HEARTS Accreditation: institutionalizing quality improvement of integrated cardiovascular, kidney, and metabolic services in primary care.

Cardiovascular diseases are the leading cause of death in the World Health Organization (WHO) Region of the Americas, with uncontrolled hypertension as the main modifiable risk factor. Their frequent coexistence with kidney and metabolic conditions creates an interconnected cardiovascular, kidney, and metabolic burden and highlights gaps in prevention, detection, continuity, integration, and quality of care. HEARTS in the Americas is one of the largest regional implementations of the WHO's Global HEARTS initiative and a central platform for strengthening primary care. Building on the HEARTS quality improvement model and HEARTS 2.0 clinical pathway, this report presents a service-oriented accreditation framework for integrated cardiovascular, kidney, and metabolic care delivered in primary care. Rather than accrediting facilities as institutions, the model focuses on the capacity of primary care services to deliver high-quality integrated cardiovascular, kidney, and metabolic care. Developed by the Pan American Health Organization's HEARTS in the Americas team, thematic experts, and country implementers, the framework conceives accreditation as an elevated stage of continuous quality improvement rather than a stand-alone inspection. It combines self-assessment, external assessment, maturity and performance appraisal, review of organizational quality processes, improvement plans, and renewable accreditation. Based on maturity and performance results, services are classified as accredited, progressing towards accreditation, or not yet accredited, with findings linked to improvement actions, technical assistance, governance, and resource allocation. The framework offers a pragmatic pathway for strengthening cardiovascular, kidney, and metabolic services in primary care and a scalable model for extending quality improvement to other priority health services.