Candidate Interventions for Integrating Hypertension and Cardiovascular-Kidney-Metabolic Care in Primary Health Settings: HEARTS 2.0 Phase 1
Journal
Global Heart
ISSN
2211-8179
Date Issued
2025-05-27
Author(s)
Andres Rosende
Cesar Romero
Donald J. DiPette
Jeffrey Brettler
Patrick Van der Stuyft
Gautam Satheesh
Pablo Perel
Niamh Chapman
Andrew E. Moran
Aletta E. Schutte
James E. Sharman
Vilma Irazola
Mark D. Huffman
Norm R. C. Campbell
Abdul Salam
Fernando Lanas
Antonio Coca
Sebastian Garcia-Zamora
Alejandro Ferreiro
Patricio Lopez-Jaramillo
Jorge Rico-Fontalvo
Emily Ridley
Dean Picone
David Flood
Daniel José Piñeiro
Carolina Neira Ojeda
Gonzalo Rodriguez
Irmgardt A. Wellmann
Marcelo Orias
Marcela Rivera
Matías Villatoro Reyes
Oyere Onuma
Shaun Ramroop
Taskeen Khan
Yamile Valdes Gonzalez
Weimar Kunz Sebba Barroso
Frida L. Plavnik
Eric Zuniga
Ana María Grassani
Carlos Tajer
Ezequiel Zaidel
Marcos J. Marin
Shana Cyr-Philbert
Ignacio Amorin
Miguel Angel Diaz Aguilera
Luiz Bortolotto
Alvaro Avezum
Antonio Luiz P. Ribeiro
Sheldon Tobe
Teresa Aumala
Sonia Angell
Sheila Ouriques Martins
Ana Munera Echeverri
Marc G. Jaffe
Dorairaj Prabhakaran
Gianfranco Parati
Xin Hua Zhang
Anthony Rodgers
Salim Yusuf
Paul K. Whelton
Pedro Ordunez
Type
journal-article
Abstract
<jats:p>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.
Conclusion: HEARTS 2.0 Phase 1 identifies key interventions to integrate and improve hypertension and cardiovascular-kidney-metabolic care within primary care, enabling their seamless incorporation into a unified and effective clinical pathway. This process will inform an update to the HEARTS Clinical Pathway, optimizing resources, reducing care fragmentation, improving care delivery, and advancing health equity, thereby supporting global efforts to combat the leading causes of death and disability.</jats:p>
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.
Conclusion: HEARTS 2.0 Phase 1 identifies key interventions to integrate and improve hypertension and cardiovascular-kidney-metabolic care within primary care, enabling their seamless incorporation into a unified and effective clinical pathway. This process will inform an update to the HEARTS Clinical Pathway, optimizing resources, reducing care fragmentation, improving care delivery, and advancing health equity, thereby supporting global efforts to combat the leading causes of death and disability.</jats:p>
Cite this document
Rosende, A., Romero, C., DiPette, D. J., Brettler, J., Van Der Stuyft, P., Satheesh, G., Perel, P., Chapman, N., Moran, A. E., Schutte, A. E., Sharman, J. E., Irazola, V., Huffman, M. D., Campbell, N. R. C., Salam, A., Lanas, F., Coca, A., Garcia-Zamora, S., Ferreiro, A., … Ordunez, P. (2025). Candidate interventions for integrating hypertension and cardiovascular-kidney-metabolic care in primary health settings: Hearts 2. 0 phase 1. Global Heart, 20(1), 45. https://doi.org/10.5334/gh.1428