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

Rosende, AORCID logo; Romero, CORCID logo; DiPette, DJORCID logo; Brettler, JORCID logo; Van der Stuyft, PORCID logo; Satheesh, GORCID logo; Perel, PORCID logo; Chapman, NORCID logo; Moran, AEORCID logo; Schutte, AEORCID logo; +52 more...Sharman, JEORCID logo; Irazola, VORCID logo; Huffman, MDORCID logo; Campbell, NRORCID logo; Salam, AORCID logo; Lanas, FORCID logo; Coca, AORCID logo; Garcia-Zamora, SORCID logo; Ferreiro, AORCID logo; Lopez-Jaramillo, PORCID logo; Rico-Fontalvo, JORCID logo; Ridley, EORCID logo; Picone, DORCID logo; Flood, DORCID logo; Piñeiro, DJORCID logo; Ojeda, CNORCID logo; Rodriguez, GORCID logo; Wellmann, IAORCID logo; Orias, MORCID logo; Rivera, MORCID logo; Reyes, MVORCID logo; Onuma, OORCID logo; Ramroop, SORCID logo; Khan, TORCID logo; Gonzalez, YVORCID logo; Barroso, WKSORCID logo; Plavnik, FLORCID logo; Zuniga, EORCID logo; Grassani, AMORCID logo; Tajer, CORCID logo; Zaidel, EORCID logo; Marin, MJORCID logo; Cyr-Philbert, SORCID logo; Amorin, IORCID logo; Diaz Aguilera, MAORCID logo; Bortolotto, LORCID logo; Avezum, AORCID logo; Ribeiro, ALPORCID logo; Tobe, SORCID logo; Aumala, TORCID logo; Angell, SORCID logo; Lavados, PORCID logo; Martins, SOORCID logo; Echeverri, AMORCID logo; Jaffe, MGORCID logo; Prabhakaran, DORCID logo; Parati, GORCID logo; Zhang, XHORCID logo; Rodgers, AORCID logo; Yusuf, SORCID logo; Whelton, PKORCID logo; Ordunez, PORCID logo and (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-. 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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