Revista Panamericana De Salud Publica-pan American Journal of Public Health最新文献

{"title":"[National implementation of HEARTS in Cuba: Management and innovation in a context of limited resourcesImplementação nacional da iniciativa HEARTS em Cuba: gestão e inovação em um contexto de recursos limitados].","authors":"Yamilé Valdés González, Salvador Tamayo Muñiz, Armando Rodríguez Salvá, Addys Díaz Piñera, Denis Derivet Thaureaux, María Elena Pérez Leyva, Yagen Pomares, Miguel Antonio González, Libardo Rodríguez, Esteban Londoño","doi":"10.26633/RPSP.2026.96","DOIUrl":"10.26633/RPSP.2026.96","url":null,"abstract":"<p><p>The HEARTS initiative in the Americas, aimed at reducing cardiovascular mortality through the control of hypertension, required significant contextual adaptation for its successful implementation in Cuba. This article analyzes the organizational strategy and key innovations used to adapt the model to the national context, which enabled the program to expand from a single demonstration site (2016) to 451 primary care centers nationwide (2022). EThe process unfolded in three critical phases: (i) the adaptation of the HEARTS technical packages to primary health care in Cuba; ii) its adoption through a logical framework integrated with existing health policies; and iii) its institutionalization through regulatory reforms, the redesign of professional roles, and innovation in pharmaceuticals and local medical technology. A descriptive, cross-sectional study was conducted to evaluate the implementation of HEARTS in Cuba's 451 polyclinics. The results of the HEARTS quality self-assessment in 2025 (nationwide) and in the first half of 2026 (at the demonstration site) are included. Despite severe economic constraints, the institutionalization of HEARTS within Cuba's National Hypertension Program ensured its sustainability through governance restructuring, ongoing training, and data monitoring via the DHIS2 platform. This integration demonstrates that it is possible to implement global health policies through systematic adaptation and to expand coverage based on best practices through international technical cooperation.</p>","PeriodicalId":21264,"journal":{"name":"Revista Panamericana De Salud Publica-pan American Journal of Public Health","volume":"50 ","pages":"e96"},"PeriodicalIF":1.7,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13599985/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149040444","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[HEARTS in Chile: Self-assessment of the quality of the hypertension management program in primary care, 2025A iniciativa HEARTS no Chile: autoavaliação da qualidade do programa de hipertensão arterial na atenção primária, 2025].","authors":"Carolina Neira, Carla Hernández, Ximena Neculhueque, Marcela Rivera","doi":"10.26633/RPSP.2026.94","DOIUrl":"10.26633/RPSP.2026.94","url":null,"abstract":"<p><strong>Objective: </strong>To analyze the implementation status of the HEARTS initiative in Chile's primary healthcare network based on the results of self-assessment of quality in the domains fidelity, feasibility, acceptability, and effectiveness.</p><p><strong>Methods: </strong>A descriptive, cross-sectional study based on self-reported quality data collected between July and December 2025 from primary care teams implementing HEARTS. Of the 544 primary care centers that reported active implementation, 511 (93.9%) completed the self-assessment; relative to the national total of 602 primary care centers, coverage was 84.9%. A total of 6,233 staff members participated. The database was closed and validated on 31 March 2026, following a review of the completeness, consistency, and consolidation of reports available on the DHIS2 HEARTS platform. The domains fidelity, feasibility, acceptability, and effectiveness were evaluated.</p><p><strong>Results: </strong>The fidelity domain achieved a maturity index of 15.01/21, corresponding to level 4. Gaps were identified in treatment intensification by non-physician healthcare workers (13.2%, level 1) and in continuity of care for individuals at high cardiovascular risk (59.1%, level 3). Feasibility was 93.0%, and acceptability was 93.5%. The lowest acceptability was observed for intensification of pharmacological treatment by nurses under supervision and according to protocol (65%). The performance index scored 1.0 out of 4.0, corresponding to the \"incipient\" category.</p><p><strong>Conclusions: </strong>Implementation shows advances in relation to processes, while coverage and monitoring results continue to lag behind. These findings support the need to strengthen the quality of record-keeping, longitudinal follow-up, protocol-based redistribution of tasks within the current regulatory framework, and the provision of tailored technical assistance to regions with lower maturity.