Scaling integrated cardiovascular–kidney–metabolic care through primary health care in the Americas: a health policy analysis of HEARTS 2.0 implementation levers and architecture

Unlike previous HEARTS 2.0 publications on candidate interventions, readiness assessment, prioritization, and the clinical pathway, this Health Policy analysis examines the implementation architecture required to scale integrated cardiovascular–kidney–metabolic (CKM) care through primary health care (PHC) in the Americas. Renewed political commitments to PHC, hypertension control, and integrated CKM care, together with advances in medicines and health system innovations, are creating implementation momentum. Yet persistent gaps between evidence, policy commitment, and implementation continue to limit progress. These gaps mainly reflect limitations in organizing health service delivery. This analysis examines the regional landscape for scaling integrated CKM care through a PHC approach, drawing on HEARTS experience in the Americas and positioning HEARTS 2.0 as a practical pathway to accelerate delivery. It identifies key system constraints, proposes a six-lever implementation framework, and outlines an implementation architecture to align actors, strategies, and investments around scalable delivery of existing solutions.