VERSIÓN ESPAÑOL ENGLISH VERSION
Foundation:
Cardiovascular disease (CVD), with about 2.2 million deaths annually, is the leading cause of death in all countries of the Americas. CVD is the leading cause of premature mortality and disability, reducing the life expectancy of the population, and increasing inequities. In addition, the reduction in cardiovascular mortality has slowed down in the last decade (2010-2019), putting at risk the regional goal of reducing premature mortality from noncommunicable diseases by 30% by 2030.
Hypertension (≥ 140/90 mm Hg) affects more than one-third of adults in this region and is the main modifiable risk factor for CVD. However, despite the efforts made, approximately 30% of people with hypertension are unaware of their condition, and only half of those who receive treatment achieve adequate control of their blood pressure. As a result, only about 37% of people with hypertension in the region manage to keep their blood pressure under control. These figures show significant gaps in access, coverage, and quality of health services, particularly in timely diagnosis and effective treatment, highlighting the limitations of the current model of health care.
What factors are limiting the effective control of hypertension in the health systems of the Region? How can primary care teams overcome current barriers and achieve better results?
HEARTS in the Americas, the regional adaptation of the World Health Organization's (WHO) Global HEARTS initiative, seeks to transform hypertension care and cardiovascular risk management through a continuous quality improvement approach in primary health care (PHC). This multicomponent, evidence-based program uses the clinical management of hypertension as a starting point to integrate and strengthen prevention and treatment of cardiovascular, renal, and metabolic diseases, which represent the main causes of disease burden in the region.
HEARTS is fully aligned with PAHO's strategy "Better Care for Noncommunicable Diseases: Accelerating Action in PHC" and acts as its spearhead to improve the quality of care for these conditions in the region's health systems. It is estimated that a 1% increase in population hypertension control in the region can reduce CVD mortality by about 3% per 100,000 people, especially due to ischemic heart disease and stroke. If Latin America and the Caribbean were to increase the level of population control of high blood pressure to 50%, around 500,000 premature deaths could be avoided in a period of five years. And if cardiovascular risk were addressed in an integrated way, as HEARTS proposes, the impact would be even greater, also reducing complications related to diabetes and chronic kidney disease.
The HEARTS quality improvement methodology guides the systematic implementation of the Drivers for Hypertension Control and Cardiovascular Risk Management, reducing gaps in hypertension coverage and control and reducing associated mortality. Central to this process is the HEARTS Clinical Pathway, a standardized, evidence-based tool designed to guide the comprehensive management of hypertension and cardiovascular risk in primary care settings, simplifying decision-making and facilitating the delivery of quality care.
HEARTS conceives quality monitoring and evaluation as a continuous process of collective learning and strengthening of organizational commitment. This non-punitive process is aimed at identifying barriers in implementation and developing innovative, effective and sustainable local solutions that improve both processes and health outcomes. The evaluation for quality improvement in HEARTS focuses on a systematic and standardized assessment of four fundamental domains: fidelity, feasibility, acceptability, and effectiveness of the interventions promoted by the program.
General objective:
Strengthen the competencies of primary care teams to systematically implement the HEARTS program in the Americas, applying its methodology of continuous quality improvement and integrating clinical and management tools, with the purpose of closing gaps in the care and control of hypertension and cardiovascular risk, and contributing to the reduction of premature mortality from noncommunicable diseases in line with the goal established for 2030.
General Competencies:
- To analyze the impact of cardiovascular diseases in the region of the Americas, understanding hypertension as the main modifiable risk factor and applying the concept of the "Treatment Cascade" to identify gaps in care and accelerate the implementation of the quality standards of the HEARTS program in primary health care.
- Introduce the HEARTS in the Americas initiative, understanding its vision, mission, and programmatic strategies to facilitate the transition to a model of continuous quality improvement in primary care centers and its effective integration into health systems.
- Recognize and apply the Drivers and essential clinical tools of the HEARTS program, operationalized in primary care through the Clinical Pathway, to optimize the management of hypertension and cardiovascular risk.
- Implement the HEARTS continuous quality improvement methodology, designing and implementing improvement cycles that include: the development of an implementation plan; the systematic integration of HEARTS drivers into clinical and management processes; the documentation of improvements; the conduct performance review meetings; continuous feedback to health teams; and the establishment of effective communication mechanisms.
- Use monitoring and evaluation tools for continuous improvement, analyzing the fidelity, feasibility, acceptability, and effectiveness of the interventions proposed by the HEARTS program, and developing improvement plans that contribute to optimizing the performance of primary care centers in the population control of hypertension and cardiovascular risk.
Admission profile:
This course is aimed at professionals and workers in the health sector at any level of the system (macro, meso or micro) who wish to contribute from their role to the reduction of preventable mortality and the alleviation of individual and collective suffering caused by avoidable morbidity and mortality due to cardiovascular conditions. It is especially aimed at those who work in primary health care and seek to improve the quality of services in the control of hypertension and the management of cardiovascular risk. No previous experience in quality improvement methodologies is required.
Course Format:
The course is available on the PAHO/WHO Virtual Campus for Public Health (VCPH) platform, 24 hours a day, 7 days a week. As it is a self-study course, participants can regulate their times and moments of dedication.
The course issues a certificate with 8 hours that can be automatically downloaded once participants have met the course completion requirements, including passing the assessment of each module with 80% or more and completing the VCPH Quality Survey.
Modules:
- Module 1. The central role of hypertension control in advancing in the reduction of mortality from cardiovascular diseases in the region of the Americas.
- Module 2. HEARTS Continuous Quality Improvement Methodology for Primary Care Settings.
- Module 3. Essential clinical tools for quality improvement.
- Module 4. Implementation of the HEARTS quality improvement methodology in primary care facilities.
- Module 5. Monitoring and evaluation of the implementation of HEARTS in primary care facilities.
Expected results:
At the end of the course, and using the technical and methodological knowledge, as well as the clinical and management tools that HEARTS in the Americas makes available to countries, participants will be able to implement and evaluate effective interventions to improve the quality of care in their health centers. In this way, they will be able to contribute to the reduction of mortality and morbidity associated with hypertension and cardiovascular diseases in the region of the Americas.
Assessment and certification:
This course will provide participants with the tools needed to drive meaningful changes in cardiovascular health care in each country implementing the HEARTS program, ensuring comprehensive, equitable, and sustainable management of hypertension and cardiovascular risk in communities.
Participants must pass the evaluation corresponding to each module (5 in total). These assessments are designed to offer participants multiple opportunities and consist of five multiple-choice questions.
Participants who meet the course requirements and obtain the minimum passing grade of 80% will be able to download their certificate, issued by the Pan American Health Organization/World Health Organization (PAHO/WHO).