Adoption, implementation, and evaluation of the HEARTS initiative on blood pressure outcomes: a quality improvement project in a large healthcare system in the United States.

Abstract

The HEARTS Initiative, based on the World Health Organization Global HEARTS Initiative and the Pan American Health Organization HEARTS in the Americas program, has been used globally to improve cardiovascular health. Given a literature dearth on its implementation in the United States, this study evaluated the impact of a HEARTS-derived quality improvement program on achieving at-target, follow-up blood pressure (BP) among patients with elevated BP (EBP). Electronic health record data from 191,418 adult patients with EBP (i.e. ≥140 mmHg systolic and/or ≥90 mmHg diastolic) visiting an eligible primary care center between 2021 and 2024 was utilized. HEARTS-based initiatives were gradually introduced systemwide. Patients whose first EBP encounter during the study period occurred in 2021 and 2024 comprised the pre-intervention and post-intervention cohorts, respectively. At-target follow-up BP was defined as a follow-up BP reading of <140 mmHg systolic and <90 mmHg diastolic taken within 6 months of index EBP. Descriptive statistics, bivariate analyses, and generalized linear mixed-effects models were conducted. This system's HEARTS Maturity Index score improved from 2 to 11. Patients were predominately female (108,407; 56.6%), 65+ years old (74,054; 38.7%), and White (130,507; 69.1%). After adjusting for site-level clustering and key predictors, the post-intervention cohort had higher odds of achieving at-target BP within 6 months of index EBP, compared to the pre-intervention cohort (adjusted odds ratio = 1.14; 95% confidence interval = 1.11-1.18). Successful integration of HEARTS serves as a salient opportunity for further research and efforts to tailor and disseminate these initiatives in the United States. None.