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Can the HEARTS initiative reduce the burden of cardiovascular disease?
  1. Martin O'Flaherty1,
  2. Nikkil Sudharsanan2,
  3. Chris Kypridemos1
  1. 1Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
  2. 2Behavioural Science for Disease Prevention and Health Care, Technical University of Munich, Munchen, Bayern, Germany
  1. Correspondence to Dr Martin O'Flaherty, Public Health, Policy and Systems, University of Liverpool, Liverpool, UK; moflaher{at}

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What is HEARTS?

Cardiovascular disease (CVD) continues to exert a heavy burden in most countries in the world, with high blood pressure continuing to be one of the most important drivers of this burden. The urgency to tackle CVD has never been clearer.

WHO launched a global effort (the Global Hearts Initiative) with five technical packages aimed at targeting major drivers of the CVD burden, including actions on tobacco (MPOWER), physical activity (ACTIVE), some aspects of diet such as reducing salt (SHAKE) and trans fats intake (REPLACE) and HEARTS. HEARTS is a set of activities to improve cardiovascular risk management in primary care, with a focus on high blood pressure.1

The HEARTS technical package is an institutionalised model of care and a set of guidelines for cardiovascular risk management, focusing on hypertension control and secondary prevention in primary healthcare. HEARTS is structured around six pillars, focusing on treatment and medication protocols, better quality blood pressure measurement, training and education of the care team, innovation in the organisation of care and team-based care, data standardisation and novel data utilisation. Furthermore, the programme builds on implementation research and programme evaluation, with developed frameworks for monitoring implementation and outcomes, including performance scorecards.1 It provides well-designed scaling up plans that rely on vertical scaling up (through institutionalisation through policy, legal, budgetary and systems-level change) and horizontally, by diffusion and replication in different populations or enlarging the served population in larger communities, to ensure programme delivery at national and regional basis. HEARTS is well grounded in established models of care, such as the Chronic Care Model,2 which has shown effectiveness in improving the care of chronic conditions, such as heart failure, diabetes and asthma, with improvements in therapy, reduced resource use and reduced CVD risk in persons with diabetes.2

How could HEARTS reduce the burden of cardiovascular disease?

HEARTS focus is justified. Between …

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  • Contributors MOF: conceptualisation, writing the original draft, and reviewing and editing the manuscript. NS: conceptualisation and reviewing and editing the manuscript. CK: conceptualisation and reviewing and editing the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; externally peer reviewed.