Estrategias para fortalecer los sistemas de salud en la atención cardiovascular: una revisión de alcance desde las Redes Integradas de Servicios de Salud
e202611094
DOI:
https://doi.org/10.67113/resp.v100i1.1653Palabras clave:
Enfermedades cardiovasculares, Sistemas de salud, Política de salud, Prestación integrada de servicios de salud, Atención Primaria de saludResumen
FUNDAMENTOS // Las Redes Integradas de Servicios de Salud (RISS) buscan fortalecer el desempeño y la resiliencia de los sistemas de salud; sin embargo, la evidencia sobre su implementación en la atención cardiovascular es limitada. El objetivo de este estudio fue mapear las estrategias implementadas o recomendadas en los sistemas de salud a nivel mundial para mejorar la atención de las personas con enfermedades cardiovasculares.
MÉTODOS // Se realizó una revisión de alcance conforme a la metodología del Instituto Joanna Briggs y a la guía PRISMA-ScR. La búsqueda se efectuó en MEDLINE, CINAHL, IRIS-OPS, LILACS y Web of Science para identificar artículos originales, revisiones, estudios de caso e informes institucionales publicados entre 2018 y 2025. Se utilizó la nemotecnia Población, Concepto y Contexto (PCC), considerando personas con enfermedades cardiovasculares, estrategias implementadas o recomendadas y sistemas de salud a nivel mundial. La búsqueda utilizó términos MeSH y DeCS combinados mediante operadores booleanos. Dos revisores realizaron de forma independiente el cribado y la selección de los estudios. La evidencia se sintetizó mediante análisis descriptivo y categorización temática de acuerdo con los dominios de las RISS.
RESULTADOS // Se incluyeron 30 estudios realizados en países de América (n=15), Asia (n=7), África (n=5), Europa (n=2) y Oceanía (n=1). Las estrategias se clasificaron en cinco dominios: gobernanza (n=11); tecnología (n=8); organización y gestión (n=5); modelos de atención (n=5) y financiación (n=1). Las principales estrategias incluyeron
el fortalecimiento de la Atención Primaria, la coordinación intersectorial, la implementación de tecnologías digitales y el uso de intervenciones costo-efectivas para mejorar el acceso y la continuidad de la atención cardiovascular.
CONCLUSIONES // La evidencia sintetizada sugiere que el fortalecimiento de la atención cardiovascular requiere estrategias integradas, centradas en la Atención Primaria y alineadas con las RISS. Los hallazgos destacan la importancia de combinar acciones de gobernanza, organización y gestión, innovación digital y financiación para fortalecer la respuesta de los sistemas de salud frente a las enfermedades cardiovasculares.
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1. Tsao CW, Aday AW, Almarzooq ZI, Anderson CAM, Arora P, Avery CL et al. Heart disease and stroke statistics—2023 update: a report from the American Heart Association. Circulation. 2023;147(8):e93-e621. https://doi.org/10.1161/CIR.0000000000001123 DOI: https://doi.org/10.1161/CIR.0000000000001137
2. Chong B, Jayabaskaran J, Jauhari SM, Chan SP, Goh R, Kueh MTW et al. Global burden of cardiovascular diseases: projections from 2025 to 2050. Eur J Prev Cardiol. 2025;32(11):1001-1015. https://doi.org/10.1093/eurjpc/zwae281 DOI: https://doi.org/10.1093/eurjpc/zwae281
3. World Health Organization. Development of an implementation roadmap 2023-2030 for the global action plan for the prevention and control of noncommunicable diseases 2013-2030 [Internet]. Geneva: World Health Organization; 2021 [consultado 17 jul 2026]. Disponible en: https://www.who.int/teams/noncommunicable-diseases/governance/roadmap
