New research presented at ESC Congress 2025 on the use of reconditioned pacemakers in low- and middle-income countries and a home-based model of hypertension care in South Africa signals promising advancements for global heart health.

In the MHYH trial, researchers assessed the safety of implanting reconditioned pacemakers in patients from Kenya, Mexico, Mozambique, Nigeria, Paraguay, Sierra Leone and Venezuela. More than 300 adult patients with life expectancy of at least two years, a class I indication for pacemaker therapy and no financial means to acquire a new device were randomized to receive a reconditioned pacemaker or a new pacemaker. The primary endpoint was procedure-related infection at 12 months.

Overall results found procedure-related infection rates were noninferior between reconditioned pacemakers and new pacemakers, with no malfunctions.

Our trial demonstrates the safety of pacemakers reconditioned using a specific protocol, with noninferior infection rates to new pacemakers and no malfunctions," said Thomas C. Crawford, MD, FACC, who presented the findings. "The work of Project My Heart Your Heart serves as a blueprint that can be replicated by other organizations to enable wider pacemaker reuse. We would also like to expand into reconditioned [ICD] devices, which are even more expensive and out of reach for many patients across the world."

In South Africa, a rural home-based hypertension program led to significant reductions in mean systolic blood pressure at six months when compared with standard clinic-based care, based on findings from the IMPACT-BP trial, which was simultaneously published in NEJM.

"Hypertension is the primary risk factor for stroke and heart disease, which are leading causes of death in South Africa," said Co-Principal Investigator Thomas Andrew Gaziano, MD, FACC, in presenting the findings. "Despite the wide availability of low-cost, effective therapies, hypertension control remains extremely poor in resource-limited settings. Obstacles include a lack of patient confidence to manage their own hypertension care, overcrowded clinics with long wait times and the cost of transport to clinics."

A total of 774 adults with hypertension were randomized into three groups: 1) home-based care; 2) enhanced home-based care; and 3) standard clinical care. Home-based care consisted of patient monitoring of blood pressure, home visits from a community health worker for data collection and medication delivery, and remote nurse-led decision making supported by a mobile application. Enhanced home-based care included the same interventions as home-based care, but with the addition of blood pressure machines for automatically transmitting readings.

At six months, the mean systolic blood pressure was lower in the home-based care group vs. the standard care group (difference, –7.9 mm Hg; 95% confidence interval [CI], −10.5 to −5.3; p<0.001), as well as in the enhanced home-based care group vs. the standard care group (difference, −9.1 mm Hg; 95% CI, −11.7 to −6.4; p<0.001).

In other findings, the percentage of participants with hypertension control at six months was 57.6% in the standard-care group, as compared with 76.9% in the home-based care group and 82.8% in the enhanced home-based care group. The improvements in systolic blood pressure and hypertension control with home-based care appeared to persist at 12 months, researchers said.

"Achieving hypertension control in over 80% of people in a predominantly Black African community in rural South Africa is a clear example that equitable health care access can be achieved in disadvantaged communities," said Professor Nombulelo Magula. "Similar models of care that address structural barriers could be considered to improve hypertension control in other remote and resource-limited settings. Expansion of the model to include the care of people with multiple comorbidities may also be valuable."