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Canadian Journal of Cardiology

WHO HEARTS: A Global Program to Reduce Cardiovascular Disease Burden: Experience Implementing in the Americas and Opportunities in Canada

Published:December 10, 2020DOI:https://doi.org/10.1016/j.cjca.2020.12.004

      Abstract

      Globally, cardiovascular diseases (CVDs) are the leading cause of death. Viewed as a threat to the global economy, the United Nations included reducing noncommunicable diseases, including CVDs, in the 2030 sustainable development goals, and the World Health Assembly agreed to a target to reduce noncommunicable diseases 25% by the year 2025. In response, the World Health Organisation led the development of HEARTS, a technical package to guide governments in strengthening primary care to reduce CVDs. HEARTS recommends a public health and health system approach to introduce highly simplified interventions done systematically at a primary health care level and has a focus on hypertension as a clinical entry point. The HEARTS modules include healthy lifestyle counselling, evidence-based treatment protocols, access to essential medicines and technology, CVD risk-based management, team-based care, systems for monitoring, and an implementation guide. There are early positive global experiences in implementing HEARTS. Led by the Pan American Health Organisation, many national governments in the Americas are adopting HEARTS and have shown early success. Unfortunately, in Canada hypertension control is declining in women since 2010-2011 and the dramatic reductions in rates of CVD seen before 2010 have flattened when age adjusted and increased for rates that are not age adjusted, and there are marked increases in absolute numbers of Canadians with adverse CVD outcomes. Several steps that Canada could take to enhance hypertension control are outlined, the core of which is to implement a strong governmental nongovernmental collaborative strategy to prevent and control CVDs, focusing on HEARTS.

      Résumé

      Principale cause de décès dans le monde, les maladies cardiovasculaires (MCV) sont considérées comme une menace pour l’économie mondiale; l’Organisation des Nations Unies a inclus la réduction des maladies non transmissibles, y compris les MCV, dans ses objectifs de développement durable à atteindre d’ici 2030, et l’Assemblée mondiale de la Santé a adopté une cible de réduction de 25 % des maladies non transmissibles d’ici 2025. Ces décisions ont incité l'Organisation mondiale de la Santé à mettre au point le guide technique HEARTS, qui vise à aider les gouvernements à améliorer les soins primaires afin de réduire les MCV. Le guide technique HEARTS recommande l’adoption d’une approche de santé publique et de systèmes de santé axés sur la mise en place d’interventions hautement simplifiées en contexte de soins de santé primaires, et désigne l’hypertension comme un point d’entrée clinique. Les modules du guide HEARTS portent notamment sur les services de counseling relatifs à l’adoption d’un mode de vie sain, la mise en œuvre de protocoles thérapeutiques reposant sur des données factuelles, l’accès aux médicaments essentiels et aux technologies de santé de base, la prise en charge des risques de MCV, et le recours à des équipes de soins et la mise en place de systèmes de suivi; ils comprennent également un guide de mise en œuvre. Les premiers résultats de la mise en œuvre du guide HEARTS sont positifs. Sous la direction de l’Organisation panaméricaine de la Santé, bon nombre d’administrations publiques nationales du continent américain ont adopté le guide HEARTS et en constatent déjà les avantages. Malheureusement, la maîtrise de l’hypertension chez les femmes a diminué au Canada depuis 2010-2011. En effet, les réductions spectaculaires des taux de MCV observés avant 2010 atteignent un plateau lorsqu’ils sont corrigés pour tenir compte de l’âge, et augmentent si on ne tient pas compte de l’âge. On note aussi des hausses marquées du nombre absolu de Canadiens chez qui les issues des MCV sont défavorables. Nous présentons plusieurs mesures que le Canada pourrait prendre pour améliorer la maîtrise de l’hypertension, la principale étant d’adopter une solide stratégie de collaboration entre organismes gouvernementaux et non gouvernementaux axée sur le guide HEARTS afin de prévenir et de maîtriser les MCV.
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