Newest Atherosclerosis Risk Calculator Aims to Adjust Predictions as Prevention Tactics Kick In

A new assessment tool backed by multiple cardiovascular associations may give clinicians a better view of how their interventions are quantifiably affecting their high-risk patients over time.

“We have these risk-score tools that have been developed, and there are a number of them, but all they do is tell you about the patient's risk today and not what approaches would be most effective to reduce that risk,” said writing committee co-chair Donald M. Lloyd-Jones, MD (Northwestern University Feinberg School of Medicine, Chicago, IL), in an interview with TCTMD.

Partnering with the Million Hearts Initiative—developed by the US Department of Health and Human Services to prevent one million heart attacks and strokes by 2017—Lloyd-Jones and colleagues at the American College of Cardiology (ACC) and the American Heart Association (AHA) developed an evaluation instrument that builds off of the preexisting atherosclerotic cardiovascular disease (ASCVD) pooled cohort equation first published in the 2013 ACC/AHA guidelines on cardiovascular risk assessment. They call it the Million Hearts Longitudinal ASCVD Risk Assessment Tool.

The US Centers for Medicare & Medicaid Services (CMS) was also in need of a method to quantify risk in this patient group, as the organization is planning a trial to study whether incentivizing physicians works to reduce patient risk, according to Lloyd-Jones. “They needed a tool to both understand who those high-risk Medicare recipients are and then also to help practitioners and patients make decisions about the most effective ways to reduce that risk,” he said.

Details on the tool were published online recently in the Journal of the American College of Cardiology.

Easy as ABCS

The resulting tool is based upon the evidence supporting “ABCS therapies,” standing for aspirin, blood-pressure lowering, cholesterol management, and smoking cessation, and is expected to predict risk out to 10 years, Lloyd-Jones explained. Clinicians are encouraged to use it at initial patient visits and then again at follow-up appointments. It is “really unique,” he said, in that “it allows you to put in the patient's actual response to [a] therapy . . . and see what the updated risk is as a result of that.”

One noticeable gap is the tool’s exclusion of diet or exercise as interventions alongside pharmaceuticals. When asked about these components, Lloyd-Jones said “those are obviously critically important pieces of any prevention visit and must remain first and foremost,” but added that the difficulty in quantifying these interventions and the lack of “routine approaches” in how to counsel patients in diet and exercise makes them unsuitable to include in a tool like this. “There is no one size fits all for those approaches the way there is, I think, consensus around aspirin, blood pressure, cholesterol, and smoking cessation,” he added.

An additional caveat is that the tool has not been evaluated in low-risk populations. However, Lloyd-Jones reported “we are actively looking” to support its use in these patients as well.

For now, he said, the Million Hearts tool is available to healthcare practices participating in the CMS clinical trial and will soon be available online and in app form to clinicians wanting to incorporate it into their practices.