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Brant LCC, Miranda JJ, Carrillo-Larco RM, Flood D, Irazola V, Ribeiro ALP. Epidemiology of cardiometabolic health in Latin America and strategies to address disparities. Nat Rev Cardiol 2024:10.1038/s41569-024-01058-2. [PMID: 39054376 DOI: 10.1038/s41569-024-01058-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/14/2024] [Indexed: 07/27/2024]
Abstract
In Latin America and the Caribbean (LAC), sociodemographic context, socioeconomic disparities and the high level of urbanization provide a unique entry point to reflect on the burden of cardiometabolic disease in the region. Cardiovascular diseases are the main cause of death in LAC, precipitated by population growth and ageing together with a rapid increase in the prevalence of cardiometabolic risk factors, predominantly obesity and diabetes mellitus, over the past four decades. Strategies to address this growing cardiometabolic burden include both population-wide and individual-based initiatives tailored to the specific challenges faced by different LAC countries, which are heterogeneous. The implementation of public policies to reduce smoking and health system approaches to control hypertension are examples of scalable strategies. The challenges faced by LAC are also opportunities to foster innovative approaches to combat the high burden of cardiometabolic diseases such as implementing digital health interventions and team-based initiatives. This Review provides a summary of trends in the epidemiology of cardiometabolic diseases and their risk factors in LAC as well as context-specific disease determinants and potential solutions to improve cardiometabolic health in the region.
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Affiliation(s)
- Luisa C C Brant
- Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
- Hospital das Clínicas Telehealth Center, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
| | - J Jaime Miranda
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Rodrigo M Carrillo-Larco
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - David Flood
- Department of Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Vilma Irazola
- Center of Excellence for Cardiovascular Health, Department of Research in Chronic Diseases, Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Antonio Luiz P Ribeiro
- Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Hospital das Clínicas Telehealth Center, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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Otero J, Ortiz-Gomez Y, Lopez-Jaramillo P. Dentists´ knowledge about common risk factors for cardiovascular diseases and periodontitis: An opportunity to be part of a multidisciplinary team. J Clin Exp Dent 2024; 16:e580-e585. [PMID: 38988757 PMCID: PMC11231897 DOI: 10.4317/jced.60766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 04/10/2024] [Indexed: 07/12/2024] Open
Abstract
Background Reducing the disease burden of cardiovascular diseases and periodontitis continues to be a priority and dentists are part of the primary care team. However, it is unclear whether Colombian dentists have the necessary knowledge to identify cardiovascular disease risk factors in clinical practice. The main aim of this study was to investigate Colombian dentists' knowledge about common risk factors for cardiovascular disease and periodontitis. Material and Methods A cross-sectional study was conducted. A self-administered electronic survey was validated by experts and completed by 232 dentists who practiced in Colombia. Descriptive and multivariate analyzes were performed, including hierarchical cluster analysis. Results Regarding the identification of shared risk factors for the development of cardiovascular disease or periodontitis, 80.6% identified smoking and 72.8% diabetes. The correct identification of cardiovascular disease risk factors was between 34.9% in the case of eating practices and 78.0% for physical inactivity. Being a woman (79.8%), under 40 years of age (64.0%), not having completed a postgraduate degree (68.5%), and working in private institutions (88.8%) were the characteristics of dentists that best identified common risk factors for both cardiovascular disease and periodontitis. Conclusions Colombian dentists had good knowledge of common risk factors for both cardiovascular diseases and periodontitis, but limited knowledge about cardiovascular disease risk factors. Younger dentists better identified risk factors. Conversely, older, more experience, and more specialized practitioners could benefit from more training about cardiovascular risk factors in order to truly be part of multidisciplinary teams in primary care. Key words:Dentists, Cardiovascular Diseases, Periodontitis, Health Knowledge, Attitudes, Practice, Patient Care Team.
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Affiliation(s)
- Johanna Otero
- DDS, MPH. Faculty of Dentistry, Universidad Santo Tomás, Bucaramanga, Colombia. MASIRA Research Institute, Universidad de Santander, Bucaramanga, Colombia
| | | | - Patricio Lopez-Jaramillo
- MD, PhD. MASIRA Research Institute, Universidad de Santander, Bucaramanga, Colombia. Universidad UTE, Facultad de Ciencias de la Salud Eugenio Espejo, Quito, Ecuador
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Ordunez P, Campbell NRC, DiPette DJ, Jaffe MG, Rosende A, Martinez R, Gamarra A, Lombardi C, Parra N, Rodriguez L, Rodriguez Y, Brettler J. HEARTS in the Americas: Targeting Health System Change to Improve Population Hypertension Control. Curr Hypertens Rep 2024; 26:141-156. [PMID: 38041725 PMCID: PMC10904446 DOI: 10.1007/s11906-023-01286-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2023] [Indexed: 12/03/2023]
Abstract
PURPOSE OF REVIEW HEARTS in the Americas is the regional adaptation of Global Hearts, the World Health Organization initiative for cardiovascular disease (CVD) prevention and control. Its overarching goal is to drive health services to change managerial and clinical practice in primary care settings to improve hypertension control and CVD risk management. This review describes the HEARTS in the Americas initiative. First, the regional epidemiological situation of CVD mortality and population hypertension control trends are summarized; then the rationale for its main intervention components: the primary care-oriented management system and the HEARTS Clinical Pathway are described. Finally, the key factors for accelerating the expansion of HEARTS are examined: medicines, team-based care, and a system for monitoring and evaluation. RECENT FINDINGS Thus far, 33 countries in Latin America and the Caribbean have committed to integrating this program across their primary healthcare network by 2025. The increase in hypertension coverage and control in primary health care settings compared with the traditional model is promising and confirms that the interventions under the HEARTS umbrella are feasible and acceptable to communities, patients, providers, decision-makers, and funders. This review highlights some cases of successful implementation. Scaling up effective treatment for hypertension and optimization of CVD risk management is a pragmatic way to accelerate the reduction of CVD mortality while strengthening primary healthcare systems to respond effectively, with quality, and equitably, to the challenge of non-communicable diseases, not only in low-middle income countries but in all communities globally.
