HEARTS360: Hypertension Dashboard

1. Overview indicators

Patients protected from heart attacks and strokes with world-class treatment

4,808 patients

in River District with BP <140/90

Hypertension treatment cascade

Estimated adults (>30) in River District with hypertension who are registered, under care, and controlled.

Estimated population with hypertension is derived from a STEPS Community Survey conducted in 2022.

Patients under care are patients with hypertension with at least 1 visit in the past 12 months

100%

250,800

Estimated people with hypertension

12,213

Cumulative registered patients

10,632

Patients under care

4,808

Patients with BP controlled

2. Program management indicators

Hypertension treatment outcomes

Numerator for BP controlled: Patients with BP <140 AND <90 at their latest visit in the past 3 months

Numerator for BP uncontrolled: Patients with BP ≥140 OR ≥90 at their latest visit in the past 3 months

Numerator for No visit in 3 months: Patients with no visit in the past 3 months.

Denominator: Patients with hypertension registered before the past 3 months. Dead patients (205) and 12 month lost to follow-up patients (1,562) are excluded.

Outcomes for 7,882 patients under care (registered before 1-May-2024) between 1-May-2024 to 31-Jul-2024

BP controlled at latest visit in past 3 months

61%

4,808 patients with BP <140/90

BP not controlled at latest visit in past 3 months

17%

1,340 patients with BP ≥140/90

No visit in past 3 months

22%

1,734 patients with no visit

Patients under care

Patients under care: Registered patients with hypertension with at least 1 visit in the past 12 months. Dead patients (205) and 12 month lost to follow-up patients (1,562) are excluded.

Cumulative registered patients: All patients with hypertension registered. Dead patients (205) are excluded.

Monthly registered patients: Patients with hypertension registered each month.

Patients with hypertension with at least 1 visit in the past 12 months

10,632

1,043 patients registered in Jul-2024

of 12,213 cumulative registered patients

12 month lost to follow-up

Numerator: Patients with no visit in the past 12 months

Denominator: Registered patients with hypertension. Dead patients (205) are excluded.

Patients with hypertension with no visit in the past 12 months

10%

1,562 patients with no visit from Aug-2023 to Jul-2024

of 12,213 cumulative registered patients

Opportunistic screening

Numerator: Patients screened for hypertension months

Denominator: Approximate adult patients OPD per month

% of estimated adult OPD patients screened for hypertension

23%

6,900 individuals screened for hypertension in Jul-2024

of ~30,000 estimated OPD patients >18 years

Compare sub-regions

Treatment outcomes for patients with hypertension at their latest visit from 1-May-2024 to 31-Jul-2024

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Sub-regions	Total	Jul-2024	Total	Percent	Total	Percent	Total	Percent
	Patients under care	Monthly new patients registered	BP controlled		BP uncontrolled		No visit in past 3 months
River District	10,539	1,043	4,808	61%	1,340	17%	1,734	22%
Cherry Blossom County	1,100	139	450	50%	145	16%	212	34%
Fern Grove County	505	106	245	84%	12	4%	56	12%
Grasslands County	321	6	120	39%	21	7%	120	54%
Hillside County	3,203	305	1,802	69%	291	11%	245	19%
Ice Caps County	867	65	500	68%	100	14%	70	19%
Mangrove County	345	100	72	50%	22	15%	15	35%
Mountain County	900	56	240	30%	108	14%	289	56%
Oceanside County	123	106	4	24%	2	12%	70	65%
Peaks County	2,104	120	972	52%	421	23%	320	25%
Rain Forest County	56	0	20	36%	6	11%	30	54%
Rivers Edge County	145	10	45	36%	19	15%	50	49%
Sunshine Coast County	203	5	103	53%	21	11%	45	36%
Tree Top County	32	6	10	50%	4	20%	5	30%
Vineland County	221	11	120	60%	20	10%	47	30%
Wind Canyon County	414	8	105	26%	100	25%	160	48%

Quarterly cohort reports

The treatment outcomes for newly registered patients at the end of the following quarter

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63%

18%

21%

Q4-2022 cohort 1,006 patients

Result from past visit in Q1-2023

66%

15%

21%

Q1-2023 cohort 600 patients

Result from latest visit in Q2-2023

60%

19%

21%

Q2-2023 cohort 892 patients

Result from latest visit in Q3-2023

68%

16%

22%

Q3-2023 cohort 1,315 patients

Result from latest visit in Q4-2023

76%

10%

14%

Q4-2023 cohort 941 patients

Result from latest visit in Q1-2024

80%

12%

Q1-2024 cohort 1,281 patients

Result from latest visit in Q2-2024

Q2-2024 cohort 2,725 patients

Coming Oct-2024

BP controlled

BP uncontrolled

No visit in quarter

3. Inventory indicators

Anti-hypertensive drug stock

Numerator: Facilities with ≥30 patient days protocol drugs in stock.

