Advancing Cardiovascular Health: WHO’s HEARTS Technical Package Implementation GSA 2023, Uruguay Update

06 Dec 2023

During the Global Stroke Alliance 2023 in Uruguay, the World Health Organization's (WHO) HEARTS program took center stage, outlining its impactful journey toward enhancing cardiovascular health worldwide.

Understanding HEARTS: A Public Health Approach

At the core of the initiative is the HEARTS technical package, employing a public health approach to address hypertension and other cardiovascular disease (CVD) risk factors at the primary health care level. This strategic framework consists of six modules and an implementation guide, supporting ministries of health in bolstering CVD management in primary health care settings.

WHO's HEARTS program has been successfully implemented in over 40 countries, impacting 17.4 million patients worldwide. This significant milestone underscores the program's effectiveness in addressing the growing global burden of cardiovascular diseases.
The HEARTS Partner Forum, led by WHO and comprising 11 supporting partner organizations, including the World Stroke Organization (WSO), underscores the collaborative spirit driving this initiative. This diverse group, featuring organizations like the American Heart Association, Pan American Health Organization, and World Heart Federation, aims to pool resources and expertise to strengthen CVD management globally.

Unlocking the Potential of HEARTS: Three Key Factors to accelerate the expansion of this initiative as was mentioned in the ‘’ HEARTS in the Americas: Targeting Health System Change to Improve Population Hypertension Control’’ article by Pedro Ordunez et al:

Political Will and Priority Placement: The landscape of healthcare is often crowded with competing priorities, making it challenging to garner the necessary attention for initiatives focused on non-communicable diseases (NCDs). The key lies in emphasizing the critical role hypertension plays in the realm of NCDs and chronic vascular diseases. By highlighting its central role, there's an opportunity to elevate the urgency and secure the political backing needed for successful implementation
Understanding the Central Role of Hypertension: A significant barrier to the success of HEARTS lies in the lack of understanding regarding the pivotal role of hypertension. This condition not only stands as a cause of NCDs but also plays a central role in managing other major chronic vascular diseases and various NCDs, especially in primary healthcare (PHC) settings. Addressing this knowledge gap is crucial. Education and awareness campaigns targeted at healthcare providers and policymakers can create a shift in perception, underscoring the importance of hypertension management in the broader context of public health.
Navigating Structural Challenges in Primary Care Settings: Structural challenges within primary care settings are well-documented obstacles. Inadequate resources, high patient care burden, lack of equipment, and staff shortages are just a few of the hurdles that need strategic navigation. For HEARTS to thrive, a comprehensive approach is required. This includes securing sufficient resources, optimizing workflow processes, and investing in training and capacity-building programs for healthcare staff. Overcoming these structural challenges will pave the way for the effective implementation and scaling up of HEARTS.

(P. Ordunez et al (2003, November 8) HEARTS in the Americas: Targeting Health System Change to Improve Population Hypertension Control)

In this sense, the HEARTS initiative offers practical tools that consolidate these principles and that, in turn, serve as a roadmap to navigate the challenges that arise in health systems. The Clinical Pathway is one of the most outstanding innovations. It is a clinical and management tool that includes the recommendations of the WHO 2021 Hypertension Treatment Guideline[1], the drivers to improve the control of high blood pressure[2] and the integrated management of CV risk, already adopted by 16 countries.

WHO and WSO Local Initiatives: Site Visit in Uruguay

During the GSA2023 meeting, representatives from WHO Taskeen Khan, accompanied by Mia Grupper from WSO, Pedro Ordunez and Gonzalo Rodriguez from Panamerican Health Organization (PAHO), conducted a site visit to two private hospitals in Uruguay—Sanatorio Mautone and Asistencial Médica. They were joined by delegates from the Ministry of Health of Uruguay, including Dr. Pablo García de Rosa.

Both institutions, actively preparing for HEARTS implementation, showcased their dedication through the development of training materials, population outreach activities, and incorporation of innovative healthcare technologies.

The visit provided insights into their comprehensive approach, including the adoption of national clinical pathways, electronic health record systems, and nurse-led blood pressure self-monitoring programs. The preparations witnessed during the visits were truly inspiring, reflecting Uruguay's commitment to effectively implement the HEARTS program. The focus on controlling hypertension, a silent yet formidable health threat, stands as a beacon of dedication toward reducing the burden of cardiovascular diseases and strokes.

Looking ahead, proposed HEARTS activities aim for more concrete information sharing, enhanced partner synergy, support for implementation, capacity building, and advocacy with ministries of health. This structured approach aligns with successful global partnerships, fostering a formalized forum that mirrors achievements in communicable diseases.

Together, we strive to assist countries in reducing CVD mortality and achieving global sustainable development goals.

https://www.frontiersin.org/articles/10.3389/fpubh.2023.1146441/full

[1] Guideline for the pharmacological treatment of hypertension in adults. Geneva: World Health Organization; 2021

[2] J. Brettler et al (2022, March 5): Drivers and scorecards to improve hypertension control in primary care practice: Recommendations from the HEARTS in the Americas Innovation Group

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