</p>","PeriodicalId":21264,"journal":{"name":"Revista Panamericana De Salud Publica-pan American Journal of Public Health","volume":"50 ","pages":"e94"},"PeriodicalIF":1.7,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13599984/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149040446","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[HEARTS in Guatemala: Implementation experience in addressing cardiorenometabolic risk, 2022-2025HEARTS na Guatemala: experiência de implementação para abordar o risco cardiovascular, renal e metabólico, 2022-2025].","authors":"Ana Irina Alvarez-Nufio, César Javier Herrera Muñoz, Wilder Bautista, Randall Lou-Meda","doi":"10.26633/RPSP.2026.93","DOIUrl":"https://doi.org/10.26633/RPSP.2026.93","url":null,"abstract":"<p><p>Guatemala faces a growing burden of chronic noncommunicable diseases, with hypertension and type 2 diabetes mellitus being the leading contributors to cardiovascular mortality and progression to chronic kidney disease. In 2022, the Ministry of Public Health and Social Assistance began implementing the Pan American Health Organization/World Health Organization's HEARTS technical package to strengthen the prevention and clinical management of these conditions in low- and medium-complexity health care facilities. Between 2022 and 2025, the strategy was implemented in 11 Departmental Directorates of Integrated Health Services Networks and reached 104 municipal districts with an estimated resident population of 3 260 691 people aged 30 and older, equivalent to 43.9% of the national population in that age group. Clinical pathways, tools for patient follow-up and medication estimation were developed, and 624 health workers were trained through a train-the-trainer program. Between 2022 and 2025, morbidity records for hypertension, type 2 diabetes mellitus, and both conditions combined in low- and medium-complexity healthcare facilities rose from 232 932 to 318 099 people, reflecting an increase in the care burden recorded in the public health system. The Guatemalan experience documents the first steps toward a more organized and standardized primary care response to chronic noncommunicable diseases, with an emphasis on timely diagnosis, clinical follow-up, and management of hypertension and type 2 diabetes mellitus, to help prevent complications and reduce avoidable premature mortality.</p>","PeriodicalId":21264,"journal":{"name":"Revista Panamericana De Salud Publica-pan American Journal of Public Health","volume":"50 ","pages":"e93"},"PeriodicalIF":1.7,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13599986/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149040473","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[The HEARTS initiative: Experience with community cardiovascular health champions in a municipality in ChileIniciativa HEARTS: experiência com promotores comunitários de saúde cardiovascular em um município chileno].","authors":"Catherine Vega Gual, Gina Brun Mautino, Dorka Norambuena Perea, Romane Véliz Lobos, Ximena Zapata Neculhueque, Elizabeth Flores González, Carolina Neira Ojeda, Marcela Rivera Medina","doi":"10.26633/RPSP.2026.86","DOIUrl":"10.26633/RPSP.2026.86","url":null,"abstract":"<p><strong>Objective: </strong>To describe an experience with community health champions in the prevention of cardiovascular diseases within the framework of the HEARTS initiative, taking into account territorial characteristics.</p><p><strong>Methods: </strong>Convergent mixed-methods study with a census-style quantitative component, which included 56 community cardiovascular health champions from urban and rural areas, and a qualitative component with a phenomenological approach and theoretical and purposive sampling of 13 participants. The results were integrated through data triangulation, comparison with the literature, and feedback from participants.</p><p><strong>Results: </strong>The findings revealed a workforce with a clear predominance of women (92.9%) and an average age of 57.7 years. A total of 973 blood pressure checks, 447 records, and 34 referrals to health centers were performed, highlighting the role of these workers in the early detection of cardiovascular diseases. Rural health champions reported greater confidence in their performance (94.5%) than their urban counterparts, which was associated with social capital and territorial trust. There was no statistically significant association between the variables. The qualitative analysis yielded seven categories, grouped into two central themes: \"Significance of the role of cardiovascular health champion\" and \"Social practices and cultural contexts\". The champions' motivation stems from personal and family experiences, as well as a strong calling to serve. They act as mediators, reduce geographic and cultural barriers, and address issues such as the digital divide, the limited systematization of records, and community resistance to changing habits.