Denominator: All facilities in the hypertension program.

Facilities with ≥30 patient days of hypertension protocol drugs in stock

Step 1 drugs — 94% in Jul-2024

Step 2 drugs — 64% in Jul-2024

Step 3 drugs — 90% in Jul-2024

Blood pressure monitors

Numerator: Facilities with 1 or more functioning BP monitors.

Denominator: All facilities in the hypertension program.

Facilities with a functioning BP monitor

98%

157 facilities with a functioning BP monitor

of 160 facilities reporting in Jul-2024

3 facilities without a functioning BP monitor:

CHC Turnip, CHC Zucchiniville, PHC Grapefruit Hill

Stock reporting by facility

Jul-2024 reports

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Facility	Sub-region	Step 1 drugs in patient days	Step 2 drugs in patient days	Step 3 drugs in patient days	BP monitors
River District		54	60	45	210
CHC Apple Orchard	Wind Canyon County	54	68	90	1
CHC Bramble River	Tree Top County	34	6	67	1
CHC Bumpy Hill	Fern Grove County	33	92	120	1
CHC Carrot Peak	Cherry Blossom County	134	0	180	1
CHC Cumin Creek	Oceanside County	46	48	78	1
CHC Dandelion Wine	Vineland County	44	103	12	1
CHC Elderflower Ridge	Riverside County	90	21	180	1
CHC Riverside	Grasslands County	40	14	22	2
CHC Rhubarb Hills	Mangrove County	65	50	90	1
CHC Turnip	Rain Forest County	45	109	33	0
CHC Ugly Fruit Bay	Wind Canyon County	54	68	90	1
CHC Vine Bay	Tree Top County	34	6	67	1
CHC Watermelon Cove	Fern Grove County	33	92	120	1
CHC Weather Top	Cherry Blossom County	134	180	0	1
CHC Yellow Melon	Oceanside County	102	90	80	1
CHC Young Potato	Vineland County	365	12	103	1
CHC Zucchiniville	Riverside County	21	45	99	0
District Hospital Strawberry	Oceanside County	102	90	80	1
PHC Apricot Island	Grasslands County	14	40	44	2
PHC Azalea Hills	Mangrove County	65	50	90	1
PHC Bumblebee	Rain Forest County	45	109	33	3
PHC Capital Town	Wind Canyon County	54	68	90	1
PHC Copperville	Tree Top County	34	6	67	1
PHC Cupola	Fern Grove County	33	92	120	1
PHC Dartboard Hill	Cherry Blossom County	134	0	180	1
PHC Deck Town	Oceanside County	46	48	78	1
PHC Dune Hill	Vineland County	44	103	12	1
PHC Eagle Hill	Riverside County	90	21	180	1
PHC Eggplant Mountain	Grasslands County	12	40	24	2
PHC El Toro	Mangrove County	65	50	90	1
PHC Fang Cove	Rain Forest County	45	109	33	1
PHC Grapefruit Hill	Wind Canyon County	54	68	90	0
PHC Gumdrop Cove	Tree Top County	34	6	67	1
PHC Happy Street	Fern Grove County	33	92	120	1
PHC Hilltop Station	Cherry Blossom County	134	180	0	1
PHC Iceberg	Oceanside County	102	90	80	1
PHC Idaho Hills	Vineland County	365	12	103	1
PHC Jackfruit	Riverside County	21	45	99	1
PHC Juniperberry	Grasslands County	14	40	44	2
PHC Lard Lane	Mangrove County	65	50	90	1
PHC Lobby Mountain	Rain Forest County	45	109	33	3
Subdistrict Hospital Grape	Mangrove County	32	40	50	1
Subdistrict Hospital Juniper	Oceanside County	202	290	280	1
Subdistrict Hospital Grasslands	Grasslands County	100	106	109	1
UPHC Cinnamon Hill	Mangrove County	19	66	150	1
UPHC Dandelion Mountain	Oceanside County	52	12	100	1
UPHC Dill Weed	Grasslands County	80	90	45	1
UPHC Dry Marjoram	Mangrove County	100	12	90	1
UPHC Dry Mustard	Oceanside County	90	0	87	1
UPHC Dry Nutmeg	Grasslands County	90	90	90	1

>180 days drug supply

<30 days drug supply or no BP monitor

4. Comorbidity indicators

Hypertension and diabetes comorbidity

All patients registered in the hypertension and/or diabetes programs

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	Patients under care	Cumulative registered patients	Died^*
Hypertension-only	8,632	10,000	105
Both hypertension and diabetes	2,000	2,213	100
Diabetes-only	1,500	2,100	50
TOTAL	12,132	14,313	255

^*Deaths may be undercounted.

