This technical package provides a strategic approach to improving cardiovascular health in countries. It comprises six modules and an implementation guide. This package supports Ministries of Health to strengthen CVD management in primary health care settings. The practical, step-by step modules are... supported by an overarching technical document that provides a rationale and framework for this integrated approach to the management of NCDs.
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The American Heart Association and the American College of Cardiology are excited to provide a series of cardiovascular prevention guidelines for the assessment of cardiovascular risk, lifestyle modifications that reduce risk, management of elevated blood cholesterol, and management of increased bod...y weight in adults.
To support the implementation of these guidelines, the Pooled Cohort Equations CV Risk Calculator and additional Prevention Guideline Tools are available in the tools below as well as the AHA Guidelines On-the-Go Mobile App, found in the Apple Store and Google Play. Others may be developed and available in the near future.
The purpose of the ASCVD Risk Calculator is to estimate a patient’s 10-year ASCVD risk at an initial visit to establish a reference point. ACC/AHA guidelines recommend the use of the PCE as an important starting point, not as the final arbiter, for decision making in primary prevention of ASCVD.
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Development of cardiovascular disease (CVD) is influenced by risk factors such as:
tobacco use, an unhealthy diet, physical inactivity, obesity (which can result from
a combination of unhealthy diet, physical inactivity, and other factors), elevated
blood pressure (hypertension), abnormal blood l...ipids (dyslipidaemia) and elevated blood glucose (diabetes mellitus). Continuing exposure to these risk factors leads
to further progression of atherosclerosis, resulting in clinical manifestations of these diseases, including angina pectoris, myocardial infarction, heart failure and stroke. Total CVD risk depends on the individual’s overall risk-factor profile.
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N Engl J Med 2019;380:2429-39.DOI: 10.1056/NEJMoa1901113
A Manual for Medical Officer
Developed under the Government of India – WHO Collaborative Programme 2008-2009
Accessed: 11.03.2019
Guide technique pour la prise en charge des maladies cardiovasculaires dans le cadre des soins de santé primaires
Los módulos que conforman el paquete técnico HEARTS están dirigidos a los formuladores de políticas públicas y gerentes, directores o coordinadores de programas a diferentes niveles dentro de los ministerios de salud cuyo trabajo influye sobre la prestación de servicios de salud a nivel prima...rio para la atención de las enfermedades cardiovasculares. Dentro de cada módulo existen secciones dirigidas a actores en niveles específicos de los sistemas de salud, así como a diferentes grupos de profesionales. En ese sentido, todos los módulos requieren ser adaptados al contexto de cada país.
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Los módulos que conforman el paquete técnico HEARTS están dirigidos a los formuladores de políticas públicas y gerentes, directores o coordinadores de programas a diferentes niveles dentro de los ministerios de salud cuyo trabajo influye sobre la prestación de servicios de salud a nivel prima...rio para la atención de las enfermedades cardiovasculares. Dentro de cada módulo existen secciones dirigidas a actores en niveles específicos de los sistemas de salud, así como a diferentes grupos de profesionales. En ese sentido, todos los módulos requieren ser adaptados al contexto de cada país.
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Technical package for cardiovascular disease management in primary health care.
Guide technique pour la prise en charge des maladies cardiovasculaires dans le cadre des soins de santé primaires
Many low-resource settings have a shortage of physicians and health workers. (1) In order to provide patient-centred continuous care more effectively, primary care systems can include team-based care strategies in their clinic workflows and protocols. Team-based care uses multidisciplinary teams (wh...ich may involve new staff, or the shifting of tasks among existing staff). Teams can include patients themselves, primary care physicians, and other allied health professionals, such as nurses, pharmacists, counsellors, social workers, nutritionists, community health workers, or others. Teams reduce the burden on physicians by utilizing the skills of trained health workers. Strong evidence shows that team-based care is effective in improving hypertension control among patients in a cost-effective way. (2) Some amount of task shifting/team-based care is already taking place in many settings; this module provides further guidance on how to maximize this approach for greater impact.
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Los módulos que conforman el paquete técnico HEARTS están dirigidos a los formuladores de políticas públicas y gerentes, directores o coordinadores de programas a diferentes niveles dentro de los ministerios de salud cuyo trabajo influye sobre la prestación de servicios de salud a nivel primar...io para la atención de las enfermedades cardiovasculares. Dentro de cada módulo existen secciones dirigidas a actores en niveles específicos de los sistemas de salud, así como a diferentes grupos de profesionales. En ese sentido, todos los módulos requieren ser adaptados al contexto de cada país.
