HEARTS Technical Package for Cardiovascular Disease Management in Primary Health Care: Evidence-Based Treatment Protocols. Geneva: World Health Organization; 2018
(2018; 43 pages) [French] [Russian]


More people die each year from cardiovascular diseases (CVDs) than from any other cause. Over three-quarters of heart disease and stroke-related deaths occur in low- and middle-income countries.

The HEARTS technical package provides a strategic approach to improving cardiovascular health. It comprises six modules and an implementation guide. This package supports Ministries of Health to strengthen CVD management in primary care and aligns with WHO’s Package of Essential Noncommunicable Disease Interventions (WHO PEN).

HEARTS modules are intended for use by policymakers and programme managers at different levels within Ministries of Health who can influence CVD primary care delivery. Different sections of each module are aimed at different levels of the health system and different cadres of workers. All modules will require adaptation at country level.

In many low- and middle-income countries, there is a wide gap between evidence-based recommendations and current practice. Treatment of major CVD risk factors remains suboptimal, and only a minority of patients who are treated reach their target levels for blood pressure, blood sugar and blood cholesterol.

In other areas, overtreatment can occur with the use of non-evidence-based protocols. The aim of using standard treatment protocols is to improve the quality of clinical care, reduce clinical variability and simplify the treatment options, particularly in primary health care. Standard treatment protocols can be developed by preparing new national treatment guidelines or by adapting or adopting international guidelines.

The Evidence-based protocols module uses hypertension and diabetes screening and treatment as an entry point to control cardiovascular risk factors, prevent target organ damage, and reduce premature morbidity and mortality. A comprehensive risk- based approach for integrated management of hypertension, diabetes, and high cholesterol is included in the Risk-based CVD management module.

This module includes clinical practice points and sample protocols for:

1. hypertension detection and treatment

2. type 2 diabetes detection and treatment

3. identifying basic emergencies – care and referral.

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