WHF Roadmap for Integrated Care in People Living with - or at Risk of - Cardiovascular Disease and Multiple Long-Term...

Area of Science:

• Public Health
• Health Services Research
• Cardiology

Background:

• Cardiovascular disease (CVD) frequently coexists with multiple long-term conditions (MLTC), creating a syndemic burden.
• This complex comorbidity leads to poorer health outcomes, polypharmacy, high treatment burden, and increased healthcare costs.
• Current single-disease care models are inadequate for addressing the complexity of MLTC.

Purpose of the Study:

• To present a structured framework (WHF roadmap) for designing, implementing, and scaling integrated care models for individuals with CVD and MLTC.
• To outline epidemiological and systemic challenges associated with MLTC.
• To identify practical strategies for integrated care adaptable across diverse global settings.

Main Methods:

• The roadmap is based on current evidence, expert consensus, case studies, and stakeholder surveys.
• It synthesizes findings to address the challenges of MLTC.
• Strategies are developed for adaptability across high-, middle-, and low-income settings.

Main Results:

• The roadmap emphasizes key elements for integrated care: multidisciplinary teamwork, aligned financing, digital health infrastructure, workforce development, patient partnership, and robust monitoring and evaluation.
• It proposes a shift from siloed care to integrated, capacity-sensitive approaches.
• Identifies practical, adaptable strategies for managing CVD and MLTC.

Conclusions:

• Integrated, person-centred care models are crucial for improving clinical outcomes and quality of life in patients with CVD and MLTC.
• Implementing integrated care can reduce avoidable hospitalizations and enhance health system resilience.
• The WHF roadmap provides a global framework to support the transition to integrated care systems.