Saving Lives: The HEARTS Initiative in Saint Lucia

CHICAGO, Illinois — Saint Lucia is an island nation in the Eastern Caribbean. Home to a population of 180,000 Saint Lucians, the island is considered an upper middle-income economy, though it is still referred to as a developing nation.

While Saint Lucia is on track to become one of the most developed countries in the Eastern Caribbean Currency Union (ECCU), it was still host to a poverty rate of 25% in 2016, higher than the average poverty rate of 23% for the Eastern Caribbean.

Saint Lucia has also suffered from a high rate of cardiovascular diseases which have been the main causes of death in the country for a decade. Almost a third of all deaths in Saint Lucia were the result of cardiovascular diseases in 2017.

On October 24, 2019, to address this startling statistic Saint Lucia launched the Global HEARTS Initiative (GHI) in association with PAHO, becoming the first country in the Organization of Eastern Caribbean States (OECS) to do so.

Background

The Global HEARTS Initiative is a joint effort between the WHO and the US CDC, among other organizations, to help countries manage the current levels of cardiovascular diseases present in their health care systems, as well as lower the rate of these diseases in the future.

Created on September 15, 2016, the GHI includes five technical packages that governments can implement with the initiative’s assistance, each of which targets a different issue surrounding the treatment and prevention of cardiovascular diseases. These packages include the MPOWER package which focuses on tobacco control, the ACTIVE package to increase exercise and physical activity, the SHAKE package to reduce salt intake, the REPLACE package to eradicate industrially-made trans fat from the world’s food supply and the HEARTS package to improve cardiovascular disease management in primary health care.

The Department of Noncommunicable Diseases and Mental Health of PAHO is providing logistical support for these efforts which cover almost 30 million people in the region. The goal of this HEARTS initiative is to become the model for cardiovascular disease risk management in the region, including diseases like diabetes and hypertension, by 2025. In order to achieve this goal, the initiative stands on 6 major pillars: standardization of treatment protocols and medication, blood pressure management, training and education, standardization of data and innovation in data use, implementation research, program evaluation and innovation in the organization of care and team-based care.

One of HEARTS in the Americas most interesting strategies in promoting heart health was the creation of a free mobile app that allows practitioners to easily determine the cardiovascular risk level of patients. By inputting information about their patients into the app, health care workers can use the resulting calculations of risk to quickly provide patients with health advice in response to their likelihood of developing cardiovascular disease.

Saint Lucia’s Efforts

Initially, Saint Lucia’s Department of Health and Wellness planned for the HEARTS initiative to take place in six wellness centers throughout the island. After completing pre-implementation data collection and holding capacity-building meetings with stakeholders, the country was interrupted in the process of carrying out the initiative by its first COVID-19 infection on March 13, 2020. By August 2020 of that year, however, the government planned to start renewed capacity-building sessions for all health care workers, revealing a strong commitment to the HEARTS Initiative in Saint Lucia.

During the pandemic, health care strategies turned towards self-management, leading to the growth of the Healthy-Living Counseling Module and its emphasis on the risk management of noncommunicable diseases like cardiovascular diseases. Saint Lucian health care workers received tent calendars, which are basic job aids, on July 31, 2020. These job aids, which were made by Saint Lucia’s Ministry of Health alongside PAHO, are meant to strengthen techniques in the Health-Living Counseling Module and were not only present in all health care facilities in the country but were used during home visits and outreach activities.

The first HEARTS initiative workshop in the Caribbean was also held this May in Saint Lucia, attended by regional Ministry of Health representatives and health managers.

Made up of 17 Caribbean countries and attended by over 55 participants, the workshop, “Improving CVD Clinical Management and NCD Surveillance in the Context of COVID-19 through HEARTS Implementation: Lessons Learned and Plan for Scale Up,” was a week-long event with an agenda that targeted cardiovascular risk management training for health care workers in Saint Lucia, the improvement of clinical management by implementing the HEARTS initiative and the development of an upgraded framework for monitoring and evaluating noncommunicable diseases.

This agenda is intended to refine knowledge and demonstration of cardiovascular risk management, share best practices for implementing the HEARTS initiative and create a plan for the application of hypertension control methods as well as a monitoring framework for noncommunicable diseases that is tailored to each country. Saint Lucia was also one of several countries at the workshop that had already outlined its Hypertension Clinical Pathway, a tool that is part of the HEARTS initiative that is meant to enhance and standardize hypertension and cardiovascular risk management.

Looking Ahead

High rates of morbidity and mortality due to cardiovascular diseases have long impacted Saint Lucia, with rates failing to meaningfully decrease for decades. With the end of the COVID-19 pandemic allowing health care systems in all countries to focus on diseases that were unfortunately but unavoidably pushed to the side during the past few years, it will be possible to fully implement the HEARTS initiative in Saint Lucia and provide patients with an enhanced standard of care. The nation’s health care system will also be able to utilize any lessons it learned from the pandemic in order to better implement the HEARTS initiative in Saint Lucia and avoid possible obstacles in its administration.

– Sofia Oliver
Photo: Wikimedia Commons