{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T09:40:41Z","timestamp":1792402841863,"version":"4.4.0"},"reference-count":18,"publisher":"Pan American Health Organization","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,10,19]]},"abstract":"<title>ABSTRACT<\/title>\n                  <sec>\n                    <title>Objective.<\/title>\n                    <p>To evaluate early implementation of the HEARTS initiative in Suriname (2022-2025), identify key barriers and facilitators, and assess initial program performance.<\/p>\n                  <\/sec>\n                  <sec>\n                    <title>Methods.<\/title>\n                    <p>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.<\/p>\n                  <\/sec>\n                  <sec>\n                    <title>Results.<\/title>\n                    <p>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.<\/p>\n                  <\/sec>\n                  <sec>\n                    <title>Conclusions.<\/title>\n                    <p>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.<\/p>\n                  <\/sec>","DOI":"10.26633\/rpsp.2026.88","type":"journal-article","created":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T08:51:41Z","timestamp":1792399901000},"page":"1","source":"Crossref","is-referenced-by-count":0,"title":["Improving cardiovascular care in a resource-limited setting through the HEARTS initiative in Suriname, 2022 to 2025"],"prefix":"10.26633","volume":"50","author":[{"given":"Ritesh","family":"Dhanpat","sequence":"first","affiliation":[{"name":"Faculty of Medical Science, Anton de Kom University of Suriname, Paramaribo, Suriname."},{"name":"dhanpatritesh@gmail.com"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robbert","family":"Bipat","sequence":"additional","affiliation":[{"name":"Faculty of Medical Science, Anton de Kom University of Suriname, Paramaribo, Suriname."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aloysius","family":"Koendjbiharie","sequence":"additional","affiliation":[{"name":"Regional Health Service, Paramaribo, Suriname"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rakesh","family":"Gajadhar Sukul","sequence":"additional","affiliation":[{"name":"Ministry of Health, Wellness, and Labor, Paramaribo, Suriname"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marina","family":"Bersaoui","sequence":"additional","affiliation":[{"name":"Faculty of Medical Science, Anton de Kom University of Suriname, Paramaribo, Suriname."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johanna","family":"Lakhisaran","sequence":"additional","affiliation":[{"name":"Ministry of Health, Wellness, and Labor, Paramaribo, Suriname"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jerry","family":"Toelsie","sequence":"additional","affiliation":[{"name":"Faculty of Medical Science, Anton de Kom University of Suriname, Paramaribo, Suriname."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"11167","reference":[{"key":"ref1","unstructured":"World Health Organization. Global Health Estimates 2021: disease burden by cause, age, sex, by country and by region, 2000-2021. Geneva; 2024. [Accessed 28 April 2026]. Available from https:\/\/www.who.int\/data\/gho\/data\/themes\/mortality-and-global-health-estimates\/global-health-estimates-leading-causes-of-dalys"},{"key":"ref2","unstructured":"World Health Organization, Pan American Health Organization. HEARTS in the Americas. 2024. [Accessed 23 August 2026]. Available from https:\/\/www.paho.org\/en\/hearts-americas"},{"key":"ref3","doi-asserted-by":"crossref","unstructured":"Gonz\u00e1lez YV, Giraldoni AM, Perea LP, Chiquet AJ, L\u00f3pez Lima C, Campbell N, et al. The HEARTS Initiative in Cuba: experience of five years of implementation. Rev Panam Salud Publica. 2022;46:e176. doi:10.26633\/RPSP.2022.176","DOI":"10.26633\/RPSP.2022.176"},{"key":"ref4","doi-asserted-by":"crossref","unstructured":"Campbell NRC, Padwal R, Tsuyuki RT, Leung AA, Bell A, Kaczorowski J, et al. 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Implementation of the HEARTS initiative in Argentina: initial results. Rev Panam Salud Publica. 2022;46:e181. doi:10.26633\/RPSP.2022.181","DOI":"10.26633\/RPSP.2022.181"},{"key":"ref15","doi-asserted-by":"crossref","unstructured":"Casales-Hern\u00e1ndez MG, Molina-Cuevas V, Gloria-Hern\u00e1ndez LE, D\u00edaz-Aguilera MA, Malo-Serrano HM. Preliminary results of the HEARTS Initiative in Mexico: facilitators and barriers in information systems. Rev Panam Salud Publica. 2022;46:e167. doi:10.26633\/RPSP.2022.167","DOI":"10.26633\/RPSP.2022.167"},{"key":"ref16","doi-asserted-by":"crossref","unstructured":"Chivardi C, Hutchinson B, Molina V, Moreno E, Fajardo I, Giraldo-Arcila GP, et al. Assessing costs of a hypertension program in primary care: evidence from the HEARTS program in Mexico. 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Rev Panam Salud Publica. 2022;46:e128. doi:10.26633\/RPSP.2022.128","DOI":"10.26633\/RPSP.2022.128"}],"container-title":["Revista Panamericana de Salud P\u00fablica"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/iris.paho.org\/bitstreams\/d3afa1f4-63f8-4302-9e46-d9a48a0a5210\/download","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T08:51:48Z","timestamp":1792399908000},"score":1,"resource":{"primary":{"URL":"https:\/\/iris.paho.org\/handle\/10665.2\/72447"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,19]]},"references-count":18,"alternative-id":["RPSP.2026.88"],"URL":"https:\/\/doi.org\/10.26633\/rpsp.2026.88","relation":{},"ISSN":["1020-4989","1680-5348"],"issn-type":[{"value":"1020-4989","type":"print"},{"value":"1680-5348","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,19]]}}}