Comorbid patients with BP controlled

Patients with both hypertension and diabetes with BP controlled at latest visit in past 3 months

50%

1,000 patients with BP <140/90

5. Age and sex

Age and sex of patients under care for hypertension

10,632 patients under care

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Age	Female (64%)	Male (36%)	Female and male
18-29	6%	4%	10%
30-49	28%	17%	45%
50-69	19%	6%	25%
70+	12%	8%	20%

Cumulative registered patients
All patients diagnosed with hypertension. Dead patients are excluded.
Patients under care
All patients diagnosed with hypertension with a "visit" recorded in the last 12 months. A visit can have a simplified definition: the patient had a BP measure recorded in the last 12 months. Dead patients are excluded.
12 month lost to follow-up patients
All patients diagnosed with hypertension with no "visit" recorded in the last 12 months. A visit can have a simplified definition: the patient had no BP measures recorded in the last 12 months. Note: Some of the key indicators exclude 12-month lost to follow-up patients (i.e. the indicators only use "Patients under care") because these patients become a drag on the health system at scale and muddy the view of progress being made improving hypertension control.
Died
Dead patients are excluded from most indicators.
Patients with controlled blood pressure and Patients with uncontrolled blood pressure in a month
Controlled blood pressure in most countries is a BP measure <140 mmHg systolic AND <90 mmHg diastolic. In a simple healthcare system, you can use the most recent BP measure in a month to calculate BP control. In more complex health systems where multiple blood pressures are recorded at each visit, you may need to average the measures.
Screened patients (Aggregate data)
Estimated monthly adult OPD patients (Aggregate data)

Overview indicators

The overview indicators are OPTIONAL indicators that are useful as your program scales. They can be used both for program management and can be useful data for advocacy.

Patients protected

This indicator is a very simplistic representation of the number of patients controlled. It is primarily useful as a motivational tool for health staff and for advocacy. The data simply represents the numerator from the "BP controlled at latest visit in past 3 months" indicator below.

Value

Number of patients with controlled blood pressure (<140 systolic AND <90 diastolic) recorded at the patient's most recent visit within the past 3 months.

Example

By the end of July, 4808 patients had a visit anytime from May 1 to July 31 and at their most recent visit, they had their BP controlled.

Hypertension treatment cascade

This indicator gives a view of how many expected individuals in the region are under treatment for hypertension and, of those patients, how many have their blood pressure under control.

Note: The "Estimated number of adults" is usually derived from community surveys (e.g. WHO STEPS survey) and can be updated annually or even less frequently in a data system.

Numerators

The numerators for Cumulative registered patients, Patients under care, and Patients with BP controlled are simply the values from the charts lower in the report.

Denominator

Number of people in the region estimated to have hypertension. (This is commonly derived from community survey data e.g. STEPS survey)

Hypertension treatment outcomes

The 3 treatment outcome indicators show whether patients in the hypertension control program are visiting health facilities regularly. Blood pressure control is the best indicator to know if patients under treatment are being treated effectively.

All 3 indicators have the same denominator.

BP controlled at latest visit in past 3 months

How many patients enrolled in the hypertension control program visited a health facility in the past 3 months with a healthy blood pressure?

Why are patients registered within the past 3 months excluded? Three months gives patients time to take their hypertension medication and to get their BP controlled. Most newly registered patients have uncontrolled blood pressure and including them would not reflect an accurate picture of actual controlled patients.

Why is this important? BP controlled reflects the overall health of a hypertension control program and is the most important hypertension control indicator.

Numerator

Patients with controlled blood pressure (<140 systolic AND <90 diastolic) recorded at the patient's most recent visit within the past 3 months.

Denominator

Patients under care in the hypertension program registered before the past 3 months. Exclusions: Dead and 12 month lost to follow-up patients are excluded from the denominator.

BP not controlled at latest visit in past 3 months

How many patients enrolled in the hypertension control program visited a health facility in the past 3 months with high blood pressure?