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Los módulos que conforman el paquete técnico HEARTS están dirigidos a los formuladores de políticas públicas y gerentes, directores o coordinadores de programas a diferentes niveles dentro de los ministerios de salud cuyo trabajo influye sobre la prestación de servicios de salud a nivel primar...io para la atención de las enfermedades cardiovasculares. Dentro de cada módulo existen secciones dirigidas a actores en niveles específicos de los sistemas de salud, así como a diferentes grupos de profesionales. En ese sentido, todos los módulos requieren ser adaptados al contexto de cada país.
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Monitoring is a crucial element in any successful programme. It is important to
know if health care facilities – and ultimately countries – are meeting the agreed
goals and objectives for preventing and managing cardiovascular diseases (CVD).
Monitoring is the on-going collection, management ...and use of information to
assess whether an activity or programme is proceeding according to plan and/
or achieving defined targets. Not all outcomes of interest can be monitored. Clear
outcomes must be identified that relate to the most important changes expected to result from the project and to what is realistic and measurable within the timescale of the project. Once these outcomes have been articulated, indicators can be chosen that best measure whether the desired outcomes are being met.
To allow progress to be monitored, this module provides a set of indicators on
CVD management. Agreeing on a set of indicators allows countries to compare
progress in CVD management and treatment across different districts or
subnational jurisdictions, as well as at a facility level, identify where performance
can be improved, and track trends in implementation over time. Monitoring
these indicators also helps identify problems that may be encountered so that
implementation efforts can be redirected.
This module starts from the collection of data at facility level, which is then
“transferred up” the system: facility-level data are aggregated at subnational level
to produce reports that allow tracking of facility and subnational performance over time and allow for comparison among facilities. National-level data are obtained through population-based surveys.
Implementing a monitoring system requires action at many levels. At national and
subnational levels, staff can determine how best to integrate data elements into
existing data collection systems – such as the routine service-delivery data that are collected through facility-level Health Management Information Systems (HMIS).
In the facility setting, personnel must be aware of what data are needed. Sample
data-collection tools are included, recognizing that countries use different datamanagement systems for HMIS, so the CVD monitoring tools will be adapted to work with the HMIS system being used by the country, such that the indicators can be collected with minimal disruption/work to existing systems and tools
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This Cardiac Rehabilitation Change Package was completed by the Centers for Disease Control and Prevention (CDC) in collaboration with the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) with the purpose of helping cardiac rehabilitation programs, hospital quality improv...ement teams, and public health professionals who partner with these groups to implement systems and strategies that improve care for patients who are eligible for cardiac rehabilitation. AACVPR is a multidisciplinary professional association comprised of health professionals who serve in the field of cardiac and pulmonary rehabilitation.
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Procurement and supply management activities are fundamental to consistent and reliable access to essential medicines and health products. To reduce the impact of CVD, action needs to be taken to improve prevention, diagnosis, care and management of CVD diseases. Affordable essential medicines and t...echnologies to manage CVD disease must be available where and when they are required. Medicines and technologies need to be managed appropriately to ensure that the correct medicines are selected, procured in the right quantities, distributed to facilities in a timely manner, and handled and stored in a way that maintains their quality. This needs to be backed up by policies that enable sufficient quantities to be procured in order to reduce cost inefficiencies, ensure the reliability and security of the distribution system, and encourage the appropriate use of these health products. In order to avoid stock-outs and the disruption of treatment, all related activities need to be conducted in a timely manner, with performance continually monitored, and prompt action taken in response to problems that may arise. Additionally, medication must be dispensed correctly and used rationally by the healthcare provider and patient alike. The purpose of this guide is to explain the necessary steps.
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In many low- and middle-income countries, there is a wide gap between evidencebased 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 choles...terol.
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.
HEARTS emphasizes adaptation, dissemination, and use of a standardized set of
simple clinical-management protocols, which should be drug- and dose-specific,
and include a core set of medications. The simpler the protocols and management tools, the more likely they are to be used correctly, and the higher the likelihood that a programme will achieve its goals.
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