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Affiliation(s)
- Pedro Ordunez
- Department of Non-Communicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, USA.
| | - Norm R C Campbell
- Department of Medicine, Libin Cardiovascular Institute, The University of Calgary, Calgary, AB, T2N 1N4, Canada
| | - Donald J DiPette
- University of South Carolina and University of South Carolina School of Medicine, Columbia, SC, USA
| | - Marc G Jaffe
- Department of Endocrinology, The Permanente Medical Group, Kaiser San Francisco Medical Center, San Francisco, CA, USA
| | - Andres Rosende
- Department of Non-Communicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, USA
| | - Ramon Martinez
- Department of Non-Communicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, USA
| | - Angelo Gamarra
- Department of Non-Communicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, USA
| | - Cintia Lombardi
- Department of Non-Communicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, USA
| | - Natalia Parra
- Department of Non-Communicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, USA
| | - Libardo Rodriguez
- Department of Non-Communicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, USA
| | - Yenny Rodriguez
- Department of Non-Communicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, USA
| | - Jeffrey Brettler
- Southern California Permanente Medical Group, Department of Health Systems Science, Regional Hypertension Program, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, USA
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Belete AM, Melese DM, Asefa A, Aynalem YA, Bewket B, Shiferaw WS, Yazie TS. The effectiveness of short mobile phone text message reminders compared to usual care on medication adherence in patients with hypertension: a systematic review protocol. Syst Rev 2024; 13:53. [PMID: 38317254 PMCID: PMC10840260 DOI: 10.1186/s13643-023-02394-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 11/17/2023] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND Poor adherence to long-term medication increases the risk of morbidity and mortality and decreases the quality of life of patients with hypertension. One strategy to improve treatment adherence is to use a short text message reminder. Although evidence indicates that such programs increase medication adherence, the extent of their effectiveness and translation into clinical practice needs to be better documented. Our systematic review will collect and analyze the available evidence for clinical practice implementation. This systematic review aimed to evaluate the effectiveness of short mobile phone text message reminders versus usual/standard care for medication adherence in patients with hypertension. METHODS This review will include and summarize evidence from randomized controlled trials. Adults (age > 18 years) with hypertension. The comparator group received either the usual care or standard care. It encompasses standard medical care for patients not participating in a structured and supervised intervention program such as a telemedicine program. We will include studies that assess the effectiveness of short mobile phone text message reminders in improving medication adherence in patients with hypertension compared to usual care. We will search the following databases: PubMed, EMBASE, CINAHL, SCOPUS, Web of Science, Cochrane Library Central Register of Controlled Trials, and Cochrane Library. We will include studies published in English. Furthermore, we will consider studies published from the inception of the database until April 20, 2024. At least two reviewers will independently conduct study selection, data extraction, and quality assessment. A third reviewer will determine and resolve discrepancies. We will conduct a quality assessment using the ROBIS 2 critical appraisal checklist. At least two independent reviewers will crosscheck the data synthesis. DISCUSSION We expect this review to provide current evidence for future studies and clinical practice concerning the impact of mobile phone text message reminders on medication adherence issues. We will publish our results in a peer-reviewed journal for publication. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42023391236.
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Affiliation(s)
- Abebe Muche Belete
- Department of Biomedical Science, Asrat Weldeyes Health Science Campus, Debre Berhan University, Debre Berhan, Ethiopia.
| | - Daniel Molla Melese
- Department of Biomedical Science, Asrat Weldeyes Health Science Campus, Debre Berhan University, Debre Berhan, Ethiopia
| | - Addisu Asefa
- Department of Biomedical Science, Asrat Weldeyes Health Science Campus, Debre Berhan University, Debre Berhan, Ethiopia
| | | | - Bekalu Bewket
- Department of Nursing, College of Health Science, Injibara University, Injibara, Ethiopia
| | | | - Taklo Simeneh Yazie
- Department of Pharmacy, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia
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Wellmann IA, Ayala LF, Rodríguez JJ, Guetterman TC, Irazola V, Palacios E, Huffman MD, Rohloff P, Heisler M, Ramírez-Zea M, Flood D. Implementing integrated hypertension and diabetes management using the World Health Organization's HEARTS model: protocol for a pilot study in the Guatemalan national primary care system. Implement Sci Commun 2024; 5:7. [PMID: 38195600 PMCID: PMC10775666 DOI: 10.1186/s43058-023-00539-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 12/07/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND The HEARTS technical package was developed by the World Health Organization to address the implementation gap in cardiovascular disease prevention in low- and middle-income countries. Guatemala is a middle-income country that is currently implementing HEARTS. National authorities in Guatemala are interested in exploring how hypertension and diabetes management can be integrated in HEARTS implementation. The objective of this study is to conduct a feasibility and acceptability pilot trial of integrated hypertension and diabetes management based on HEARTS in the publicly funded primary care system in Guatemala. METHODS A single-arm pilot trial for 6 months will be carried out in 11 Ministry of Health primary care facilities starting in September 2023. A planned sample of 100 adult patients diagnosed with diabetes (n = 45), hypertension (n = 45), or both (n = 10) will be enrolled. The intervention will consist of HEARTS-aligned components: Training health workers on healthy-lifestyle counseling and evidence-based treatment protocols, strengthening access to medications and diagnostics, training on risk-based cardiovascular disease management, team-based care and task sharing, and systems monitoring and feedback, including implementation of a facility-based electronic monitoring tool at the individual level. Co-primary outcomes of feasibility and acceptability will be assessed using an explanatory sequential mixed-methods design. Secondary outcomes include clinical effectiveness (treatment with medication, glycemic control, and blood pressure control), key implementation outcomes (adoption, fidelity, usability, and sustainability), and patient-reported outcome measures (diabetes distress, disability, and treatment burden). Using an implementation mapping approach, a Technical Advisory Committee will develop implementation strategies for subsequent scale-up planning. DISCUSSION This trial will produce evidence on implementing HEARTS-aligned hypertension and diabetes care in the MOH primary care system in Guatemala. Results also will inform future HEARTS projects in Guatemala and other low- and middle-income countries. TRIAL REGISTRATION ClinicalTrials.gov ID NCT06080451. The trial was prospectively registered on October 12, 2023.
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Affiliation(s)
- Irmgardt Alicia Wellmann
- Research Center for Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala
| | - Luis Fernando Ayala
- Research Center for Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala
| | - José Javier Rodríguez
- Research Center for Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala
| | | | - Vilma Irazola
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Eduardo Palacios
- National Program for the Prevention of Chronic Non-Communicable Diseases and Cancer, Ministry of Health, Guatemala City, Guatemala
| | - Mark D Huffman
- Department of Medicine and Global Health Center, Washington University in St. Louis, St. Louis, MO, USA
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Peter Rohloff
- Center for Indigenous Health Research, Wuqu' Kawoq, Tecpán, Guatemala
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA
| | - Michele Heisler
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, 48109, USA
- Veterans Affairs Ann Arbor Center for Clinical Management Research, Ann Arbor, MI, USA
| | - Manuel Ramírez-Zea
- Research Center for Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala
| | - David Flood
- Research Center for Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala.
