S-21-1: IMPLEMENTING HEARTS HYPERTENSION CONTROL PROJECT IN CHINA

Abstract

Hypertension is the leading cause of death and disability worldwide, due to its high prevalence and severe complications (stroke, heart attack, etc). Control of hypertension could prevent most unnecessary outcomes. However, detecting hundreds of millions of hypertensive patients globally and controlling BP to target for the rest of their lives could be a huge burden to all health care systems. The HEARTS technical package developed by WHO provides tools for governments and professional organizations to support primary care services (PCS) to apply evidence-based strategies to control and prevent cardiovascular diseases. The HEARTS China hypertension control project was initiated in 2017. It is owned by governments, technically supported by a hypertension specialist committee and managed by the secretariat. The standard protocol with screening for all adult visitors, and stepwise treatment with calcium channel blockers + ARB + thiazide-like diuretic was selected by the advisory committee. The supply of selected medications was supported by governments. The HEARTS monitoring system, with ID card-driven automatic BP measurement and data transfer to the doctors web page (no data entry), records screening, registration and prescriptions during daily practice. The information helps physicians with decision making in diagnosis and treatment and provides regular quality and progress reports to PSCs and health authorities. Up to December 2021, a cumulative total of 894 PSCs participated in the project. They screened more than 620,000 adults, registered over 268,000 and treated 190,000 hypertensive patients. A total of 86,523 patients achieved the goal of BP control at their last visit. The awareness, treatment and control rates improved continuously in the project-involved areas. Consequently, the episodes of hospitalization for cardiovascular disease among all-cause hospitalizations reduced by 13%. It reduced more in the service areas that screened and treated more hypertensive patients, than in those that screened and treated fewer patients (-15% vs -6%). However, the data recorded in the monitoring system indicated serious clinical inertia in the implementation of the HEARTS protocol: screening does not yet involve all visitors; nearly 30% of diagnosed patients were untreated, 70% of treated patients were not regularly followed-up; only 19% of patients with BP> = 160/100 initiated treatment with combined medications; 64% of revisited patients with uncontrolled BP failed to intensify treatment. More training courses and incentive mechanisms may help PSCs to improve the quality of care. Implementing HEARTS has improved quality and coverage for hypertension control. Overcoming clinical inertia should be able to accelerate this progress.