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Evaluating the World Health Organization's Hearts Model for Hypertension and Diabetes Management: A Pilot
Irmgardt Alicia Wellmann1, Luis Fernando Ayala1, Taryn M Valley2,3
1INCAP Research Center for Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala.
Insights
This pilot study found that integrating hypertension and diabetes management using the World Health Organization HEARTS Technical Package was feasible and acceptable in Guatemalan primary care facilities, informing future scale-up efforts.
Area of Science:
- Public Health
- Cardiovascular Disease Management
- Implementation Science
Background:
- The World Health Organization HEARTS Technical Package aims to enhance primary care for cardiovascular disease risk factors globally.
- This study piloted an integrated hypertension and diabetes management model based on the HEARTS initiative in Guatemala.
Purpose of the Study:
- To assess the feasibility and acceptability of an integrated hypertension and diabetes management pilot program.
- To evaluate implementation and clinical outcomes of the HEARTS-aligned strategies in Guatemalan primary care.
Main Methods:
- A six-month, single-arm pilot implementation trial was conducted in 11 primary care facilities.
- Feasibility and acceptability were assessed via structured interviews with Ministry of Health staff.
- Secondary outcomes included patient enrollment, retention, and treatment rates, analyzed using pre-specified benchmarks and interrupted time series.
Main Results:
- The pilot enrolled 964 patients with hypertension and/or diabetes.
- Feasibility and acceptability scores among staff exceeded benchmarks (median 5.0).
- While patient follow-up rates were lower than benchmark (36%), monthly treatment rates for hypertension increased significantly (22.3 patients/month).
Conclusions:
- The integrated HEARTS model demonstrated feasibility and acceptability within Guatemala's Ministry of Health primary care system.
- Findings provide valuable insights for refining national scale-up strategies in Guatemala.
- The results can also inform similar HEARTS implementation projects in other international settings.
Background:
The World Health Organization HEARTS Technical Package is a widely implemented global initiative to improve the primary care management of cardiovascular disease risk factors. The study's objective is to report outcomes from a pilot implementation trial of integrated hypertension and diabetes management based on the HEARTS model in Guatemala.
Methods:
We conducted a single-arm pilot implementation trial over six months from October 2023 to May 2024 in 11 Guatemalan Ministry of Health primary care facilities in two districts. The pilot evaluated a package of five HEARTS-aligned implementation strategies to improve the pharmacological treatment of hypertension and diabetes. The primary outcomes were feasibility and acceptability, measured through 20 structured interviews with Ministry of Health employees and by examining enrolment and retention data. Secondary outcomes included a suite of implementation and clinical outcomes, including treatment rates. When baseline data were available, we analyzed secondary outcomes as the net change from baseline or using an interrupted time series approach.
Results:
The study enrolled 964 patients, of whom 58.8% had hypertension only, 30.4% had diabetes only, and 10.8% had both conditions. Surveys on feasibility and acceptability among Ministry of Health staff had a median score of 5.0 (IQR: 5.0 to 5.0) and 5.0 (IQR range: 4.8 to 5.0), respectively, exceeding the prespecified benchmark of ≥3.5. Both districts achieved the prespecified benchmark of enrolling ≥25 hypertension patients and ≥25 diabetes patients. Only 36% of patients attended a follow-up visit within three months, lower than the prespecified benchmark of ≥75%. Monthly treatment rates during the pilot increased by 22.3 (95% CI: 16.2 to 28.4; P < 0.001) and 3.5 (95% CI: -1.6 to 8.7; P = 0.17) patients per month for hypertension and diabetes, respectively.
Conclusions:
Implementation of an integrated hypertension and diabetes model based on HEARTS was generally feasible and acceptable in the Ministry of Health in Guatemala. Findings can refine national scale-up in Guatemala and inform HEARTS implementation projects in other settings.
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