The Multilingual ASCVD Risk Estimator is a simplified web-based version of the ASCVD Risk Estimator Plus app, that provides clinicians with an efficient way to calculate a patient's estimated 10-year ASCVD risk, optimal risk and lifetime risk. The user has the option to use the app in English, Arabic (Modern Standard), German, Indonesian, Portuguese (Brazil), or Spanish (Spain) by selecting the desired language. The app is based on data from U.S. populations and may contain information that is culturally nuanced. It is intended for primary prevention and is not applicable for patients with established ASCVD.

The Multilingual ASCVD Risk Estimator helps clinicians implement guideline-recommended risk equations to facilitate clinician-patient discussions and support decision making to optimize care and lower risk for atherosclerotic cardiovascular disease (ASCVD). Clinicians and patients should weigh and incorporate the information provided by this app in the context of other considerations, including recommended lifestyle interventions, cultural considerations, patient preferences for taking medications, potential adverse drug reactions or interactions, and which treatment intervention approach might be most successful for a particular patient. The content in the app is based on data from U.S. populations and may contain information that is culturally nuanced. It is intended for primary prevention and is not applicable for patients with established ASCVD.

Estimate Screen: Estimate a patient's 10-year risk for atherosclerotic cardiovascular disease by entering their data to calculate risk using the pooled cohort equations. The optimal and lifetime risk scores will also be displayed.

Summary Screen: The Summary page features the risk scores, user inputs and email and print options.

• Risk scores: Displays the patient's 10-year ASCVD risk percentage and classification (low/borderline/intermediate/high), lifetime risk score and optimal risk score.
• Inputs: Capture a summary of the patient parameters entered into the app.
• Email and Print Options: Email and/or print a summary of the calculated ASCVD risk score and patient inputs to use as a patient handout or to include in your records for this patient.

Resources Screen: Visit this tab in the app for

• A sample practice scenario for how to use this app with a patient
• Definitions of key terms, concepts, and calculations in the app
• Informative resources for both clinicians and patients
• Links to reference documents

The information and recommendations in this app are meant to support clinical decision making. They are not meant to represent the only or best course of care or replace clinical judgment. Therapeutic options should be determined after discussion between the patient and their care provider.

The Multilingual ASCVD Risk Estimator is a simplified web-based version of the ASCVD Risk Estimator Plus app, with the option to use the app in English, Portuguese (Brazil), or Arabic (Modern Standard). The user can still calculate a patient's 10-year ASCVD risk via the Pooled Cohort Equations. Lifetime risk and optimal risk scores are also displayed. After entering patient data, the user can view the inputs and risk scores on the Summary page, and email/print this information. The web app also includes an extensive Resources section which can be viewed in the selected language. It does not include the tailored guideline advice based on inputs, functionality for comparing current risk to a previous visit, or estimating the impact of a particular therapy on risk scores.

10-year ASCVD risk is calculated via the Pooled Cohort Equations published as part of the 2013 ACC/AHA Guideline on the Assessment of Cardiovascular Risk. Lifetime risk is a risk stratification from the publication Prediction of Lifetime Risk for Cardiovascular Disease by Risk Factor Burden at 50 Years of Age.

The app also features an extensive Resources section with referenced content from the 2020 Expert Consensus Decision Pathway on Novel Therapies for Cardiovascular Risk Reduction in Patients with Type 2 Diabetes, the 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease, the 2018 ACC/AHA et al. Guideline on the Management of Blood Cholesterol, 2018 ACC Expert Consensus Decision Pathway on Tobacco Cessation Treatment, the 2013 ACC/AHA Guideline on the Assessment of Cardiovascular Risk, the 2017 ACC/AHA et al. Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults.

10-Year ASCVD Risk
The 10-year ASCVD Risk is calculated using the ACC/AHA 2013 Pooled Cohort Equations, which predict the absolute 10-year risk for ASCVD based on a patient's profile.

