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

• DOI: 10.5334/gh.1428
• Publication Date: 2025-05-27T10:54:37Z
• Authors: Andres Rosende; Cesar Romero; Donald J. DiPette; Jeffrey Brettler; Patrick Van der S...; 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-...; Alejandro Ferreiro; Patricio Lopez-Ja...; 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 ...; Oyere Onuma; Shaun Ramroop; Taskeen Khan; Yamile Valdes Gon...; Weimar Kunz Sebba...; Frida L. Plavnik; Eric Zuniga; Ana María Grassani; Carlos Tajer; Ezequiel Zaidel; Marcos J. Marin; Shana Cyr-Philbert; Ignacio Amorin; Miguel Angel Diaz...; Luiz Bortolotto; Alvaro Avezum; Antonio Luiz P. R...; Sheldon Tobe; Teresa Aumala; Sonia Angell; Pablo Lavados; Sheila Ouriques M...; Ana Munera Echeverri; Marc G. Jaffe; Dorairaj Prabhakaran; Gianfranco Parati; Xin Hua Zhang; Anthony Rodgers; Salim Yusuf; Paul K. Whelton; Pedro Ordunez

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.