Improving cardiovascular care in a resource-limited setting through the HEARTS initiative in Suriname, 2022 to 2025

Objective. To evaluate early implementation of the HEARTS initiative in Suriname (2022-2025), identify key barriers and facilitators, and assess initial program performance. Methods. A mixed-methods implementation evaluation was conducted using the Consolidated Framework for Implementation Research (CFIR) and the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework (RE-AIM). Qualitative data were collected through structured monitoring, training and workshop feedback, and stakeholder consultations from December 2021 to December 2025, and analyzed deductively using predefined CFIR constructs. Quantitative indicators were assessed across RE-AIM domains, including reach, adoption, implementation fidelity, and early maintenance. Results. HEARTS was implemented in 56 primary health care facilities, involving 460 health care workers and 11 187 patients. Scale-up was rapid, with facilities increasing from 21 to 56 over six semesters. Among patients with follow-up measurements, blood pressure control improved from 47.0% to 56.2%. However, only 52.6% had at least one follow-up visit, indicating suboptimal continuity of care. Key facilitators included strong political commitment, standardized treatment protocols, and a real-time digital monitoring system. Major barriers were limited workforce capacity, infrastructure variability, and financial constraints affecting access to essential medications and equipment. Conclusions. Early HEARTS implementation in Suriname shows that rapid scale-up of standardized cardiovascular care is feasible in a mixed public-private system. Strengthening follow-up, workforce capacity, and sustainable financing are essential to achieve long-term effectiveness and population-level impact.