Estimating Longitudinal Risks and Benefits From Cardiovascular Preventive Therapies Among Medicare Patients
Key result
Million Hearts tool estimates 10-year ASCVD risk and projects personalized risk reductions from preventive therapies.
Why the study?
This special report describes the development and intended use of the Million Hearts Longitudinal ASCVD Risk Assessment Tool to assess a value-based payment approach toward reducing 10-year predicted ASCVD risk.
Key Points
- To describe the development of a tool for estimating 10-year ASCVD risk in Medicare patients using preventive therapies.
- Developed the Million Hearts Longitudinal ASCVD Risk Assessment Tool.
- Assessed the impact of ABCS strategies on reducing ASCVD risk over time.
- Utilized high-quality systematic reviews and meta-analyses for evidence-based updates.
- The tool estimates individual risk levels for ASCVD based on 10-year projections.
- It supports clinicians in personalized therapy targeting for high-risk patients.
- It reinforces ABCS strategies, potentially reducing heart attack and stroke incidence.
Structured PICO
P
Population
A special report detailing the development of the Million Hearts Longitudinal ASCVD Risk Assessment Tool for primary prevention in adults aged 40 to 79 years.
I
Intervention
Million Hearts Longitudinal ASCVD Risk Assessment Tool (assessing ABCS: aspirin, blood pressure control, cholesterol management, smoking cessation)
O
Outcome
10-year predicted risk of atherosclerotic cardiovascular disease (ASCVD)
The Million Hearts Longitudinal ASCVD Risk Assessment Tool provides personalized 10-year ASCVD risk estimates to help target preventive therapies in primary prevention patients.
Limitations
- The Pooled Cohort Equations may overestimate risk in selected healthy volunteer cohorts and underestimate risk in patient groups with inflammatory conditions.
- Evidence regarding the interaction effects of combination therapy for primary prevention of ASCVD is of low quality.
- Adverse effects of blood pressure-lowering therapy and tobacco cessation drugs were inconsistently reported in the underlying trials.
Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“The new tool is based upon a formal systematic review of the evidence of ABCS therapies to define what the expected risk reduction would be from each one, used alone or in combination. At an initial visit, clinicians can use the tool to project the expected updated risk if one or more of the ABCS interventions were initiated, then it can be used at a subsequent follow-up visit to estimate what is the actual achieved updated risk based on the patient's individual response to those therapies and any lifestyle changes they may have made as well.”
“We have these risk-score tools that have been developed, and there are a number of them, but all they do is tell you about the patient's risk today and not what approaches would be most effective to reduce that risk.”
Implication
Value-based CVD risk payments may encourage prevention; leaves open whether they reduce events in practice.
Abstract
The Million Hearts Initiative has a goal of preventing 1 million heart attacks and strokes—the leading causes of mortality—through several public health and healthcare strategies by 2017. The American Heart Association and American College of Cardiology support the program. The Cardiovascular Risk Reduction Model was developed by Million Hearts and the Center for Medicare & Medicaid Services as a strategy to asses a value-based payment approach toward reduction in 10-year predicted risk of atherosclerotic cardiovascular disease (ASCVD) by implementing cardiovascular preventive strategies to manage the “ABCS” (aspirin therapy in appropriate patients, blood pressure control, cholesterol management, and smoking cessation). The purpose of this special report is to describe the development and intended use of the Million Hearts Longitudinal ASCVD Risk Assessment Tool. The Million Hearts Tool reinforces and builds on the “2013 ACC/AHA Guideline on the Assessment of Cardiovascular Risk” by allowing clinicians to estimate baseline and updated 10-year ASCVD risk estimates for primary prevention patients adhering to the appropriate ABCS over time, alone or in combination. The tool provides updated risk estimates based on evidence from high-quality systematic reviews and meta-analyses of the ABCS therapies. This novel approach to personalized estimation of benefits from risk-reducing therapies in primary prevention may help target therapies to those in whom they will provide the greatest benefit, and serves as the basis for a Center for Medicare & Medicaid Services program designed to evaluate the Million Hearts Cardiovascular Risk Reduction Model.
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Cite This Study
Lloyd‐Jones et al. (2016) conducted a review in Atherosclerotic cardiovascular disease. Million Hearts Longitudinal ASCVD Risk Assessment Tool (ABCS therapies) vs. Usual care was evaluated. The Million Hearts Longitudinal ASCVD Risk Assessment Tool was developed to estimate baseline 10-year ASCVD risk and project personalized risk reductions from evidence-based preventive therapies including aspirin, blood pressure control, statins, and smoking cessation.