- Center for Indigenous Health Research, Wuqu' Kawoq, Tecpán, Guatemala.
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, 48109, USA.
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Sanchez-Samaniego G, Hartinger SM, Mäusezahl D, Hattendorf J, Fink G, Probst-Hensch N. Prevalence, awareness, treatment and control of high blood pressure in a cohort in Northern Andean Peru. Glob Health Action 2023; 16:2285100. [PMID: 38038648 PMCID: PMC10795589 DOI: 10.1080/16549716.2023.2285100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 11/14/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND Gaps exist along the high blood pressure (HBP) diagnosis-treatment-control pathway in high, low and middle-income countries. OBJECTIVE To determine the prevalence of HBP and to describe the levels of awareness, control and treatment of HBP in the rural Peruvian Andes. METHODS This cross-sectional study is embedded into a multigenerational cohort. We analysed data of all adult participants aged ≥ 30 years (n = 2752) who answered a baseline health and lifestyle questionnaire and underwent a physical examination, which included three blood pressure readings. HBP was defined as measured systolic or diastolic blood pressure (BP) ≥140 and/or 90 mm Hg and/or self-reported physician-diagnosed hypertension and/or self-reported antihypertensive intake. The determinants of the prevalence of HBP, unawareness of HBP and uncontrolled HBP were assessed using mixed-effect logistic regressions. RESULTS HBP was present in 18.9% of the participants. Of those with measured HBP, 72.2% were unaware of their HBP. Among those with a diagnosed or medically treated hypertension, 58.4% had uncontrolled HBP. The prevalence of HBP was higher in women (OR: 1.12, CI: 1.02-1.24), increased with age (OR: 1.01, CI: 1.01-1.01) and the presence of family history of hypertension (OR: 1.15, CI: 1.08-1.24), and decreased with healthier lifestyle score (OR: 0.93, CI: 0.91-0.95). Unawareness of HBP was lower among women (OR: 0.56, CI: 0.38-0.83), higher among participants living over 3000 m Above Sea Level (OR: 1.15, CI: 1.03-1.27) and decreased with age (OR: 0.99, CI: 0.98-0.99). CONCLUSIONS Unawareness of HBP was high, few HTN patients received treatment and BP remained high in the presence of antihypertensive treatment.
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Affiliation(s)
- Giuliana Sanchez-Samaniego
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- Faculty of Science, University of Basel, Basel, Switzerland
| | - Stella Maria Hartinger
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- Faculty of Science, University of Basel, Basel, Switzerland
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, UPCH, Lima, Peru
| | - Daniel Mäusezahl
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- Faculty of Science, University of Basel, Basel, Switzerland
| | - Jan Hattendorf
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- Faculty of Science, University of Basel, Basel, Switzerland
| | - Günther Fink
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- Faculty of Science, University of Basel, Basel, Switzerland
| | - Nicole Probst-Hensch
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- Faculty of Science, University of Basel, Basel, Switzerland
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Salazar Flórez JE, Echeverri Rendón ÁP, Giraldo Cardona LS. Burden of undiagnosed hypertension and its associated factors: A challenge for primary health care in urban Colombia. PLoS One 2023; 18:e0294177. [PMID: 38015897 PMCID: PMC10684019 DOI: 10.1371/journal.pone.0294177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 10/26/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND Arterial hypertension is one of the most prevalent chronic, non-communicable diseases and the leading preventable risk factor for cardiovascular disease (CVD) and all-cause mortality worldwide. Although its primary causes and consequences are preventable, it often remains undiagnosed. Consequently, this study aims to determine the prevalence and factors associated with normotensive, diagnosed, and undiagnosed hypertension in adults. METHODS A cross-sectional, population-based study was conducted in Sabaneta, Colombia, between 2021 and 2022, with 286 adults aged 18 and older. Stratified and systematic random sampling methods were employed. The World Health Organization STEP survey and the Perez Rojas test were utilized to assess behavioral risk factors and sedentary lifestyles. Body mass index, waist circumference, and arterial tension were measured using standardized instruments. The prevalence of hypertension was then estimated. Risk factors influencing normotensive, diagnosed, and undiagnosed hypertension were analyzed using multinomial regression. The outcome variable comprised three categories: normotensive (reference category), diagnosed hypertension, and undiagnosed hypertension. The multinomial regression coefficients were exponentiated and are presented as relative risk ratios (RRR) with 95% confidence intervals (CI). The model was adjusted for sex and sample weight per neighborhood. RESULTS The study revealed a hypertension prevalence of 38.5% and an undiagnosed hypertension rate of 50.9%. Those with undiagnosed hypertension were predominantly adults over 60 years (RRR = 0.68; 95% CI: 0.53-0.86), individuals with an elementary school education (RRR = 1.75; 95% CI: 1.27-2.42), those physically active (RRR = 1.52; 95% CI: 1.22-1.89), without prior diagnoses of chronic comorbidities (RRR = 1.42; 95% CI: 1.12-1.82), and with obesity (RRR = 2.25; 95% CI: 1.63-3.11) or overweight conditions (RRR = 1.70; 95% CI: 1.334-2.15). CONCLUSIONS Undiagnosed hypertension was significant among populations without risk conditions. There is an urgent need for community-based early detection and education strategies to mitigate this issue.