</p><p><strong>Conclusions: </strong>Community health champions play a strategic role in the early detection of cardiovascular diseases and in fostering treatment adherence, in particular in rural settings. The sustainability of HEARTS requires strengthened coordination with the health system, ongoing training, and gender equity.</p>","PeriodicalId":21264,"journal":{"name":"Revista Panamericana De Salud Publica-pan American Journal of Public Health","volume":"50 ","pages":"e86"},"PeriodicalIF":1.7,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13587969/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149008954","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Healthcare providers' perceptions of the HEARTS Clinical Pathway in Belize: barriers and facilitators.","authors":"Myra C Fernandez, Marvin Arthurs, Vyktor Smith, Stephanie Castillo, Aldo Sosa, Viola Tuyud, Javier Novelo, Edgar Nah, Russell Manzanero, Marlon Herrera, Corine J Lambey, Elaine Campos, Julius McLaughlin, Jenny Martinez, Florencio Tun, Cardinal Lopez","doi":"10.26633/RPSP.2026.90","DOIUrl":"10.26633/RPSP.2026.90","url":null,"abstract":"<p><strong>Objective: </strong>To estimate the proportion of healthcare providers who perceived the HEARTS Clinical Pathway as easy to apply in routine practice and identify perceived barriers and facilitators influencing its use.</p><p><strong>Methods: </strong>A cross-sectional analytical study was conducted among HEARTS-trained healthcare providers in public primary health care facilities across Belize between 29 September and 3 October 2025. A structured questionnaire assessed training, leadership, resources, and pathway applicability. Quantitative data were analyzed descriptively and through exploratory logistic regression, while qualitative responses underwent thematic analysis.</p><p><strong>Results: </strong>A total of 227 healthcare providers from 22 public primary health care facilities participated. Overall, 23.8% (95% CI [18.7, 29.7]) perceived the HEARTS Clinical Pathway as easy to apply in routine practice. Leadership support (aOR = 6.47, <i>p</i> < 0.001) and resource availability (aOR = 2.93, <i>p</i> = 0.002) were independently associated with greater perceived pathway applicability. Commonly reported barriers included medication stock-outs, limited consultation time, and workflow complexity, while leadership engagement, teamwork, standardized protocols, and refresher training were identified as facilitators.</p><p><strong>Conclusions: </strong>Perceived applicability of the HEARTS Clinical Pathway was limited despite positive perceptions of training. Leadership support and resource availability were more strongly associated with pathway applicability than training alone. Strengthening governance, essential resources, and multidisciplinary support may facilitate broader adoption of HEARTS in Belize. Findings reflect implementation readiness rather than implementation fidelity or program effectiveness.</p>","PeriodicalId":21264,"journal":{"name":"Revista Panamericana De Salud Publica-pan American Journal of Public Health","volume":"50 ","pages":"e90"},"PeriodicalIF":1.7,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13584973/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148991190","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Strengthening awareness and preparedness of human dermatophilosis surveillance in the Region of the Americas.","authors":"","doi":"10.26633/RPSP.2026.83","DOIUrl":"10.26633/RPSP.2026.83","url":null,"abstract":"","PeriodicalId":21264,"journal":{"name":"Revista Panamericana De Salud Publica-pan American Journal of Public Health","volume":"50 ","pages":"e83"},"PeriodicalIF":1.7,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13584975/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148991256","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mejorar el funcionamiento de la atención primaria de salud: HEARTS 2.0 ofrece una gran oportunidad para integrar la atención cardiovascular, renal y metabólica.","authors":"Pedro Ordúñez, Jarbas Barbosa da Silva","doi":"10.26633/RPSP.2026.99","DOIUrl":"10.26633/RPSP.2026.99","url":null,"abstract":"","PeriodicalId":21264,"journal":{"name":"Revista Panamericana De Salud Publica-pan American Journal of Public Health","volume":"50 ","pages":"e99"},"PeriodicalIF":1.7,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13584974/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148991170","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[HEARTS best practices in the Dominican RepublicBoas práticas da iniciativa HEARTS na República Dominicana].","authors":"Víctor Atallah, Andelys de la Rosa, Viery Franco, Vhania Batista","doi":"10.26633/RPSP.2026.81","DOIUrl":"10.26633/RPSP.2026.81","url":null,"abstract":"<p><p>The HEARTS initiative in the Americas is a key strategy for strengthening primary health care