Carolina Neira Ojeda

Background: HEARTS in the Americas is the regional adaptation of the WHO Global HEARTS Initiative. This paper presents Phase 3 of HEARTS 2.0, an evidence-informed process to prioritize clinical and health-system interventions to support the operationalization of integrated cardiovascular, kidney, and metabolic (CKM) care in primary health care (PHC) and to inform the update of the HEARTS Clinical Pathway. CKM conditions frequently coexist, sharing common risk factors and pathophysiological mechanisms that exacerbate cardiovascular disease burden. Despite their overlap, clinical practice often remains siloed due to condition-specific guidelines, and its integration remains limited. To prioritize evidence-informed clinical and health-system interventions that support the operationalization of integrated CKM care within PHC and inform the update of the HEARTS Clinical Pathway. Methods: Building on previous phases of HEARTS 2.0, a multidisciplinary panel evaluated 45 candidate interventions in different areas. The selection process utilized structured evidence appraisal, Evidence-to-Decision frameworks, and a modified RAND/UCLA appropriateness method involving anonymized rating rounds. Results: A total of 38 interventions were prioritized for implementation. Although hypertension management remains the primary entry point, the resulting framework integrates early detection of diabetes and chronic kidney disease, lifestyle interventions, risk-based combination pharmacotherapy, task-sharing, and longitudinal follow-up. Conclusions: By translating dispersed guideline recommendations into implementable interventions, Phase 3 of HEARTS 2.0 provides an evidence-informed basis for advancing integrated CKM care at scale in PHC and guiding the forthcoming update of the HEARTS Clinical Pathway. The resulting framework offers a flexible, scalable approach for countries confronting similar epidemiological and health system challenges.

RESUMEN Las enfermedades cardiovasculares siguen siendo la principal causa de morbilidad y mortalidad prematuras en todo el mundo, y la hipertensión es su principal factor de riesgo modificable. En América Latina y el Caribe, aunque la hipertensión afecta a más del 30% de las personas adultas, las tasas de control siguen siendo alarmantemente bajas. La iniciativa HEARTS en las Américas, liderada por la Organización Panamericana de la Salud, promueve un modelo de atención basada en el trabajo en equipo para mejorar el manejo del riesgo de hipertensión y enfermedades cardiovasculares en la atención primaria de salud. En la atención basada en el trabajo en equipo se aprovechan las competencias de diversos profesionales de la salud —por ejemplo, profesionales de la enfermería, personal farmacéutico y agentes comunitarios de salud— para optimizar la asignación de recursos, la división de tareas y la prestación de cuidados. La evidencia subraya la eficacia de la atención basada en el trabajo en equipo para mejorar el control de la presión arterial, reducir el número de hospitalizaciones y mejorar la calidad de vida mediante estrategias como el seguimiento periódico y el ajuste de la medicación. A pesar de sus ventajas, la implantación de la atención basada en el trabajo en equipo enfrenta obstáculos culturales y sistémicos. En este informe especial se presenta un marco de política para ampliar la atención basada en el trabajo en equipo en toda la Región de las Américas, garantizando un acceso equitativo a una prevención y atención de buena calidad y costo-efectiva de las enfermedades cardiovasculares.