4. Yang J, Park B. A scoping review key elements and effects of cardiovascular disease management programs based on community-based participatory research. PLoS One. 2023;18(1):e0279563. https://doi.org/10.1371/journal.pone.0279563 DOI: https://doi.org/10.1371/journal.pone.0279563
5. Pan American Health Organization. Strategy and plan of action to improve quality of care in health service delivery 2020-2025 [Internet]. Washington (DC): Pan American Health Organization; 2019 [consultado 17 jul 2026]. Disponible en: https://iris.paho.org/handle/10665.2/51717
6. Pan American Health Organization. Improving chronic illness care through integrated health service delivery networks [Internet]. Washington (DC): Pan American Health Organization; 2012 [consultado 17 jul 2026]. Disponible en: https://iris.paho.org/handle/10665.2/3395
7. Pan American Health Organization. Redes integradas de servicios de salud: recomendaciones estratégicas [Internet]. Washington (DC): Pan American Health Organization; 2018 [consultado 17 jul 2026]. Disponible en: https://iris.paho.org/handle/10665.2/49645
8. Cid Pedraza C. Financiamiento de redes integradas de servicios de salud. Rev Panam Salud Publica. 2020;44:e121. https://doi.org/10.26633/RPSP.2020.121 DOI: https://doi.org/10.26633/RPSP.2020.121
9. Peters MDJ, Godfrey C, McInerney P, Munn Z, Tricco AC, Khalil H. Chapter 11: Scoping reviews. En: Aromataris E, Munn Z, editores. JBI Manual for Evidence Synthesis [Internet]. Adelaide (AU): JBI; 2020 [consultado 17 jul 2026]. Disponible en: https://synthesismanual.jbi.global DOI: https://doi.org/10.46658/JBIRM-20-01
10. Tricco AC, Lillie E, Zarin W, O’Brien KK, Colquhoun H, Levac D et al. PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med. 2018;169(7):467-473. https://doi.org/10.7326/M18-0850 DOI: https://doi.org/10.7326/M18-0850
11. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71. https://doi.org/10.1016/j.rec.2021.07.010 DOI: https://doi.org/10.1016/j.rec.2021.07.010
12. Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A. Rayyan-a web and mobile app for systematic reviews. Syst Rev. 2016;5(1):210. https://doi.org/10.1186/s13643-016-0384-4 DOI: https://doi.org/10.1186/s13643-016-0384-4
13. Palafox B, Seguin ML, McKee M, Dans AL, Yusoff K, Candari CJ et al. Responsive and equitable health systems-partnership on noncommunicable diseases (RESPOND) study: a mixed-methods, longitudinal, observational study on treatment seeking for hypertension in Malaysia and the Philippines. BMJ Open. 2018;8(7):e024000. https://doi.org/10.1136/bmjopen-2018-024000 DOI: https://doi.org/10.1136/bmjopen-2018-024000
14. Nascimento BR, Brant LCC, Marino BCA, Passaglia LG, Ribeiro ALP. Implementing myocardial infarction systems of care in low/middle-income countries. Heart. 2019;105(1):20-26. https://doi.org/10.1136/heartjnl-2018-313398 DOI: https://doi.org/10.1136/heartjnl-2018-313398
15. Stub D, Lefkovits J, Brennan AL, Dinh D, Brien R, Duffy SJ et al. The establishment of the Victorian Cardiac Outcomes Registry (VCOR): monitoring and optimising outcomes for cardiac patients in Victoria. Heart Lung Circ. 2018;27(4):451-463. https://doi.org/10.1016/j.hlc.2017.07.013 DOI: https://doi.org/10.1016/j.hlc.2017.07.013
16. Du X, Patel A, Anderson CS, Dong J, Ma C. Epidemiology of cardiovascular disease in China and opportunities for improvement: JACC International. J Am Coll Cardiol. 2019;73(24):3135-3147. https://doi.org/10.1016/j.jacc.2019.04.036 DOI: https://doi.org/10.1016/j.jacc.2019.04.036
17. Laar AK, Adler AJ, Kotoh AM, Legido-Quigley H, Lange IL, Perel P et al. Health system challenges to hypertension and related non-communicable diseases prevention and treatment: perspectives from Ghanaian stakeholders. BMC Health Serv Res. 2019;19(1):693. https://doi.org/10.1186/s12913-019-4571-6 DOI: https://doi.org/10.1186/s12913-019-4571-6
