A new risk assessment tool, funded by the Centers for Medicare and Medicaid Services (CMS) in partnership with the ACC and the American Heart Association (AHA), may help to better predict the 10-year risk of developing atherosclerotic cardiovascular disease (ASVCD) and how that risk may change over time as preventive treatments are initiated. The tool, published Nov. 4 in the Journal of the American College of Cardiology, is an extension of the ASCVD Pooled Cohort Equation first published in the 2013 AHA/ACC Guideline on Lifestyle Management to Reduce Cardiovascular Risk.

The Million Hearts Model Longitudinal ASCVD Risk Assessment tool is a large-cluster randomized payment model test of value-based payment tested by the Center for Medicare and Medicaid Innovation to determine whether financially rewarding clinicians for reducing 10-year predicted risk for ASCVD across their patient population is an effective way to reduce first-time heart attacks and strokes. Over 500 applicant organizations were selected to participate. The tool was funded in order to improve the ACC/AHA Pooled Cohort Equations risk estimator, currently used by practices participating in the Model, and aims to provide a framework for delivering appropriate risk-reducing strategies to Medicare patients with a 10-year ASCVD risk of greater than 30 percent.

According to the writing committee, the tool is not a replacement for the risk estimator. Rather, the risk estimator is incorporated into the initial risk assessments of patients in the Model. The committee added existing evidence to extend the risk equation, and it is based upon a formal systematic review of the evidence of “ABCS” therapies –aspirin therapy, blood pressure control, cholesterol management and smoking cessation – to define what the expected risk reduction would be from each one, used alone or in combination. 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 the actual achieved updated risk was based on the patient’s individual response to those therapies and any lifestyle changes that were made.

The goal of the tool is to assist not only clinicians, but also patients, in understanding risk, monitoring risk over time, and quantifying potential benefits of preventive therapies.

“This tool will help clinicians and patients with shared-decision making and will aid in the understanding of how the ‘ABCS’ may help to reduce risk,” said Donald M. Lloyd-Jones, MD, ScM, FACC, chair of the writing committee.

Keywords: American Heart Association, Aspirin, Atherosclerosis, Blood Pressure, Cardiovascular Diseases, Centers for Medicare and Medicaid Services, U.S., Cholesterol, Decision Making, Follow-Up Studies, Life Style, Medicaid, Medicare, Myocardial Infarction, Risk Assessment, Risk Factors, Risk Reduction Behavior, Smoking Cessation, Stroke, Diabetes Mellitus, Dyslipidemias, Geriatrics, Secondary Prevention, Lipid Metabolism, Hypertension

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