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

Andres Rosende ORCID logo ; Cesar Romero ORCID logo ; Donald J DiPette ORCID logo ; Jeffrey Brettler ORCID logo ; Patrick Van der Stuyft ORCID logo ; Gautam Satheesh ORCID logo ; Pablo Perel ORCID logo ; Niamh Chapman ORCID logo ; Andrew E Moran ORCID logo ; Aletta E Schutte ORCID logo ; +52 more... James E Sharman ORCID logo ; Vilma Irazola ORCID logo ; Mark D Huffman ORCID logo ; Norm RC Campbell ORCID logo ; Abdul Salam ORCID logo ; Fernando Lanas ORCID logo ; Antonio Coca ORCID logo ; Sebastian Garcia-Zamora ORCID logo ; Alejandro Ferreiro ORCID logo ; Patricio Lopez-Jaramillo ORCID logo ; Jorge Rico-Fontalvo ORCID logo ; Emily Ridley ORCID logo ; Dean Picone ORCID logo ; David Flood ORCID logo ; Daniel José Piñeiro ORCID logo ; Carolina Neira Ojeda ORCID logo ; Gonzalo Rodriguez ORCID logo ; Irmgardt A Wellmann ORCID logo ; Marcelo Orias ORCID logo ; Marcela Rivera ORCID logo ; Matías Villatoro Reyes ORCID logo ; Oyere Onuma ORCID logo ; Shaun Ramroop ORCID logo ; Taskeen Khan ORCID logo ; Yamile Valdes Gonzalez ORCID logo ; Weimar Kunz Sebba Barroso ORCID logo ; Frida L Plavnik ORCID logo ; Eric Zuniga ORCID logo ; Ana María Grassani ORCID logo ; Carlos Tajer ORCID logo ; Ezequiel Zaidel ORCID logo ; Marcos J Marin ORCID logo ; Shana Cyr-Philbert ORCID logo ; Ignacio Amorin ORCID logo ; Miguel Angel Diaz Aguilera ORCID logo ; Luiz Bortolotto ORCID logo ; Alvaro Avezum ORCID logo ; Antonio Luiz P Ribeiro ORCID logo ; Sheldon Tobe ORCID logo ; Teresa Aumala ORCID logo ; Sonia Angell ORCID logo ; Pablo Lavados ORCID logo ; Sheila Ouriques Martins ORCID logo ; Ana Munera Echeverri ORCID logo ; Marc G Jaffe ORCID logo ; Dorairaj Prabhakaran ORCID logo ; Gianfranco Parati ORCID logo ; Xin Hua Zhang ORCID logo ; Anthony Rodgers ORCID logo ; Salim Yusuf ORCID logo ; Paul K Whelton ORCID logo ; Pedro Ordunez ORCID logo ; (2025) Candidate Interventions for Integrating Hypertension and Cardiovascular-Kidney-Metabolic Care in Primary Health Settings: HEARTS 2.0 Phase 1. Global Heart, 20 (1). p. 45. ISSN 2211-8160 DOI: 10.5334/gh.1428
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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. 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.

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