18. Hamid S, Groot W, Pavlova M. Trends in cardiovascular diseases and associated risks in sub-Saharan Africa: a review of the evidence for Ghana, Nigeria, South Africa, Sudan and Tanzania. Aging Male. 2019;22(3):169-176. https://doi.org/10.1080/13685538.2019.1582621 DOI: https://doi.org/10.1080/13685538.2019.1582621
19. Frederix I, Caiani EG, Dendale P, Anker S, Bax J, Böhm A et al. ESC e-Cardiology Working Group position paper: overcoming challenges in digital health implementation in cardiovascular medicine. Eur J Prev Cardiol. 2019;26(11):1166-1177. https://doi.org/10.1177/2047487319832394 DOI: https://doi.org/10.1177/2047487319832394
20. Cheadle A, Rosaschi M, Burden D, Ferguson M, Greaves B, Houston L et al. A community-wide collaboration to reduce cardiovascular disease risk: the Hearts of Sonoma County initiative. Prev Chronic Dis. 2019;16:E89. http://dx.doi.org/10.5888/pcd16.180596 DOI: https://doi.org/10.5888/pcd16.180596
21. Pahigiannis K, Thompson-Paul AM, Barfield W, Ochiai E, Loustalot F, Shero S et al. Progress toward improved cardiovascular health in the United States: Healthy People 2020 heart disease and stroke objectives. Circulation. 2019;139(16):1957-1973. https://doi.org/10.1161/CIRCULATIONAHA.118.035408 DOI: https://doi.org/10.1161/CIRCULATIONAHA.118.035408
22. Yin X, He Y, Zhang J, Song F, Liu J, Sun G et al. Patient-level and system-level barriers associated with treatment delays for ST-elevation myocardial infarction in China. Heart. 2020;106(19):1477-1482. https://doi.org/10.1136/heartjnl-2020-316621 DOI: https://doi.org/10.1136/heartjnl-2020-316621
23. Rumsfeld JS, Shah RU, Druz RS. Innovation in cardiology: the ACC Innovation Program. Methodist Debakey Cardiovasc J. 2020;16(4):304-308. https://doi.org/10.14797/mdcj-16-4-304 DOI: https://doi.org/10.14797/mdcj-16-4-304
24. Brunetti ND, Molinari G, Acquistapace F, Zimotti T, Parati G, Indolfi C et al. 2019 Italian Society of Cardiology census on telemedicine in cardiovascular disease: a report from the Working Group on Telecardiology and Informatics. Open Heart. 2020;7(1):e001157. https://doi.org/10.1136/openhrt-2019-001157 DOI: https://doi.org/10.1136/openhrt-2019-001157
25. Mori M, Khera R, Lin Z, Ross JS, Schulz WL, Krumholz HM. The promise of big data and digital solutions in building a cardiovascular learning system: opportunities and barriers. Methodist Debakey Cardiovasc J. 2020;16(3):212-219. https://doi.org/10.14797/mdcj-16-3-212 DOI: https://doi.org/10.14797/mdcj-16-3-212
26. Ali S, Subahi S. A multi-sectoral, non-governmental program for control of rheumatic heart disease: SUR I CAAN: a model for developing countries. Int J Cardiol. 2020;309:159-163. https://doi.org/10.1016/j.ijcard.2020.03.009 DOI: https://doi.org/10.1016/j.ijcard.2020.03.009
27. Shams P, Hussain M, Karani S, Mahmood S, Hasan A, Siddiqi S et al. Can sound public health policies stem the tide of burgeoning epidemic of cardiovascular disease in South Asians? Curr Cardiol Rep. 2022;24(2):77-84. https://doi.org/10.1007/s11886-021-01612-1 DOI: https://doi.org/10.1007/s11886-021-01612-1
28. Fort MP, Mundo W, Paniagua-Avila A, Cardona S, Figueroa JC, Hernández-Galdamez D et al. Hypertension in Guatemala’s public primary care system: a needs assessment using the Health System Building Blocks Framework. BMC Health Serv Res. 2021;21(1):908. https://doi.org/10.1186/s12913-021-06889-0 DOI: https://doi.org/10.1186/s12913-021-06889-0