Optimal 10-Year ASCVD Risk
The optimal risk score uses the same Pooled Cohort Equations as the 10-year risk calculation, except it uses preset optimal values for someone with the same age and race/ethnicity category. The preset values of an optimal risk factor profile are: total cholesterol, 170 mg/dL; HDL-cholesterol, 60 mg/dL; SBP, 110 mm Hg; nonsmoker; non-diabetic; and no blood pressure–lowering drugs.

Lifetime ASCVD Risk
Estimates of lifetime risk for ASCVD are provided for adults 20 through 59 years of age and are shown as the lifetime risk for ASCVD for a 50-year old without ASCVD who has the risk factor values entered. Because the primary use of these lifetime risk estimates is to facilitate the very important discussion regarding risk reduction through lifestyle change, the imprecision introduced is small enough to justify proceeding with lifestyle change counseling informed by these results.

ACC/AHA guidelines stress the importance of lifestyle modification as the foundation to lowering cardiovascular disease risk. This includes eating a heart-healthy diet, regular aerobic exercises, maintenance of desirable body weight and avoidance of tobacco products. The Resources section of the app contains referenced content from multiple ACC/AHA documents which include information on lifestyle intervention.

The Multilingual ASCVD Risk Estimator is free for both ACC members and non-members. Currently the app is web only and not available in mobile app stores. It can be accessed on the web at:
https://tools.acc.org/Multilingual-ASCVD-Risk-Estimator

This web app is an adapted version of the ASCVD Risk Estimator Plus. Testing and development included review and feedback by clinicians and language translators for Portuguese and Arabic.

Content in the app will be updated to reflect any changes to its source documents and the related clinical environment. Relevant relationships to other existing ACC clinical policy documents and resources will also be considered in future updates. Ongoing user feedback helps identify needs and opportunities for future updates.

Provide feedback and suggestions about the app by completing the ACC survey for this app here.

The ACC also collects data about the app through analytics and usability studies. Feedback is used to ensure the app's accuracy, to identify opportunities for improving the user experience, and to inform the ACC app portfolio. No personal data is collected through the app.

The primary intended audience of the app are clinicians involved in managing a patient's risk factors for ASCVD. The multiple language options are intended to help expand use of the app to international audiences.

It may also be used by patients, and contains a patient-centered resources section for this purpose. Clinicians may also use the app together with a patient, to facilitate a discussion about ASCVD risk and possible intervention plans that match with patient preferences and goals.

Patients may find the app helpful in monitoring their own ASCVD risk. To facilitate this, the Resources section of the app includes a variety of resources targeted specifically for a patient audience. In addition, the app is designed to be used by both clinicians and patients together, to facilitate a discussion around risk stratification and a risk-lowering intervention plan that best matches patient preferences and individualized treatment goals.

No patient information is collected and stored in the app. Anonymous user behavior (e.g., number of people who downloaded the app, how many times a day the app was used) will be gathered through Google Analytics. All data collected in the app is anonymous and cannot be traced back to an individual user.

The app contains referenced content from the 2020 Expert Consensus Decision Pathway on Novel Therapies for Cardiovascular Risk Reduction in Patients with Type 2 Diabetes, the 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease, the 2018 ACC/AHA et al. Guideline on the Management of Blood Cholesterol, 2018 ACC Expert Consensus Decision Pathway on Tobacco Cessation Treatment, the 2013 ACC/AHA Guideline on the Assessment of Cardiovascular Risk, the 2017 ACC/AHA et al. Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults.

The app is an adapted version of the ASCVD Risk Estimator Plus app. The content of all documents and the resulting apps were informed by input from a variety of specialists. The app is intended to be used in concert with ACC's other cholesterol and ASCVD risk management clinical policy and tools, particularly the LDL-C Manager app. The app is part of the ACC Clinical App Collection designed to be used "on the go" to help optimize patient care. More information about ACC's Clinical App Collection can be found here.

While the ASCVD Risk Estimator Plus app itself was developed by, and is solely a product of, the American College of Cardiology, the source documentation and policy were developed jointly by the ACC and the American Heart Association.

The app has an email function for users to send a summary of their individual app sessions to a recipient of their choice which can then be transferred into EMR notes.

Contact the ACC at 1-800-253-4636 or membercare@acc.org.