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Reach and effectiveness of a HEARTS hypertension pilot project in Guatemala

Irmgardt Alicia Wellmann1, José Javier Rodríguez1, Benilda Batzin2

  • 1Institute of Nutrition of Central America and Panama Research Center for Prevention of Chronic Diseases Institute of Nutrition of Central America and Panama Guatemala City Guatemala Institute of Nutrition of Central America and Panama, Research Center for Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala.

Revista Panamericana De Salud Publica = Pan American Journal of Public Health
|October 21, 2024
PubMed

Insights

The World Health Organization

Area of Science:

  • Cardiovascular disease research
  • Public health interventions
  • Hypertension management

Background:

  • The World Health Organization Global Hearts initiative (HEARTS) provides a technical package to improve population-level management of hypertension and cardiovascular disease risk factors.
  • Primary health care systems are crucial for managing chronic conditions like hypertension, especially in resource-limited settings.
  • Implementing standardized, evidence-based protocols is essential for effective hypertension control.

Purpose of the Study:

  • To describe the first pilot implementation of the HEARTS technical package within Guatemala's Ministry of Health (MOH) primary health care system.
  • To evaluate the feasibility and outcomes of adapting HEARTS strategies for sustainability in rural indigenous communities.
  • To assess the impact of the HEARTS intervention on patient reach and blood pressure control using the RE-AIM framework.

Main Methods:

  • A pilot project was conducted in six primary health care facilities across three rural indigenous municipalities in Guatemala, starting April 2022.
  • HEARTS-aligned strategies were adapted for local sustainability.
  • Outcomes were measured using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework, focusing on treatment count and blood pressure control metrics.

Main Results:

  • A statistically significant increase in monthly hypertension treatment counts was observed post-implementation (25 patients/month increase, P=.002, followed by 2.4 additional patients/month, P=.005).
  • Mean systolic blood pressure decreased significantly (-4.4 mmHg, P=0.028), while diastolic blood pressure showed a non-significant trend towards reduction (-0.9 mmHg, P=0.376).
  • The proportion of patients achieving blood pressure control (<130/80 mmHg) increased from 33.4% at baseline to 47.1% at 6 months (adjusted change 13.7%, P=0.027).

Conclusions:

  • The HEARTS model is feasible for implementation within the Guatemalan Ministry of Health's primary health care system.
  • The intervention demonstrated positive impacts on patient reach and blood pressure control, particularly in rural, indigenous populations.
  • Findings support the scalability of the HEARTS program for improving hypertension management nationwide, reaching the majority of patients seeking care.

Keywords:
GuatemalaHypertensionglobal healthhealth policyimplementation science

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