HEARTS provides a set of locally adaptable tools for strengthening the management of CVD in primary health care. HEARTS is designed to enhance implementation of WHO PEN by providing: • operational guidance on further integrating CVD management • technical guidance on evaluating the impact of CVD care on patient outcomes. For countries not using WHO PEN, CVD management can still be integrated into primary health care. The process of implementing HEARTS will vary, depending on country context, and may require a significant reorienting and strengthening of the health system. At some sites, existing CVD management services may be reoriented toward a risk-based approach, while other sites may adopt a public health approach, strengthening management of particular risk factors such as hypertension. Whether or not introducing CVD management into primary care is a new intervention, successful implementation will require engagement with national and local health planners, managers, service providers, and other stakeholders.