29. Ogah OS, Umuerri EM, Adebiyi A, Orimolade OA, Sani MU, Ojji DB et al. SARS-CoV-2 infection (COVID-19) and cardiovascular disease in Africa: health care and socio-economic implications. Glob Heart. 2021;16(1):18. https://doi.org/10.5334/gh.829 DOI: https://doi.org/10.5334/gh.829
30. Shrestha A, Maharjan R, Karmacharya BM, Bajracharya S, Jha N, Shrestha S et al. Health system gaps in cardiovascular disease prevention and management in Nepal. BMC Health Serv Res. 2021;21(1):655. https://doi.org/10.1186/s12913-021-06681-0 DOI: https://doi.org/10.1186/s12913-021-06681-0
31. Wosik J, Clowse MEB, Overton R, Adagarla B, Economou-Zavlanos N, Cavalier J et al. Impact of the COVID-19 pandemic on patterns of outpatient cardiovascular care. Am Heart J. 2021;231:1-5. https://doi.org/10.1016/j.ahj.2020.10.074 DOI: https://doi.org/10.1016/j.ahj.2020.10.074
32. Doon R, Malcolm T, Lewis Y, Holder L, Gulston L, Hamid A et al. Improving cardiovascular health with the patient-centered, integrated primary care HEARTS model in Trinidad and Tobago. Rev Panam Salud Publica. 2022;46:e169. https://doi.org/10.26633/RPSP.2022.169 DOI: https://doi.org/10.26633/RPSP.2022.169
33. Hancco Saavedra J, Pérez Jiménez V. La voluntad política y la gobernanza: claves en la implementación de HEARTS en el Perú. Rev Panam Salud Publica. 2022;46:e85. https://doi.org/10.26633/RPSP.2022.85 DOI: https://doi.org/10.26633/RPSP.2022.85
34. Husain MJ, Haider MS, Tarannum R, Jubayer S, Bhuiyan MR, Kostova D et al. Cost of primary care approaches for hypertension management and risk-based cardiovascular disease prevention in Bangladesh: a HEARTS costing tool application. BMJ Open. 2022;12(6):e061467. https://doi.org/10.1136/bmjopen-2022-061467 DOI: https://doi.org/10.1136/bmjopen-2022-061467
35. Balasubramanian BA, Lindner S, Marino M, Springer R, Edwards ST, McConnell KJ et al. Improving delivery of cardiovascular disease preventive services in small-to-medium primary care practices. J Am Board Fam Med. 2022;35(5):968-978. https://doi.org/10.3122/jabfm.2022.05.220038
36. Brettler JW, Giraldo Arcila GP, Aumala T, Best A, Campbell NRC, Cyr S et al. Factores impulsores y métodos de puntuación para mejorar el control de la hipertensión en la práctica clínica de la atención primaria: recomendaciones del grupo de innovación de HEARTS en las Américas. Rev Panam Salud Publica. 2022;46:e56. https://doi.org/10.26633/RPSP.2022.56 DOI: https://doi.org/10.26633/RPSP.2022.56
37. Williams BA, Voyce S, Sidney S, Roger VL, Plante TB, Larson S et al. Establishing a national cardiovascular disease surveillance system in the United States using electronic health record data: key strengths and limitations. J Am Heart Assoc. 2022;11(8):e024409. https://doi.org/10.1161/JAHA.121.024409 DOI: https://doi.org/10.1161/JAHA.121.024409
38. Hasan BS, Bhatti A, Mohsin S, Barach P, Ahmed E, Ali S et al. Recommendations for developing effective and safe paediatric and congenital heart disease services in low-income and middle-income countries: a public health framework. BMJ Glob Health. 2023;8(5):e012049. https://doi.org/10.1136/bmjgh-2023-012049 DOI: https://doi.org/10.1136/bmjgh-2023-012049
39. Klassen SL, Then K, Warnica JW, Burton J, Stephen WO, Lane T et al. The Guyana Program to Advance Cardiac Care: a model for equitable cardiovascular care delivery. Glob Heart. 2023;18(1):22. https://doi.org/10.5334/gh.1193 DOI: https://doi.org/10.5334/gh.1193
40. Doku AK, Tetteh J, Edzeame J, Peters RJG, Agyemang C, Otchi EH et al. The Ghana heart initiative – a health system strengthening approach as index intervention model to solving Ghana’s cardiovascular disease burden. Front Public Health. 2024;12:1330708. https://doi.org/10.3389/fpubh.2024.1330708 DOI: https://doi.org/10.3389/fpubh.2024.1330708