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Affiliation(s)
- Jorge Emilio Salazar Flórez
- Research Center, Grupo de Estudio de Enfermedades Infecciosas y Crónicas (GEINCRO), San Martin University Foundation, Sabaneta, Colombia
| | | | - Luz Stella Giraldo Cardona
- Research Center, Grupo de Estudio de Enfermedades Infecciosas y Crónicas (GEINCRO), San Martin University Foundation, Sabaneta, Colombia
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Martínez R, Soliz P, Campbell NRC, Lackland DT, Whelton PK, Ordúñez P. [Association between population hypertension control and ischemic heart disease and stroke mortality in 36 countries of the Americas, 1990-2019: an ecological studyAssociação entre controle populacional da hipertensão e mortalidade por doença cardíaca isquêmica e acidente vascular cerebral em 36 países das Américas, 1990-2019: um estudo ecológico]. Rev Panam Salud Publica 2023; 47:e124. [PMID: 37497153 PMCID: PMC10367117 DOI: 10.26633/rpsp.2023.124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 07/06/2022] [Indexed: 07/28/2023] Open
Abstract
Objective To quantify the association between the prevalence of population hypertension control and ischemic heart disease (IHD) and stroke mortality in 36 countries of the Americas from 1990 to 2019. Methods This ecologic study uses the prevalence of hypertension, awareness, treatment, and control from the NCD-RisC and IHD and stroke mortality from the Global Burden of Disease Study 2019. Regression analysis was used to assess time trends and the association between population hypertension control and mortality. Results Between 1990 and 2019, age-standardized death rates due to IHD and stroke declined annually by 2.2% (95% confidence intervals: -2.4 to -2.1) and 1.8% (-1.9 to -1.6), respectively. The annual reduction rate in IHD and stroke mortality deaccelerated to -1% (-1.2 to -0.8) during 2000-2019. From 1990 to 2019, the prevalence of hypertension controlled to a systolic/diastolic blood pressure ≤140/90 mmHg increased by 3.2% (3.1 to 3.2) annually. Population hypertension control showed an inverse association with IHD and stroke mortality, respectively, regionwide and in all but 3 out of 36 countries. Regionwide, for every 1% increase in population hypertension control, our data predicted a reduction of 2.9% (-2.94 to -2.85) in IHD deaths per 100 000 population, equivalent to an averted 25 639 deaths (2.5 deaths per 100 000 population) and 2.37% (-2.41 to -2.33) in stroke deaths per 100 000 population, equivalent to an averted 9 650 deaths (1 death per 100 000 population). Conclusion There is a strong ecological negative association between IHD and stroke mortality and population hypertension control. Countries with the best performance in hypertension control showed better progress in reducing CVD mortality. Prediction models have implications for hypertension management in most populations in the Region of the Americas and other parts of the world.
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Affiliation(s)
- Ramón Martínez
- Organización Panamericana de la SaludWashington, D.C.Estados Unidos de AméricaOrganización Panamericana de la Salud, Washington, D.C., Estados Unidos de América.
| | - Patricia Soliz
- Organización Panamericana de la SaludWashington, D.C.Estados Unidos de AméricaOrganización Panamericana de la Salud, Washington, D.C., Estados Unidos de América.
| | | | - Daniel T. Lackland
- Universidad Médica de Carolina del SurCharlestonEstados Unidos de AméricaUniversidad Médica de Carolina del Sur, Charleston, Estados Unidos de América.
| | - Paul K. Whelton
- Universidad TulaneNueva OrleansEstados Unidos de AméricaUniversidad Tulane, Nueva Orleans, Estados Unidos de América.
| | - Pedro Ordúñez
- Organización Panamericana de la SaludWashington, D.C.Estados Unidos de AméricaOrganización Panamericana de la Salud, Washington, D.C., Estados Unidos de América.
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Khan T, Moran AE, Perel P, Whelton PK, Brainin M, Feigin V, Kostova D, Richter P, Ordunez P, Hennis A, Lackland DT, Slama S, Pineiro D, Martins S, Williams B, Hofstra L, Garg R, Mikkelsen B. The HEARTS partner forum-supporting implementation of HEARTS to treat and control hypertension. Front Public Health 2023; 11:1146441. [PMID: 37554732 PMCID: PMC10405076 DOI: 10.3389/fpubh.2023.1146441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 07/03/2023] [Indexed: 08/10/2023] Open
Abstract
Cardiovascular diseases (CVD), principally ischemic heart disease (IHD) and stroke, are the leading causes of death (18. 6 million deaths annually) and disability (393 million disability-adjusted life-years lost annually), worldwide. High blood pressure is the most important preventable risk factor for CVD and deaths, worldwide (10.8 million deaths annually). In 2016, the World Health Organization (WHO) and the United States Centers for Disease Control (CDC) launched the Global Hearts initiative to support governments in their quest to prevent and control CVD. HEARTS is the core technical package of the initiative and takes a public health approach to treating hypertension and other CVD risk factors at the primary health care level. The HEARTS Partner Forum, led by WHO, brings together the following 11 partner organizations: American Heart Association (AHA), Center for Chronic Disease Control (CCDC), International Society of Hypertension (ISH), International Society of Nephrology (ISN), Pan American Health Organization (PAHO), Resolve to Save Lives (RTSL), US CDC, World Hypertension League (WHL), World Heart Federation (WHF) and World Stroke Organization (WSO). The partners support countries in their implementation of the HEARTS technical package in various ways, including providing technical expertise, catalytic funding, capacity building and evidence generation and dissemination. HEARTS has demonstrated the feasibility and acceptability of a public health approach, with more than seven million people already on treatment for hypertension using a simple, algorithmic HEARTS approach. Additionally, HEARTS has demonstrated the feasibility of using hypertension as a pathfinder to universal health coverage and should be a key intervention of all basic benefit packages. The partner forum continues to find ways to expand support and reinvigorate enthusiasm and attention on preventing CVD. Proposed future HEARTS Partner Forum activities are related to more concrete information sharing between partners and among countries, expanded areas of partner synergy, support for implementation, capacity building, and advocacy with country ministries of health, professional societies, academy and civil societies organizations. Advancing toward the shared goals of the HEARTS partners will require a more formal, structured approach to the forum and include goals, targets and published reports. In this way, the HEARTS Partner Forum will mirror successful global partnerships on communicable diseases and assist countries in reducing CVD mortality and achieving global sustainable development goals (SDGs).
