Author + information
- Published online March 20, 2017.
- Donald M. Lloyd-Jones, MD, ScM, FAHA, FACC,
- Mark D. Huffman, MD, MPH, FAHA, FACC,
- Kunal N. Karmali, MD, MS, FACC,
- Darshak M. Sanghavi, MD,
- Janet S. Wright, MD, FACC,
- Colleen Pelser, PhD,
- Martha Gulati, MD, MS, FAHA, FACC,
- Frederick A. Masoudi, MD, MSPH, FAHA, FACC and
- David C. Goff Jr., MD, PhD, FAHA
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 assess 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.
- AHA Scientific Statements
- cardiovascular diseases
- myocardial infarction
The American Heart Association and the American College of Cardiology make every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel. Specifically, all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that might be perceived as real or potential conflicts of interest.
This document was approved by the American Heart Association Science Advisory and Coordinating Committee on September 30, 2016, and the American Heart Association Executive Committee on October 17, 2016, and by the American College of Cardiology Board of Trustees on October 7, 2016.
The American College of Cardiology requests that this document be cited as follows: Lloyd-Jones DM, Huffman MD, Karmali KN, Sanghavi DM, Wright JS, Pelser C, Gulati M, Masoudi FA, Goff DC Jr. Estimating longitudinal risks and benefits from cardiovascular preventive therapies among Medicare patients: the Million Hearts Longitudinal ASCVD Risk Assessment Tool: a special report from the American Heart Association and American College of Cardiology. J Am Coll Cardiol 2017;69:1617–36.
This article has been copublished in Circulation.
Copies: This document is available on the websites of the American Heart Association (professional.heart.org) and the American College of Cardiology (www.acc.org). For copies of this document, please contact Elsevier Reprint Department via fax (212-633-3820) or e-mail ( ).
Permissions: Multiple copies, modification, alteration, enhancement, and/or distribution of this document are not permitted without the express permission of the American College of Cardiology. Requests may be completed online via the Elsevier site (http://www.elsevier.com/about/policies/author-agreement/obtaining-permission).
- 2017 American Heart Association, Inc., and the American College of Cardiology Foundation
- The Million Hearts Initiative: Preventing 1 Million Heart Attacks and Strokes
- Methods of Tool Development
- The Million Hearts Longitudinal ASCVD Risk Assessment Tool
- Recommendations for Use in Clinical Practice
- Potential Limitations
- Conclusions and Implications