41. Marvasti TB, Gao Y, Murray KR, Hershman S, McIntosh C, Moayedi Y. Unlocking tomorrow’s health care: expanding the clinical scope of wearables by applying artificial intelligence. Can J Cardiol. 2024;40(12):1934-1945. https://doi.org/10.1016/j.cjca.2024.07.009 DOI: https://doi.org/10.1016/j.cjca.2024.07.009
42. Ordunez P, Campbell NRC, DiPette DJ, Jaffe MG, Rosende A, Martinez R et al. HEARTS in the Americas: targeting health system change to improve population hypertension control. Curr Hypertens Rep. 2024;26(2):141-156. https://doi.org/10.1007/s11906-023-01286-w DOI: https://doi.org/10.1007/s11906-023-01286-w
43. Etienne CF. Ampliación del manejo de las enfermedades cardiovasculares en la atención primaria mediante HEARTS en las Américas. Rev Panam Salud Publica. 2022;46:e185. https://doi.org/10.26633/RPSP.2022.157 DOI: https://doi.org/10.26633/RPSP.2022.185
44. Schwalm JD, Joseph P, Leong DP, Lopez-Lopez JP, Onuma O, Bhatt P et al. Cardiovascular disease in the Americas: optimizing primary and secondary prevention of cardiovascular disease. Lancet Reg Health Am. 2025;42:100964. https://doi.org/10.1016/j.lana.2024.100964 DOI: https://doi.org/10.1016/j.lana.2024.100964
45. Fuady A, Anindhita M, Haniifah M, Ahsan A, Sugiharto A, Haya MAN et al. Bridging the gap: financing health promotion and disease prevention in Indonesia. Health Res Policy Syst. 2024;22(1):170. https://doi.org/10.1186/s12961-024-01206-7 DOI: https://doi.org/10.1186/s12961-024-01206-7
46. Mahdiyan S, Amini-Rarani M, Rezayatmand R, Shaarbafchizadeh N. Understanding challenges of primary healthcare financial resource allocation in Iran. Health Res Policy Syst. 2025;23(1):95. https://doi.org/10.1186/s12961-025-01331-x DOI: https://doi.org/10.1186/s12961-025-01331-x
47. Mendis S, Graham I, Hammerich A, Mikkelsen B, Kavousi M, Pathirana R et al. Promoting global cardiovascular health to advance the Sustainable Development Agenda. JACC Adv. 2024;3(12):101388. https://doi.org/10.1016/j.jacadv.2024.101388 DOI: https://doi.org/10.1016/j.jacadv.2024.101388
48. Takahashi EA, Schwamm LH, Adeoye OM, Alabi O, Jahangir E, Misra S et al. An overview of telehealth in the management of cardiovascular disease: a scientific statement from the American Heart Association. Circulation. 2022;146(25):e558-e568. https://doi.org/10.1161/CIR.0000000000001107 DOI: https://doi.org/10.1161/CIR.0000000000001107
49. Kuan PX, Chan WK, Fern Ying DK, Rahman MAA, Peariasamy KM, Lai NM et al. Efficacy of telemedicine for the management of cardiovascular disease: a systematic review and meta-analysis. Lancet Digit Health. 2022;4(9):e676-e691. https://doi.org/10.1016/S2589-7500(22)00124-8 DOI: https://doi.org/10.1016/S2589-7500(22)00124-8
50. Jaén-Extremera J, Afanador-Restrepo DF, Rivas-Campo Y, Gómez-Rodas A, Aibar-Almazán A, Hita-Contreras F et al. Effectiveness of telemedicine for reducing cardiovascular risk: a systematic review and meta-analysis. J Clin Med. 2023;12(3):841. https://doi.org/10.3390/jcm12030841 DOI: https://doi.org/10.3390/jcm12030841
51. Qi Y, Mohamad E, Azlan AA, Zhang C, Ma Y, Wu A. Digital health solutions for cardiovascular disease prevention: systematic review. J Med Internet Res. 2025;27:e64981. https://doi.org/10.2196/64981 DOI: https://doi.org/10.2196/64981
52. Oleribe OO, Momoh J, Uzochukwu BSC, Mbofana F, Adebiyi A, Barbera T et al. Identifying key challenges facing healthcare systems in Africa and potential solutions. Int J Gen Med. 2019;12:395-403. https://doi.org/10.2147/IJGM.S223882 DOI: https://doi.org/10.2147/IJGM.S223882
