivera M, Reyes MV, Onuma O, Ramroop S, Khan T, Gonzalez YV, Barroso WKS, Plavnik FL, Zuniga E, Grassani AM, Tajer C, Zaidel E, Marin MJ, Cyr-Philbert S, Amorin I, Diaz Aguilera MA, Bortolotto L, Avezum A, Ribeiro ALP, Tobe S, Aumala T, Angell S, Lavados P, Martins SO, Echeverri AM, Jaffe MG, Prabhakaran D,Parati G, Zhang XH, Rodgers A, Yusuf S, Whelton PK, Ordunez P. Candidate Interventions for Integrating Hypertension and Cardiovascular-Kidney-Metabolic Care in Primary Health Settings: HEARTS 2.0 Phase 1. Global Heart. 2025; 20(1): 45. DOI: https://doi.org/10.5334/gh.1428