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Affiliation(s)
- Taskeen Khan
- Department of Non-communicable Diseases, World Health Organization, Geneva, Switzerland
| | - Andrew E. Moran
- Resolve to Save Lives, New York, NY, United States
- Department of Medicine, Columbia University, New York, NY, United States
| | - Pablo Perel
- Centre for Global Chronic Conditions, Department of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
- World Heart Federation, Geneva, Switzerland
| | - Paul K. Whelton
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, United States
- World Hypertension League, New Orleans, LA, United States
| | - Michael Brainin
- Department of Clinical Neurology, Danube University, Krems, Austria
- World Stroke Organization, Geneva, Switzerland
| | - Valery Feigin
- World Stroke Organization, Geneva, Switzerland
- National Institute for Stroke and Applied Neurosciences, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Deliana Kostova
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Non-communicable Diseases and Mental Health, Atlanta, GA, United States
| | - Patricia Richter
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Non-communicable Diseases and Mental Health, Atlanta, GA, United States
| | - Pedro Ordunez
- Pan American Health Organization/World Health Organization, Washington, DC, United States
| | - Anselm Hennis
- Pan American Health Organization/World Health Organization, Washington, DC, United States
| | - Daniel T. Lackland
- World Hypertension League, New Orleans, LA, United States
- Division of Translational Neurosciences and Population Studies, Department of Neurology, Medical University of South Carolina, Charleston, SC, United States
| | - Slim Slama
- Department of Non-communicable Diseases, World Health Organization, Geneva, Switzerland
| | - Daniel Pineiro
- World Heart Federation, Geneva, Switzerland
- Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Sheila Martins
- World Stroke Organization, Geneva, Switzerland
- Universidade Federal of Rio Grande do Sul, Porto Alegre, Brazil
| | - Bryan Williams
- International Society of Hypertension, Essex, United Kingdom
| | - Leonard Hofstra
- Amsterdam UMC—Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Renu Garg
- Resolve to Save Lives, New York, NY, United States
| | - Bente Mikkelsen
- Department of Non-communicable Diseases, World Health Organization, Geneva, Switzerland
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Prado P, Gamarra Á, Rodríguez L, Brettler J, Farrell M, Girola ME, Malcolm T, Martínez R, Molina V, Moran AE, Neupane D, Rosende A, Valdés González Y, Mukhtar Q, Ordunez P. [Monitoring and evaluation platform for HEARTS in the Americas: improving population-based hypertension control programs in primary health carePlataforma de monitoramento e avaliação do programa HEARTS nas Américas: melhoria dos programas de controle da hipertensão de base populacional na atenção primária à saúde]. Rev Panam Salud Publica 2023; 47:e90. [PMID: 37223327 PMCID: PMC10202337 DOI: 10.26633/rpsp.2023.90] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 07/15/2022] [Indexed: 05/25/2023] Open
Abstract
HEARTS in the Americas is the Pan American Health Organization flagship program to accelerate the reduction of the cardiovascular disease (CVD) burden by improving hypertension control and CVD secondary prevention in primary health care. A monitoring and evaluation (M&E) platform is needed for program implementation, benchmarking, and informing policy-makers. This paper describes the conceptual bases of the HEARTS M&E platform including software design principles, contextualization of data collection modules, data structure, reporting, and visualization. The District Health Information Software 2 (DHIS2) web-based platform was chosen to implement aggregate data entry of CVD outcome, process, and structural risk factor indicators. In addition, PowerBI was chosen for data visualization and dashboarding for the analysis of performance and trends above the health care facility level. The development of this new information platform was focused on primary health care facility data entry, timely data reporting, visualizations, and ultimately active use of data to drive decision-making for equitable program implementation and improved quality of care. Additionally, lessons learnt and programmatic considerations were assessed through the experience of the M&E software development. Building political will and support is essential to developing and deploying a flexible platform in multiple countries which is contextually specific to the needs of various stakeholders and levels of the health care system. The HEARTS M&E platform supports program implementation and reveals structural and managerial limitations and care gaps. The HEARTS M&E platform will be central to monitoring and driving further population-level improvements in CVD and other noncommunicable disease-related health.
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Affiliation(s)
- Patric Prado
- Organización Panamericana de la SaludWashington, D.C.Estados Unidos de AméricaOrganización Panamericana de la Salud. Washington, D.C., Estados Unidos de América.
| | - Ángelo Gamarra
- Organización Panamericana de la SaludWashington, D.C.Estados Unidos de AméricaOrganización Panamericana de la Salud. Washington, D.C., Estados Unidos de América.
| | - Libardo Rodríguez
- Organización Panamericana de la SaludWashington, D.C.Estados Unidos de AméricaOrganización Panamericana de la Salud. Washington, D.C., Estados Unidos de América.
| | - Jeffrey Brettler
- Departamento de Ciencias de Sistemas de SaludFacultad de Medicina Bernard J. Tyson de Kaiser PermanentePasadenaEstados Unidos de AméricaDepartamento de Ciencias de Sistemas de Salud, Facultad de Medicina Bernard J. Tyson de Kaiser Permanente, Pasadena, Estados Unidos de América.
| | - Margaret Farrell
- Resolve to Save LivesNueva YorkEstados Unidos de AméricaResolve to Save Lives, Nueva York, Estados Unidos de América.
| | - María E. Girola
- Organización Panamericana de la SaludWashington, D.C.Estados Unidos de AméricaOrganización Panamericana de la Salud. Washington, D.C., Estados Unidos de América.
| | - Taraleen Malcolm
- Organización Panamericana de la SaludPuerto EspañaTrinidad y TobagoOrganización Panamericana de la Salud, Puerto España, Trinidad y Tobago.
| | - Ramón Martínez
- Organización Panamericana de la SaludWashington, D.C.Estados Unidos de AméricaOrganización Panamericana de la Salud. Washington, D.C., Estados Unidos de América.
| | - Virginia Molina
- Organización Panamericana de la SaludCiudad de MéxicoMéxicoOrganización Panamericana de la Salud, Ciudad de México, México.
| | - Andrew E. Moran
- Resolve to Save LivesNueva YorkEstados Unidos de AméricaResolve to Save Lives, Nueva York, Estados Unidos de América.
| | - Dinesh Neupane
- Departamento de EpidemiologíaEscuela de Salud Pública Bloomberg de la Universidad Johns HopkinsBaltimoreEstados Unidos de AméricaDepartamento de Epidemiología, Escuela de Salud Pública Bloomberg de la Universidad Johns Hopkins, Baltimore, Estados Unidos de América.
| | - Andrés Rosende
- Organización Panamericana de la SaludWashington, D.C.Estados Unidos de AméricaOrganización Panamericana de la Salud. Washington, D.C., Estados Unidos de América.
| | - Yamilé Valdés González
- Hospital Universitario General Calixto GarcíaComisión Nacional Técnica Asesora del Programa de Hipertensión ArterialLa HabanaCubaHospital Universitario General Calixto García, Comisión Nacional Técnica Asesora del Programa de Hipertensión Arterial, La Habana, Cuba.
| | - Qaiser Mukhtar
- División de Protección de la Salud MundialCentros para el Control y la Prevención de EnfermedadesAtlantaEstados Unidos de AméricaDivisión de Protección de la Salud Mundial, Centros para el Control y la Prevención de Enfermedades, Atlanta, Estados Unidos de América.
| | - Pedro Ordunez
- Organización Panamericana de la SaludWashington, D.C.Estados Unidos de AméricaOrganización Panamericana de la Salud. Washington, D.C., Estados Unidos de América.
