Readiness to deliver integrated cardiovascular, kidney and metabolic care in primary healthcare: phase II of HEARTS 2.0 in 26 countries in the Americas

WHO's Global HEARTS is the largest worldwide effort to improve hypertension control through standardised care. HEARTS in the Americas is its regional adaptation. To address the rising burden of cardiovascular, kidney and metabolic conditions, the initiative launched HEARTS 2.0, aiming to promote integrated care, reduce fragmentation and improve quality, access and health outcomes. In phase I, an expert-led consensus identified 45 evidence-based interventions for inclusion in an expanded Clinical Pathway. This report presents findings from phase II on the readiness of 26 Latin American and Caribbean countries to implement these interventions. We used a cross-sectional design and a structured, self-administered questionnaire completed by national implementation teams. It systematically assessed the availability, feasibility, time required and key barriers for each proposed intervention. While many interventions, especially for risk assessment and non-pharmacological treatments, are considered feasible in many countries, their current availability is limited due to ongoing shortages of diagnostics, medicines and infrastructure. Over the next 3 years, 18 countries are projected to implement >30 of the 45 interventions, four countries aim to implement 20-30 and four expect to implement fewer than 20. While primary health systems in most HEARTS-implementing countries do not yet appear ready to deliver integrated cardiovascular, kidney and metabolic care, the scale-up of HEARTS 2.0 presents a strong opportunity to advance this integration. As health systems worldwide face the challenge of increasing multimorbidity in their patients and fragmented care delivery systems, this assessment offers a practical tool for planning and action.