Why is this important? BP not controlled shows which patients are coming back to care, but require continued intervention to control their blood pressure.

Numerator

Patients with uncontrolled blood pressure (≥140 systolic OR ≥90 diastolic) recorded at the patient's most recent visit within the past 3 months.

Denominator

Patients under care in the hypertension program registered before the past 3 months. Exclusions: Dead and 12 month lost to follow-up patients are excluded from the denominator.

No visit in 3 months

How many patients enrolled in the hypertension control program did not visit a health facility in the past 3 months?

Note: This can also be called "3 month lost to follow-up."

Why is this important? This number reflects how good facilities are at retaining patients in care.

Numerator

Patients no BP measure recorded within the past 3 months.

Denominator

Patients under care in the hypertension program registered before the past 3 months. Exclusions: Dead and 12 month lost to follow-up patients are excluded from the denominator.

Registrations

It is useful to know how many patients are enrolled in a hypertension control program and how many of those patients are "under care" (i.e. have visited at least once in the past 12 months).

Patients under care

Track the patients who have visited in the last 12 months and can be considered to be under care in the hypertension control program.

Value
Cumulative registrations in the hypertension program excluding 12 month lost to follow-up and Dead patients.

Cumulative registrations

Track all of the patients who have been registered in the hypertension program. Over time, the cumulative registrations will be a larger number than Patients under care.

Value
Cumulative registrations in the hypertension program excluding Dead patients.

Monthly new patients registered

Monthly registrations give visibility into activity on-the-ground by health facility staff.

Value
New patients registered in the hypertension program in a month who are diagnosed with hypertension (diagnosis could have happened on any date).

12 month lost to follow-up patients

Patients with no "visit" in the past 12 months (i.e. no BP measure recorded in the past 12 months).

Numerator

Patients no BP measure recorded within the past 12 months.

Denominator

Cumulative registered patients in the hypertension program. Exclusions: Dead patients are excluded from the denominator.

% of people registered

The number of patients in the region registered in the hypertension control program.

Numerator

Cumulative registrations

Denominator

Estimated number of adults with hypertension in the community.

% of people under care

The number of patients in the region registered in the hypertension control program who have visited a facility at least once in the past 12 months.

Numerator

Patients under care

Denominator

Estimated number of adults with hypertension in the community.

% of people with BP controlled

The number of patients in the region registered in the hypertension control program who have their BP controlled in the past 3 months.

Numerator

Patients with controlled blood pressure in past 3 months.

Denominator

Estimated number of adults with hypertension in the community.

Opportunistic screening

Facility-based opportunistic screening gives visibility into how many patients in the OPD (Outpatient Department) of hospitals are having their blood pressure measured to screen for hypertension.

Note: In many health systems, the number of screened patients and the approximate number of adult patients visiting the OPD are only recorded on paper and are reported monthly in aggregate.

% of OPD patients screened for hypertension

The approximate percentage of patients screened for hypertension in a month.

Numerator

Adult OPD patients with a blood pressure measure taken in a month

Denominator

Approximate Adult patients visiting the OPD of facilities per month

Monthly OPD patients screened for hypertension

The number of patients screened for hypertension in a month.

Value

Adult OPD patients with a blood pressure measure taken in a month

Cohort reports

Cohorts allow program managers to track a set of patients receiving treatment over time. The dashboard takes all the patients registered during a quarter and displays the outcome of their visit in the following quarter.

BP controlled numerator

The number of Patients with a BP <140 AND <90 at their last visit in the quarter after the quarter when they were registered.

BP not controlled numerator

The number of Patients with a BP ≥140 OR ≥90 at their last visit in the quarter after the quarter when they were registered.

No visit in 3 months numerator

The number of Patients with no visit in the quarter after the quarter when they were registered.

Denominator

New patients registered in the hypertension program in a quarter.

Drug stock and BP monitor inventory

Description...

Anti-hypertensive drug stock

Definition...

Patient days calculation

Quantity of DRUG ABC 5 mg +
Quantity of DRUG ABC 10 mg * 2
/ Patients under care * Estimated % of patients on DRUG ABC
= Patient days of drug stock

Example

25,000 pills of Amlodipine 5 mg +
15,000 pills of Amlodipine 10 mg * 2
/ 6,000 patients under care * 72%
= 12.5 patient days of Amlodipine

Blood pressure monitors

Definition...

Numerator

Facilities with ≥1 blood pressure monitor

Denominator

All facilities in the hypertension control program.