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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Article info
Publication history
Published online: December 10, 2020
Accepted:
December 4,
2020
Received:
October 6,
2020
Footnotes
See page 753 for disclosure information.
Identification
Copyright
© 2020 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
