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Global Hearts Initiative

Supporting Implementation of Programs to Reduce Cardiovascular Disease


The Global Hearts Initiative, implemented by the World Health Organization and the U.S. Centers for Disease Control and Prevention (CDC), with other partners, is working to reduce heart attacks and strokes by scaling up a standardized set of disease management and risk reduction interventions at the primary care level.


Supporting the Global Hearts Initiative, RTI and partners developed an Excel-based costing tool that helps health districts to anticipate the costs of implementing the HEARTS intervention package. RTI and partners provide technical assistance on rolling out the costing tool, collect country costs for cardiovascular disease management, and help with data analysis and alternative case scenarios.


RTI has helped to build the evidence base for the cost-effectiveness of interventions and treatment approaches for hypertension control and cardiovascular disease prevention. RTI is also developing the capacity of local health professionals to conduct economic analyses to inform service planning and implementation.

Cardiovascular Disease is the Leading Cause of Death Worldwide

Cardiovascular disease (CVD), which includes conditions such as heart attacks, stroke, and heart failure, is the leading cause of death worldwide, causing about three out of every 10 deaths. Over 15 million CVD-attributable deaths occur in low- and middle-income countries (LMICs) each year, 38 percent of which are considered premature, meaning they occur in individuals under age 70.

The good news is that many of these premature deaths are preventable by tackling the main behavioral (e.g. tobacco use, unhealthy eating habits, physical inactivity) and metabolic (e.g. hypertension, hyperlipidemia) risk factors that increase CVD risk.

But how can governments—with constrained budgets and difficult decisions on where to allocate money to—tackle this leading health problem and effectively implement risk reduction strategies? The Global Hearts Initiative (GHI), launched in 2016 by the World Health Organization and the U.S. Centers for Disease Control and Prevention (CDC), is supporting governments around the world to scale up CVD prevention and control efforts through five technical packages, including the HEARTS technical package for improving CVD management in primary care.

As countries seek to implement and scale the HEARTS package, RTI is working with the CDC to assist local stakeholders to plan and budget for the HEARTS interventions through the creation of a tool to help estimate the cost of implementing CVD prevention and management.

Building a User-Friendly Cardiovascular Disease Costing Tool

To support the implementation of the HEARTS technical package, RTI and partners developed a user-friendly costing tool to help health districts estimate the costs of implementing the program. The HEARTS costing tool is designed to allow users to enter local risk factor prevalence, information on the health workforce, and cost and other data. This design assists in-country collaborators in conducting cost studies and economic evaluations of programs in their local area. We have developed both retrospective and prospective versions of the tool. These different perspectives allow districts to assess the costs of implementation after completion, or to plan for the resources necessary to implement services in the future.

Thus far, RTI has supported use of the tool in four countries—Chile, Colombia, Thailand, Mexico—that participate in the Global Hearts Initiative. This includes conducting trainings and workshops for local health professionals, such as doctors, nurses, and health economists. Recently, in workshops in Mexico and Colombia, we led participants through a hands-on costing exercise with the Excel-based tool. Attendees shared data on two important cost parameters—human resource time and medications—providing cost insights that are generally unavailable from public online databases. Participants leveraged their data inputs and the tool to assess the costs of implementing and operating the HEARTS package, and the quantity of time required from health and non-health personnel to carry out HEARTS protocols. The costing tool and associated user resources are available for download from the TEPHINET website.

Building the Evidence-Base: Assessing the Costs and Benefits of Treatment for Hypertension

In addition to the HEARTS costing tool, RTI is working to expand the evidence base for evaluating the costs and benefits of controlling hypertension.

RTI published a systematic review of the costs and cost-effectiveness of hypertension management in LMICs, identifying evidence gaps and implications for future hypertension treatment programs.  Evidence suggests that hypertension control is cost effective for many LMICs. However, further research is needed to understand the effect of task-shifting, risk-based treatment, and standardizing treatment protocols on the cost-effectiveness of hypertension control programs in LMICs.

RTI has also conducted economic modeling to contribute evidence to these research gaps. We have modeled the costs and benefits of treating hypertension at different severity thresholds, lending insight into the conditions under which hypertension can be cost-effectively treated at scale in LMICs.

Addressing the global and rising burden of cardiovascular disease will require high quality evidence on the most cost-effective treatment and prevention approaches. Clear and straightforward guidance about treatment protocols and health system resources can help countries make informed decisions.

This project was supported by Grant or Cooperative Agreement number NU2GGH001873 funded by the Centers for Disease Control and Prevention. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention, the Department of Health and Human Services, The Task Force for Global Health, Inc. or TEPHINET.