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11
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Rosende A, DiPette DJ, Martinez R, Brettler JW, Rodriguez G, Zuniga E, Ordunez P. HEARTS in the Americas clinical pathway. Strengthening the decision support system to improve hypertension and cardiovascular disease risk management in primary care settings. Front Cardiovasc Med 2023; 10:1102482. [PMID: 37180772 PMCID: PMC10169833 DOI: 10.3389/fcvm.2023.1102482] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 03/27/2023] [Indexed: 05/16/2023] Open
Abstract
Background HEARTS in the Americas is the regional adaptation of the WHO Global HEARTS Initiative. It is implemented in 24 countries and over 2,000 primary healthcare facilities. This paper describes the results of a multicomponent, stepwise, quality improvement intervention designed by the HEARTS in the Americas to support advances in hypertension treatment protocols and evolution towards the Clinical Pathway. Methods The quality improvement intervention comprised: 1) the use of the appraisal checklist to evaluate the current hypertension treatment protocols, 2) a peer-to-peer review and consensus process to resolve discrepancies, 3) a proposal of a clinical pathway to be considered by the countries, and 4) a process of review, adopt/adapt, consensus and approval of the clinical pathway by the national HEARTS protocol committee. A year later, 16 participants countries (10 and 6 from each cohort, respectively) were included in a second evaluation using the HEARTS appraisal checklist. We used the median and interquartile scores range and the percentages of the maximum possible total score for each domain as a performance measure to compare the results pre and post-intervention. Results Among the eleven protocols from the ten countries in the first cohort, the baseline assessment achieved a median overall score of 22 points (ICR 18 -23.5; 65% yield). After the intervention, the overall score reached a median of 31.5 (ICR 28.5 -31.5; 93% yield). The second cohort of countries developed seven new clinical pathways with a median score of 31.5 (ICR 31.5 -32.5; 93% yield). The intervention was effective in three domains: 1. implementation (clinical follow-up intervals, frequency of drug refills, routine repeat blood pressure measurement when the first reading is off-target, and a straightforward course of action). 2. treatment (grouping all medications in a single daily intake and using a combination of two antihypertensive medications for all patients in the first treatment step upon the initial diagnosis of hypertension) and 3. management of cardiovascular risk (lower BP thresholds and targets based on CVD risk level, and the use of aspirin and statins in high-risk patients). Conclusion This study confirms that this intervention was feasible, acceptable, and instrumental in achieving progress in all countries and all three domains of improvement: implementation, blood pressure treatment, and cardiovascular risk management. It also highlights the challenges that prevent a more rapid expansion of HEARTS in the Americas and confirms that the main barriers are in the organization of health services: drug titration by non-physician health workers, the lack of long-acting antihypertensive medications, lack of availability of fixed-doses combination in a single pill and cannot use high-intensity statins in patients with established cardiovascular diseases. Adopting and implementing the HEARTS Clinical Pathway can improve the efficiency and effectiveness of hypertension and cardiovascular disease risk management programs.
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Affiliation(s)
- Andres Rosende
- Department of Non-Communicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, United States
| | - Donald J. DiPette
- School of Medicine Columbia, University of South Carolina, Columbia, SC, United States
| | - Ramon Martinez
- Department of Non-Communicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, United States
| | - Jeffrey W. Brettler
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, United States
- Southern California Permanente Medical Group, Los Angeles, CA, United States
| | - Gonzalo Rodriguez
- Consultant for HEARTS in the Americas, PAHO/WHO Office in Argentina, Buenos Aires, Argentina
| | - Eric Zuniga
- Antofagasta Health Service, University of Antofagasta, Antofagasta, Chile
| | - Pedro Ordunez
- Department of Non-Communicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, United States
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12
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Steinbrook E, Flood D, Barnoya J, Montano CM, Miller AC, Rohloff P. Prevalence of Hypertension, Diabetes, and Other Cardiovascular Disease Risk Factors in Two Indigenous Municipalities in Rural Guatemala: A Population-Representative Survey. Glob Heart 2022; 17:82. [PMID: 36578912 PMCID: PMC9695220 DOI: 10.5334/gh.1171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 11/01/2022] [Indexed: 11/23/2022] Open
Abstract
Background Nearly 50% of Guatemalans are Indigenous Maya, yet few studies have examined the prevalence of modifiable cardiovascular disease (CVD) risk factors in Indigenous Maya populations. Therefore, we sought to estimate the prevalence of modifiable CVD risk factors in two Indigenous Maya areas in Guatemala. Methods We conducted, between June 2018 and October 2019, a population-representative survey of adults aged 18 years and older in two rural Indigenous Maya municipalities in Guatemala. Our primary outcomes were five modifiable CVD risk factors: diabetes, hypertension, obesity, smoking, and alcohol use. We estimated the crude and age-standardized prevalence of each outcome. We also constructed multivariable logistic regression models to assess prevalence over covariates including age, sex, education level, ethnicity, and poverty. Sampling weights adjusted for nonresponse, and appropriate survey commands were used in all analyses. Results The crude prevalence of diabetes was 12.5% (95% confidence Interval [CI] 9.6% to 16.1%), hypertension 20.3% (95% CI 17.1% to 23.9%), obesity 23.7% (95% CI 19.4% to 28.6%), smoking 10.7% (95% CI 7.8% to 14.5%), and high alcohol use 0.9% (95% CI 0.5% to 1.6%). Age-standardized prevalence of each outcome was similar to the crude prevalence. The prevalence of multiple CVD risk factors increased between the age groups 18-29 years and 50-59 years before decreasing among older age groups. Men had twenty-fold higher smoking prevalence than women (20.5% vs. 1.2%, respectively) and women had nearly double the age-adjusted prevalence of obesity as men (30.1% vs. 17.0%, respectively). Conclusion There is a substantial prevalence of modifiable CVD risk factors in rural, Indigenous populations in Guatemala, in particular hypertension, diabetes, obesity (among women), and smoking (among men). These findings can help catalyze policy and clinical investments to improve the prevention, management, and control of CVD risk factors in these historically marginalized communities.