RESUMEN HEARTS Farmacia, un proyecto que forma parte de la iniciativa HEARTS en las Américas, proporciona un marco para integrar a profesionales de farmacia en la atención primaria de salud. Los profesionales de farmacia son muy respetados en el ámbito de la atención de salud, pero se enfrentan a diversos desafíos, como el alcance limitado de su labor, los obstáculos en la regulación y un reconocimiento insuficiente, que se ven agravados por normas sociales que les impiden desarrollar todo su potencial. En este artículo se presenta evidencia convincente que indica que las intervenciones dirigidas por profesionales de farmacia mejoran el control de la presión arterial, disminuyen el riesgo cardiovascular y reducen los costos de la atención de salud. Se subraya el papel de los sistemas nacionales de farmacia para garantizar el acceso a medicamentos de gran calidad. HEARTS Farmacia hace hincapié en el papel que desempeñan los profesionales de farmacia en la atención en equipo, y destaca su competencia en el manejo de medicamentos, la educación del paciente y la adherencia al tratamiento. En este artículo se aboga por cambios de política que empoderen a los profesionales de farmacia dándoles mayor responsabilidad y que les permitan desempeñar un papel activo en la atención del paciente. También se recomiendan medidas para la integración plena de los profesionales de farmacia en los equipos de atención, y para que sean un elemento clave en el control de la hipertensión y la gestión del riesgo de enfermedades cardiovasculares en la atención primaria de salud.

Cardiovascular diseases remain the leading cause of premature morbidity and mortality globally, with hypertension as their main modifiable risk factor. In Latin America and the Caribbean, hypertension affects more than 30% of adults, yet control rates remain alarmingly low. The HEARTS in the Americas Initiative, led by the Pan American Health Organization, promotes a model of team-based care to enhance risk management for hypertension and cardiovascular diseases within primary health care. Team-based care leverages the skills of diverse health professionals, including nurses, pharmacists and community health workers, to optimize resource allocation, task-sharing and care delivery. Evidence underscores the effectiveness of team-based care in improving blood pressure control, reducing hospitalizations and enhancing quality of life through strategies such as periodic follow up and medication titration. Despite its benefits, implementing team-based care faces cultural and systemic barriers. This special report outlines a policy framework to scale team-based care across the Region of the Americas, ensuring equitable access to high-quality, cost-effective prevention and care for cardiovascular diseases.

HEARTS Pharmacy, a project within the HEARTS in the Americas Initiative, provides a framework to integrate pharmacists into primary health care. Pharmacists are highly respected in health care but face challenges, such as limited scope of practice, regulatory barriers, and insufficient recognition, compounded by social norms that hinder their full potential. This paper presents compelling evidence that pharmacist-led interventions improve blood pressure control, lower cardiovascular risk, and reduce health care costs. It underscores the role of national pharmacy systems in ensuring access to high-quality medications. HEARTS Pharmacy emphasizes the role pharmacists play in team-based care, highlighting their expertise in medication management, patient education, and adherence. This paper advocates policy changes that empower pharmacists with greater responsibility, enabling them to play an active role in patient care. It also recommends actions to fully integrate pharmacists into care teams, positioning them as key players in hypertension control and cardio-vascular disease risk management within primary health care.

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.

Global HEARTS is a WHO initiative for cardiovascular disease prevention and control. Accurate blood pressure (BP) measurement is an essential component of the initiative. This study aimed to determine the regulatory frameworks governing the accuracy of BPMDs in countries of the Americas participating in the HEARTS initiative. Quantitative and qualitative analysis of the laws and regulations relevant to ensuring the accuracy of BPMDs were determined from the Ministries of Health/Regulatory Agencies among 13 countries in Latin America and the Caribbean. Analysis included characterizing the scope of regulations (ie, pre‐market approval, sales and promotion, labeling, cuff sizes, and procurement), information systems for monitoring the models of BPMDs used in primary health care (PHC), and systems to enforce compliance with regulations. Ten of the 13 countries had medical device laws, but regulations that specifically address BPMDs only existed in three countries. Only one country (Brazil) had regulations for mandatory accuracy validation testing and only two countries regulated internet sales of BPMDs. Labeling and cuff size regulations existed in four and two countries, respectively. Less than half the countries reported having a data repository on the BPMD models being used in PHC facilities (four countries) or sold (five countries). Weak and fragmented regulatory frameworks on the accuracy of BPMDs exist among countries of the Americas. This will adversely affect the accuracy of blood pressure assessment and hence poses a major impediment for successful implementation of HEARTS initiative.