53. Gebremeskel AT, Otu A, Abimbola S, Yaya S. Building resilient health systems in Africa beyond the COVID-19 pandemic response. BMJ Glob Health. 2021;6(6):e006108. https://doi.org/10.1136/bmjgh-2021-006108 DOI: https://doi.org/10.1136/bmjgh-2021-006108
54. Grudniewicz A, Gray CS, Boeckxstaens P, De Maeseneer J, Mold J. Operationalizing the Chronic Care Model with goal-oriented care. Patient. 2023;16(6):685-695. https://doi.org/10.1007/s40271-023-00645-8 DOI: https://doi.org/10.1007/s40271-023-00645-8
55. Davy C, Bleasel J, Liu H, Tchan M, Ponniah S, Brown A. Factors influencing the implementation of chronic care models: a systematic literature review. BMC Fam Pract. 2015;16:102. https://doi.org/10.1186/s12875-015-0319-5 DOI: https://doi.org/10.1186/s12875-015-0319-5
56. Smits GHJM, van Doorn S, Bots ML, Hollander M. Cardiovascular risk reduction with integrated care: results of 8 years follow-up. BMC Prim Care. 2023;24(1):98. https://doi.org/10.1186/s12875-023-02010-y DOI: https://doi.org/10.1186/s12875-023-02010-y
57. Yip W, Fu H, Chen AT, Zhai T, Jian W, Xu R et al. 10 years of health-care reform in China: progress and gaps in universal health coverage. Lancet. 2019;394(10204):1192-1204. https://doi.org/10.1016/S0140-6736(19)32136-1 DOI: https://doi.org/10.1016/S0140-6736(19)32136-1
58. Kazi DS, Elkind MSV, Deutsch A, Dowd WN, Heidenreich PA, Khavjou O et al. Forecasting the economic burden of cardiovascular disease and stroke in the United States through 2050: a Presidential Advisory from the American Heart Association. Circulation. 2024;150(2):e89-e101. https://doi.org/10.1161/CIR.0000000000001258 DOI: https://doi.org/10.1161/CIR.0000000000001258
59. John AS, Ganapathi S, Harikrishnan S, Lekha TR, Stanley A, Soman B et al. Within-trial cost-effectiveness analysis of a family-based structured lifestyle modification intervention program for cardiovascular risk reduction: results from the PROLIFIC trial. Glob Heart. 2025;20(1):65. https://doi.org/10.5334/gh.1450 DOI: https://doi.org/10.5334/gh.1450
60. Bonekamp NE, Visseren FLJ, Van der Schouw YT, Van der Meer MG, Teraa M, Ruigrok YM et al. Cost-effectiveness of Mediterranean diet and physical activity in secondary cardiovascular disease prevention: results from the UCC-SMART cohort study. Eur J Prev Cardiol. 2024;31(12):1460-1468. https://doi.org/10.1093/eurjpc/zwae123 DOI: https://doi.org/10.1093/eurjpc/zwae123
61. Zakiyah N, Marulin D, Alfaqeeh M, Puspitasari IM, Lestari K, Lim KK et al. Economic evaluations of digital health interventions for patients with heart failure: systematic review. J Med Internet Res. 2024;26:e53500. https://doi.org/10.2196/53500 DOI: https://doi.org/10.2196/53500
62. George J, Jack S, Gauld R, Colbourn T, Stokes T. Impact of health system governance on healthcare quality in low-income and middle-income countries: a scoping review. BMJ Open. 2023;13(12):e073669. https://doi.org/10.1136/bmjopen-2023-073669 DOI: https://doi.org/10.1136/bmjopen-2023-073669
63. Otieno P, Agyemang C, Wao H, Wambiya E, Ng’oda M, Mwanga D et al. Effectiveness of integrated chronic care models for cardiometabolic multimorbidity in sub-Saharan Africa: a systematic review and meta-analysis. BMJ Open. 2023;13(6):e073652. https://doi.org/10.1136/bmjopen-2023-073652 DOI: https://doi.org/10.1136/bmjopen-2023-073652
64. Luciani S, Agurto I, Holder R, Caixeta R, Hennis AJ. Integrated approach for noncommunicable disease management in the Americas. Rev Panam Salud Publica. 2022;46:e154. https://doi.org/10.26633/RPSP.2022.154 DOI: https://doi.org/10.26633/RPSP.2022.154
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