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Affiliation(s)
- Eric Steinbrook
- University of Michigan Medical School, University of Michigan, Ann Arbor, MI, USA
| | - David Flood
- University of Michigan Medical School, University of Michigan, Ann Arbor, MI, USA
- Centro de Investigación en la Salud Indígena, Wuqu’ Kawoq, Tecpán, Guatemala, US
- Instituto de Nutrición de Centroamérica y Panamá, INCAP, Guatemala City, Guatemala Unidad de Cirugia Cardiovascular, Guatemala City, Guatemala, US
| | - Joaquin Barnoya
- Unidad de Cirugia Cardiovascular de Guatemala, Guatemala City, Guatemala, US
- Integra Cancer Institute, Guatemala City, Guatemala, US
| | - Carlos Mendoza Montano
- Instituto de Nutrición de Centroamérica y Panamá, INCAP, Guatemala City, Guatemala Unidad de Cirugia Cardiovascular, Guatemala City, Guatemala, US
| | - Ann C. Miller
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Peter Rohloff
- Centro de Investigación en la Salud Indígena, Wuqu’ Kawoq, Tecpán, Guatemala, US
- Division of Global Health Equity, Brigham and Women’s Hospital, Boston, Massachusetts, USA
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13
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Etienne CF. Ampliación del manejo de las enfermedades cardiovasculares en la atención primaria mediante HEARTS en las Américas *. Rev Panam Salud Publica 2022; 46:e185. [PMID: 36133433 PMCID: PMC9484332 DOI: 10.26633/rpsp.2022.185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 08/04/2022] [Indexed: 11/24/2022] Open
Affiliation(s)
- Carissa F Etienne
- Directora de la Oficina Sanitaria Panamericana Oficina Regional de la Organización Mundial de la Salud para las Américas Washington D.C. Estados Unidos de América Directora de la Oficina Sanitaria Panamericana, Oficina Regional de la Organización Mundial de la Salud para las Américas, Washington D.C., Estados Unidos de América
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14
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Prado P, Gamarra A, Rodriguez L, Brettler J, Farrell M, Girola ME, Malcolm T, Martinez R, Molina V, Moran AE, Neupane D, Rosende A, González YV, Mukhtar Q, Ordunez P. Monitoring and evaluation platform for HEARTS in the Americas: improving population-based hypertension control programs in primary health care. Rev Panam Salud Publica 2022; 46:e161. [PMID: 36133432 PMCID: PMC9484330 DOI: 10.26633/rpsp.2022.161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 07/15/2022] [Indexed: 02/07/2023] Open
Abstract
ABSTRACT
HEARTS in the Americas is the Pan American Health Organization flagship program to accelerate the reduction of the cardiovascular disease (CVD) burden by improving hypertension control and CVD secondary prevention in primary health care. A monitoring and evaluation (M&E) platform is needed for program implementation, benchmarking, and informing policy-makers. This paper describes the conceptual bases of the HEARTS M&E platform including software design principles, contextualization of data collection modules, data structure, reporting, and visualization. The District Health Information Software 2 (DHIS2) web-based platform was chosen to implement aggregate data entry of CVD outcome, process, and structural risk factor indicators. In addition, PowerBI was chosen for data visualization and dashboarding for the analysis of performance and trends above the health care facility level. The development of this new information platform was focused on primary health care facility data entry, timely data reporting, visualizations, and ultimately active use of data to drive decision-making for equitable program implementation and improved quality of care. Additionally, lessons learnt and programmatic considerations were assessed through the experience of the M&E software development. Building political will and support is essential to developing and deploying a flexible platform in multiple countries which is contextually specific to the needs of various stakeholders and levels of the health care system. The HEARTS M&E platform supports program implementation and reveals structural and managerial limitations and care gaps. The HEARTS M&E platform will be central to monitoring and driving further population-level improvements in CVD and other noncommunicable disease-related health.
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Affiliation(s)
- Patric Prado
- Pan American Health Organization. Washington, DC, USA
| | | | | | - Jeffrey Brettler
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, United States of America
| | | | | | - Taraleen Malcolm
- Pan American Health Organization, Port of Spain, Trinidad and Tobago
| | | | | | | | - Dinesh Neupane
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States of America
| | | | - Yamilé Valdés González
- University Hospital General Calixto García, National Technical Advisory Committee on Hypertension, Havana, Cuba
| | - Qaiser Mukhtar
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, United States of America
| | - Pedro Ordunez
- Pan American Health Organization. Washington, DC, USA
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15
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Martinez R, Soliz P, Campbell NRC, Lackland DT, Whelton PK, Ordunez P. Association between population hypertension control and ischemic heart disease and stroke mortality in 36 countries of the Americas, 1990-2019: an ecological study. Rev Panam Salud Publica 2022; 46:e143. [PMID: 36133429 PMCID: PMC9484333 DOI: 10.26633/rpsp.2022.143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 07/06/2022] [Indexed: 11/24/2022] Open
Abstract
ABSTRACT
Objective.
To quantify the association between the prevalence of population hypertension control and ischemic heart disease (IHD) and stroke mortality in 36 countries of the Americas from 1990 to 2019.
Methods.
This ecologic study uses the prevalence of hypertension, awareness, treatment, and control from the NCD-RisC and IHD and stroke mortality from the Global Burden of Disease Study 2019. Regression analysis was used to assess time trends and the association between population hypertension control and mortality.
Results.
Between 1990 and 2019, age-standardized death rates due to IHD and stroke declined annually by 2.2% (95% confidence intervals: –2.4 to –2.1) and 1.8% (–1.9 to –1.6), respectively. The annual reduction rate in IHD and stroke mortality deaccelerated to –1% (–1.2 to –0.8) during 2000-2019. From 1990 to 2019, the prevalence of hypertension controlled to a systolic/diastolic blood pressure ≤140/90 mmHg increased by 3.2% (3.1 to 3.2) annually. Population hypertension control showed an inverse association with IHD and stroke mortality, respectively, regionwide and in all but 3 out of 36 countries. Regionwide, for every 1% increase in population hypertension control, our data predicted a reduction of 2.9% (–2.94 to –2.85) in IHD deaths per 100 000 population, equivalent to an averted 25 639 deaths (2.5 deaths per 100 000 population) and 2.37% (–2.41 to –2.33) in stroke deaths per 100 000 population, equivalent to an averted 9 650 deaths (1 death per 100 000 population).
