Browsing by Autor "Jeffrey Brettler"

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HEARTS Calidad: Marco de políticas para fortalecer el manejo de la hipertensión arterial y del riesgo cardiovascular en la atención primaria de salud. Perspectivas desde HEARTS en las Américas.
(Pan American Health Organization, 2026) Esteban Londoño; Reena Gupta; Patrick Van der Stuyft; Martin Heine; Gloria Patricia Giraldo; Grace Marie Ku; Jeffrey Brettler; Andrés Rosende; V Irazola; Jerry Toelsie
HEARTS in the Americas is the largest-scale implementation of the WHO's global initiative, with 33 countries participating, 28 having adopted standardized clinical pathways, and about 10 000 primary healthcare facilities engaged. Despite progress, fragmented care, limited availability of validated blood pressure devices, restricted access to essential medicines, and weak quality assurance systems continue to hinder hypertension control and cardiovascular risk management. In response, PAHO and participating countries co-developed the HEARTS Quality Framework. Grounded in regional implementation, this model synthesizes global evidence and lessons from Latin America and the Caribbean. Co-designed by Ministries of Health, care providers, and international experts, it translates HEARTS strategies into actionable system-level objectives. Clearly defined outcome indicators and implementation targets promote institutionalization, quality improvement, and primary healthcare strengthening- supporting HEARTS scale-up and equitable outcomes. With appropriate contextualization, the HEARTS Quality Framework provides a practical roadmap for countries beyond the Region to advance primary healthcare-based chronic disease care.
Readiness to deliver integrated cardiovascular, kidney and metabolic care in primary healthcare: phase II of HEARTS 2.0 in 26 countries in the Americas
(BMJ, 2026) Pedro Ordunez; Andrés Rosende; Jeffrey Brettler; Esteban Londoño; Patrick Van der Stuyft; Ramon Martinez-Piedra; Libardo Rodríguez; Mariana Lisbeth Rodriguez de la Cerda; Kerry-Ann Renaud-Thomas; Vicente Aleixandre Benites-Zapata
WHO's Global HEARTS is the largest worldwide effort to improve hypertension control through standardised care. HEARTS in the Americas is its regional adaptation. To address the rising burden of cardiovascular, kidney and metabolic conditions, the initiative launched HEARTS 2.0, aiming to promote integrated care, reduce fragmentation and improve quality, access and health outcomes. In phase I, an expert-led consensus identified 45 evidence-based interventions for inclusion in an expanded Clinical Pathway. This report presents findings from phase II on the readiness of 26 Latin American and Caribbean countries to implement these interventions. We used a cross-sectional design and a structured, self-administered questionnaire completed by national implementation teams. It systematically assessed the availability, feasibility, time required and key barriers for each proposed intervention. While many interventions, especially for risk assessment and non-pharmacological treatments, are considered feasible in many countries, their current availability is limited due to ongoing shortages of diagnostics, medicines and infrastructure. Over the next 3 years, 18 countries are projected to implement >30 of the 45 interventions, four countries aim to implement 20-30 and four expect to implement fewer than 20. While primary health systems in most HEARTS-implementing countries do not yet appear ready to deliver integrated cardiovascular, kidney and metabolic care, the scale-up of HEARTS 2.0 presents a strong opportunity to advance this integration. As health systems worldwide face the challenge of increasing multimorbidity in their patients and fragmented care delivery systems, this assessment offers a practical tool for planning and action.