and improving the management of high blood pressure, the leading risk factor for cardiovascular disease. In the Dominican Republic, its implementation has evolved toward an institutionalized model focused on quality, governance, and access to medications.The objective of this paper is to describe the implementation and main outcomes of HEARTS in the country as of 2025. A descriptive study was conducted based on secondary data from the national systems used to monitor the HEARTS initiative, including administrative records, national reports, the District Health Information System (DHIS2), SCORECARD, the maturity and performance index, and the HEARTS HEATMAP, covering the period 2019-2025.The strategy achieved an implementation coverage of 87.7% among primary care centers (1214 of 1384), with more than 315 000 individuals being followed up. Blood pressure control among patients treated according to HEARTS protocols exceeded 80%, while clinical follow-up and timely initiation of treatment reached 100%. Overall, 77.8% of primary care centers were classified at the intermediate levels of maturity, and the system achieved a score of 2.5/4 on the HEARTS HEATMAP.These results demonstrate progress in institutionalizing the strategy and strengthening primary care, although gaps in population coverage and community-based follow-up persist.</p>","PeriodicalId":21264,"journal":{"name":"Revista Panamericana De Salud Publica-pan American Journal of Public Health","volume":"50 ","pages":"e81"},"PeriodicalIF":1.7,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13584971/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148991247","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"2025 AHA/ACC blood pressure guideline and HEARTS 2.0: implications for the future evolution of integrated cardiovascular-kidney-metabolic care in the Americas.","authors":"Donald J DiPette, Sean J Battle, Andres Rosende, Jeffrey Brettler, Marc G Jaffe, Paul K Whelton, Pedro Ordunez","doi":"10.26633/RPSP.2026.85","DOIUrl":"10.26633/RPSP.2026.85","url":null,"abstract":"<p><p>Hypertension is the leading modifiable risk factor for cardiovascular disease. In 2025, two major evidence-based frameworks evolved in parallel: HEARTS 2.0, an implementation-oriented clinical pathway for integrated cardiovascular-kidney-metabolic (CKM) care through primary health care, and the updated American Heart Association/American College of Cardiology Blood Pressure Guideline, one of the world's leading hypertension guidelines. Although developed for different intended applications, both drew on a common and rapidly expanding evidence base, making it timely to examine their areas of convergence and divergence. Using the four operational domains of the HEARTS 2.0 Clinical Pathway, this article compares both approaches and examines their implications for the future evolution of integrated CKM care in the Americas. The analysis demonstrates substantial concordance across all domains, including accurate blood pressure measurement, risk-based care, simplified treatment protocols with early use of single-pill combinations, rapid treatment intensification, team-based care, and comprehensive CKM risk reduction. The few remaining differences should not be viewed as contradictions but as opportunities for future refinement. They primarily concern the diagnostic threshold for hypertension, the application of blood pressure targets below 130/80 mmHg, and emerging cardiometabolic therapies. These areas reflect ongoing debates and evolving evidence that may inform future updates of HEARTS 2.0, with adoption varying across countries according to context, feasibility, affordability, and implementation capacity. Overall, this comparison reinforces the scientific foundations of both frameworks and supports their interpretation as complementary and mutually reinforcing approaches for advancing the implementation of scalable, integrated CKM care in the Americas.</p>","PeriodicalId":21264,"journal":{"name":"Revista Panamericana De Salud Publica-pan American Journal of Public Health","volume":"50 ","pages":"e85"},"PeriodicalIF":1.7,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13584972/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148991162","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Making primary health care work better: the HEARTS 2.0 opportunity to integrate cardiovascular-kidney-metabolic care.","authors":"Pedro Ordunez, Jarbas Barbosa da Silva","doi":"10.26633/RPSP.2026.91","DOIUrl":"10.26633/RPSP.2026.91","url":null,"abstract":"","PeriodicalId":21264,"journal":{"name":"Revista Panamericana De Salud Publica-pan American Journal of Public Health","volume":"50 ","pages":"e91"},"PeriodicalIF":1.7,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13564480/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148956443","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}