Conclusion.
There is a strong ecological negative association between IHD and stroke mortality and population hypertension control. Countries with the best performance in hypertension control showed better progress in reducing CVD mortality. Prediction models have implications for hypertension management in most populations in the Region of the Americas and other parts of the world.
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Affiliation(s)
- Ramon Martinez
- Pan American Health Organization, Washington, D.C., United States of America. ORCID 0000-0003-0641-0206
| | - Patricia Soliz
- Pan American Health Organization, Washington, D.C., United States of America. ORCID 0000-0001-5788-225X
| | | | - Daniel T. Lackland
- The Medical University of South Carolina, Charleston, United States of America. ORCID 0000-0001-5733-6283
| | - Paul K. Whelton
- Tulane University, New Orleans, United States of America. ORCID 0000-0002-2225-383X
| | - Pedro Ordunez
- Pan American Health Organization, Washington, D.C., United States of America. ORCID 0000-0002-9871-6845
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16
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Frieden TR, Moran AE, Garg R. HEARTS in the Americas: saving lives from the world’s deadliest disease. Rev Panam Salud Publica 2022; 46:e171. [PMID: 36128472 PMCID: PMC9473449 DOI: 10.26633/rpsp.2022.171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 08/23/2022] [Indexed: 11/24/2022] Open
Affiliation(s)
| | - Andrew E. Moran
- Resolve to Save Lives, New York, United States of America
- Columbia University, New York, United States of America
| | - Renu Garg
- Resolve to Save Lives, New York, United States of America
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17
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Chivardi C, Hutchinson B, Molina V, Moreno E, Fajardo I, Giraldo-Arcila GP, Malo HM, Ordunez P, Rodríguez-Franco R, Moran AE, Kostova D. Assessing costs of a hypertension program in primary care: evidence from the HEARTS program in Mexico. Rev Panam Salud Publica 2022; 46:e144. [PMID: 36128473 PMCID: PMC9473450 DOI: 10.26633/rpsp.2022.144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 06/16/2022] [Indexed: 12/04/2022] Open
Abstract
Objective. In 2021, Mexico launched the HEARTS program to improve the prevention and control of cardiovascular disease (CVD) risk factors in 20 primary care facilities in the states of Chiapas and Yucatán. This study projects the annual cost of program implementation and discusses budgetary implications for scaling up the program. Methods. We obtained district-level data on treatment protocols, medication costs, and other resources required to prevent and treat CVD. We used the HEARTS Costing Tool to estimate total and per-patient costs. A “partial implementation” scenario calculated the costs of implementing HEARTS if existing pharmacological treatment protocols are left in place. The second scenario, “full implementation,” examined costs if programs use HEARTS pharmacological protocol. Results. Respectively in the partial and full implementation scenarios, total annual costs to implement and operate HEARTS were $260 023 ($32.1 per patient/year) and $255 046 ($31.5 per patient/year) in Chiapas, and $1 000 059 ($41.3 per patient/year) and $1 013 835 ($43.3 per patient/year) in Yucatán. In Chiapas, adopting HEARTS standardized treatment protocols resulted in a 9.7 % reduction in annual medication expenditures relative to maintaining status-quo treatment approaches. In Yucatán, adoption was $12 875 more expensive, in part because HEARTS hypertension treatment regimens were more intensive than status quo regimens. Conclusion. HEARTS in the Americas offers a standardized strategy to treating and controlling CVD risk factors. In Mexico, approaches that may lead to improved program affordability include adoption of the recommended HEARTS treatment protocols with preferred medications and task shifting of services from physicians to nurses and other providers.
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Affiliation(s)
- Carlos Chivardi
- National Institute of Public Health, Mexico City, Mexico; Center for Health Economics, University of York, York, United Kingdom (current)
| | - Brian Hutchinson
- Center for Global Noncommunicable Diseases, RTI International, Seattle, United States of America
| | | | - Elena Moreno
- Department of Prevention and Control of Communicable and Non-
Communicable Diseases, Institute of Health of the State of Chiapas, Tuxtla Gutierrez, Mexico
| | - Ileana Fajardo
- Directorate of Nutrition and Chronic Diseases of Yucatan Health Services,
Merida, Yucatán, Mexico
| | - Gloria P. Giraldo-Arcila
- Department of Non-Communicable Diseases and Mental Health, Pan American
Health Organization, Washington, DC, United States of America
| | | | - Pedro Ordunez
- Department of Non-Communicable Diseases and Mental Health, Pan American
Health Organization, Washington, DC, United States of America
| | - Roxana Rodríguez-Franco
- Center of Demographic, Urban, and Environmental Studies, El Colegio de México, Mexico City, Mexico
| | | | - Deliana Kostova
- Division of Global Health Protection, Centers for Disease Control and
Prevention, Atlanta, United States of America
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18
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Etienne CF. Scaling up cardiovascular disease management in primary care through HEARTS in the Americas. Rev Panam Salud Publica 2022; 46:e157. [PMID: 36071917 PMCID: PMC9440740 DOI: 10.26633/rpsp.2022.157] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 08/04/2022] [Indexed: 12/05/2022] Open
Affiliation(s)
- Carissa F Etienne
- Director Pan American Sanitary Bureau Regional Office for the Americas of the World Health Organization Washington, D.C. United States of America Director, Pan American Sanitary Bureau, Regional Office for the Americas of the World Health Organization, Washington, D.C., United States of America
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19
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Frieden TR, Moran AE, Garg R. HEARTS en las Américas: salvar vidas de la enfermedad más letal del mundo *. Rev Panam Salud Publica 2022; 46:e189. [PMID: 36211248 PMCID: PMC9534356 DOI: 10.26633/rpsp.2022.189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 08/23/2022] [Indexed: 11/24/2022] Open
Affiliation(s)
- Thomas R Frieden
- Resolve to Save Lives Nueva York Estados Unidos de América Resolve to Save Lives, Nueva York, Estados Unidos de América
| | - Andrew E Moran
- Resolve to Save Lives Nueva York Estados Unidos de América Resolve to Save Lives, Nueva York, Estados Unidos de América
- Universidad de Columbia Nueva York Estados Unidos de América Universidad de Columbia, Nueva York, Estados Unidos de América
| | - Renu Garg
- Resolve to Save Lives Nueva York Estados Unidos de América Resolve to Save Lives, Nueva York, Estados Unidos de América
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