The following are key points to remember from this special report about the Million Hearts Longitudinal ASCVD Risk Assessment Tool:

1. Atherosclerotic cardiovascular disease (ASCVD) remains the leading cause of mortality and major morbidity in the United States, particularly among older Americans.
2. The majority of heart attacks and strokes occur in older adults as a result of cumulative exposure to preventable or modifiable causal risk factors that arise from adverse environmental conditions and behavioral/lifestyle patterns, including elevated blood pressure, adverse atherogenic blood lipid levels, diabetes, and tobacco use.
3. In 2012, the US Department of Health and Human Services (HHS) initiated Million Hearts, a national public–private initiative with an ambitious goal of preventing 1 million heart attacks and strokes by 2017.
4. Million Hearts aims to prevent heart attacks and strokes by pursuing a number of public health and health care strategies. Central to the implementation of these strategies is management of the “ABCS,” that is aspirin therapy in appropriate patients, blood pressure control, cholesterol management, and smoking cessation.
5. In support of Million Hearts, the Center for Medicare & Medicaid Innovation (CMMI) of the Centers for Medicare & Medicaid Services (CMS) recently announced its plans to perform a large cluster randomized payment model test of value-based payment designed to determine whether financially rewarding reductions in 10-year predicted risk for ASCVD across a physician’s patient population is an effective model to reduce the burden of heart attack and stroke. This Cardiovascular Risk Reduction Model will represent the largest test of value-based prevention payment ever conducted by CMS.
6. CMS solicited the creation of the Million Hearts Longitudinal ASCVD Risk Assessment Tool, an innovative tool that predicts baseline 10-year ASCVD risk, projects changes in ASCVD risk that would be expected with initiation of and adherence to evidence-based therapies, and incorporates individual patient responses to these therapies over time to allow for dynamic, longitudinal ASCVD risk prediction.
7. The 2013 Pooled Cohort Equations for estimating ASCVD risk in the US population were derived from five community- and population-based studies, including the Framingham Heart, Framingham Offspring, Atherosclerosis Risk in Communities, Cardiovascular Health, and Coronary Artery Risk Development in Young Adults Studies.
8. After estimating the baseline ASCVD risk, clinicians and patients currently have few tools to help them select and prioritize the most important or effective therapies to reduce ASCVD risk in the near-term.
9. The Million Hearts tool is intended to identify candidates for primary prevention therapies and assist in their management. Use of the tool occurs in three steps:
• Estimating the baseline 10-year risk for ASCVD,
• Considering the potential benefits of risk-reducing therapies for a given patient in the context of a patient–clinician discussion and shared decision making, and
• Assessing the updated ASCVD risk based on the response to therapy.
10. The Million Hearts Tool has been developed to assist clinicians and patients to understand risk, to monitor patients’ risks over time, and to quantify potential benefits of preventive therapies based on high-quality evidence.

Keywords: Aspirin, Atherosclerosis, Blood Pressure, Cholesterol, Diabetes Mellitus, Dyslipidemias, Geriatrics, Hypertension, Life Style, Lipids, Metabolic Syndrome, Myocardial Infarction, Patient Compliance, Primary Prevention, Public Health, Risk Assessment, Risk Factors, Smoking Cessation, Stroke, Tobacco Use

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