Improving hypertension control in Venezuela during the humanitarian crisis using the HEARTS package. the venezuela hypertension project

Background The WHO recommends the HEARTS package to improve the control of primary care hypertension (HTN). However, despite a decade-long humanitarian crisis, the implementation of the HEARTS package in Venezuela remains unexplored. This study evaluates the implementation process and impact on HTN control of the HEARTS package in Venezuela. Methods A before-and-after study was conducted in a Venezuelan community. Community health workers performed home-based blood pressure (BP) registries, while trained physicians conducted risk assessments, counseling, and treatment using an adapted guideline. Implementation outcomes were assessed using Proctor’s framework. The drug selection and dosing were adapted for Venezuela, prioritizing drug selection based on availability and cost. To limit the potential selection bias due to differential loss to follow-up, we used inverse probability of censoring weighting (IPCW) by estimating the probability of completing the intervention conditional on a set of priori-selected baseline variables. We estimated the odds of achieving BP control using a logistic regression model weighted by the estimated IPCWs. Results Of the 570 screened adults, 345 met the inclusion criteria, and 294 attended medical evaluations (69% women, mean age 65.1 years). Fidelity: The original plan of conducting a home-based registry faced challenges, as many residents were unwilling to allow CHWs into their homes, even when accompanied by community leaders. The primary reason cited for this reluctance was the high level of insecurity. Feasibility: After 12 months, the mean ± SD weeks of follow-up were 33.4 ± 19.0. In total, 153 participants completed the intervention as intended, resulting in a dropout rate of 47.9% (141 out of 294 participants). The most common reasons were lack of desire to attend (30.5%), migrating (28.3%), and lack of time to attend (16.3%). Acceptance and Appropriateness: Most participants deemed it acceptable and appropriate. Barriers: The primary obstacles to HTN control identified for both sexes were the lack of medical appointments, limited access to medications, and insufficient financial resources. BP Control: HTN control rates increased by 28.7% in men (from 52.7% to 81.4%) and 13.5% in women (from 75.4% to 88.9%) (Figure). Women were twice as likely as men to achieve BP control, while individuals with type 2 diabetes, high cardiovascular risk, or no baseline antihypertensive use had lower control rates. Conclusions The HEARTS package demonstrated feasibility and effectiveness in improving HTN control in Venezuela, even under challenging conditions. Despite high dropout rates, the intervention significantly enhanced HTN control, highlighting its potential as a viable strategy in resource-limited and crisis-affected settings.