New assessment tool may improve predictions of CV risk, impact of preventive treatments

A new assessment tool aims to help predict the 10-year risk of atherosclerotic cardiovascular disease (ASVCD) and how that risk may change over time as preventive treatments are initiated.

The Million Hearts® Model Longitudinal ASCVD Risk Assessment tool is an extension of the ASCVD Pooled Cohort Equations first published in the 2013 American College of Cardiology/ American Heart Association (ACC/AHA) Guideline on the Assessment of Cardiovascular Risk. It was funded by CMS in partnership with the ACC and AHA. The tool was described in a special report published online Nov. 4 by the Journal of the American College of Cardiology and Circulation.

The new tool aims to provide a framework for delivering appropriate risk-reducing strategies to Medicare patients with a 10-year ASCVD risk greater than 30%. Use of the tool involves three steps:

1. 1. Estimating baseline 10-year risk;
2. 2. Considering potential benefits of therapies alone and in combination; and
3. 3. Assessing updated ASCVD risk at a follow-up visit based on response to therapy.

The tool is based on a formal systematic review of the evidence on aspirin therapy, blood pressure control, cholesterol management, and smoking cessation to define the expected risk reduction from each element alone or in combination. To quantify the potential effect of evidence-based therapies on ASCVD risk, researchers estimated the 10-year predicted “natural history” risk of ASCVD and simulated the expected average risk reduction associated with a given therapeutic intervention. They then estimated the updated risk for ASCVD at a follow-up visit in patients who adopted a risk-reducing therapy, such as blood pressure or statin medications, based on the actual observed change in blood pressure or low-density lipoprotein cholesterol level, for example.

The researchers wrote that their objective was to create an innovative tool that will assist policymakers, clinicians, and patients in estimating the anticipated effects of different preventive interventions and combinations of interventions on ASCVD risk reduction in the Medicare population. They noted that an online version of the tool developed for CMS and participating medical practices will be assessed in high-risk primary prevention Medicare patients as part of the Million Hearts Cardiovascular Risk Reduction Model and that the ACC plans to develop an app for mobile devices as well as an interactive web-based tool. “Future work should assess the tool in other patient groups and clinical settings prior to its widespread application,” the researchers wrote.