HEARTS Technical Package to be implemented at primary health care level

Guyana continues to collaborate with the Pan-American Health Organisation (PAHO), the World Health Organisation (WHO) and other countries to implement the HEARTS Technical Package which will strengthen the Ministry of Health’s approach to improving cardiovascular at the primary health care level.  

The HEARTS Technical Package provides a set of effective, practical interventions for strengthening the management of risk factors for cardiovascular in primary health care and also aims to prevent cardiovascular disease (heart attacks and strokes) by ensuring reasonable access to continuous, standardized, high-quality care for people at high risk. It is aligned with and builds on the WHO’s package of Essential Non-Communicable Disease Interventions and responds to the agreement that sustainable, effective action is urgently required to prevent cardiovascular diseases, through which millions of lives could be saved.

The Hearts Technical Package comprises of six elements which cover areas of:

  • H-Healthy lifestyle
  • E- Evidence-based treatment protocol
  • A-Access to essential medicine and technology
  • R-Risk-based management
  • T-Team care and-Task Sharing
  • S-System for Monitoring

In 2018, the PAHO/WHO collaborated with the Ministry of Health (MOH) to conduct a workshop for the HEARTS Technical Package. Fifty (50) health care professionals from private and public health across all ten administrative Regions were trained to take on this new approach in health facilities across Guyana. Since this implementation, doctors from the MOH Chronic Disease Unit has participated in webinars and began the process of raising awareness on the HEARTS Technical Package along with involving key stakeholders such as the Georgetown Public Hospital Corporation (GPHC) and local Non-Governmental Organisations (NGOs) through discussions to initiate the implementation of this project countrywide.

Focal Point of High Blood Pressure and the HEARTS Technical Package Initiative, Dr. Michael Pereira, explained that the Chronic Disease Unit has since established a system of collecting data to facilitate an easy transfer of data into the Electronic Medical Record (EMR) as the HEARTS Technical Package is rolled out.

Dr. Michael Pereira

“We have utilised the patients (chronic disease) medical records along with their clinical passport and continuation sheet to keep track of how they have been coping with the disease over the years”, he explained.

He further highlighted that there are already more than 30 health centres and various regional hospitals across the country that are currently utilising these chronic disease medical records, continuation sheets and passports.

The MOH is embracing the HEARTS approach with the implementation of same which will kick-start at seven health facilities: the Lethem Hospital, Port Mourant Health Centre, Anna Regina Health Centre, Campbellville Health Centre, Industry Health Centre Lusignan Health Centre, Eccles Health Centre and Grove Health Centre.

“This package is at a primary health care level which involves physicians and non-physicians and training of these personnel at the selected implementation sites will commence very soon”, Pereira said.

He further added that plans are in place to collaborate with PAHO/WHO to conduct stakeholder meetings with various focal points and training of health-care providers in delivering effective, high-quality behaviour modification interventions, such as smoking cessation and nutrition counselling, using motivational interviewing techniques will improve people’s knowledge about CVDs risk factors and complications, as well as to promote the importance of self-care and adherence.

Dr. Pereira said that all health facilities will be required to adopt strict measures to ensure that the HEARTS approach is carried out in all aspects. This involves Evidence-Based Treatment Protocols, where treatment algorithms have already been created and will soon be standardized since the MOH has been collaborating with experts/consultants from GPHC and Private Hospital, particularly experts in Internal Medicine and Cardiology to help create and standardize these treatment protocols, since the use of these simplified, treatment protocols is important for scaling up CVD management, particularly in primary health care, as they are essential for decentralization of care, the involvement of non-physician health workers and defining a core set of medicines.

Dr. Pereira stated that these protocols will be strategically placed in areas where they can be easily identified and followed by physicians and other health care workers across various communities.

Additionally, Pereira is urging all health care professionals to support the MOH’s efforts to implement the rolling out the HEARTS Technical Package which is also a PAHO/WHO initiative to facilitate effective, practical interventions for strengthening the management of risk factors for CVDs in primary health care, and also aims to prevent cardiovascular disease (heart attacks and strokes) by ensuring reasonable access to continuous, standardized, high-quality care for people at high risk.

Reports from WHO have shown an estimated 17.5 million people in 2012, and if current trends should continue the annual number of deaths from CVD will rise to 22.2 million by 2030. Of these deaths, 80% are due to heart attacks and strokes, and over three quarters occur in low- and middle-income countries where the economic and social burden is highest amongst poor and disadvantaged groups.

The risk factors for CVD are Behavioural Factors, Physiological Factors and Social determinants and Drivers. The Behavioural Factors include tobacco use, an unhealthy diet, harmful use of alcohol and inadequate physical activity. Social determinants and Drivers focus on areas of income, housing, globalisation, aging and urbanisation. Meanwhile, Physiological Factors high blood pressure (hypertension), high blood cholesterol and high blood sugar or glucose which is linked to underlying social determinants and drivers.

Hypertension is a major risk factor and key driver of CVD globally. It is estimated to have caused 9.4 million deaths in 2010 but remains widely undetected, undertreated and poorly controlled. 

There is a significant number of people with prior heart disease or stroke that do not have access to essential medicines such as aspirin, statins, beta-blockers and angiotensin-converting enzyme inhibitors which have proven to be effective to prevent recurrent events and reduce mortality.

The increase in the burden of CVDs in LMICs is driven by both an increased prevalence of risk factors and a relative lack of access to medical care in often under resourced health systems.