TOPLINE:
The Million Hearts Model, a US Centers for Medicare & Medicaid Services (CMS) initiative that encouraged and paid healthcare organizations to assess and reduce cardiovascular disease (CVD) risk, reduced first-time myocardial infarction (MI) and strokes among Medicare beneficiaries without significant changes in Medicare spending, a randomized trial finds.
METHODOLOGY:
Researchers assessed the Million Hearts CVD Risk Reduction Model in a pragmatic, cluster-randomized trial among 342 healthcare organizations — half in the intervention group and half in the standard care control group.
Among 218,684 medium- or high-risk Medicare beneficiaries (median age, 72 years), 130,578 were in the intervention group in which Medicare paid for guideline-concordant care including routine CVD risk assessment, and 88,286 were in the standard care group.
Outcomes included first time CVD events (eg, MI, stroke, transient ischemic attack), combined first-time CVD events and CVD deaths, and Medicare spending.
TAKEAWAY:
Over a median follow-up of 4.3 years, the intervention group had a 3.3% lower rate of CVD events than the control group (adjusted hazard ratio [HR], 0.97 [90% CI, 0.93 - 1.00]; P = .09) and a 4.2% lower rate of combined first-time CVD events and CVD deaths (HR, 0.96 [90% CI, 0.93 - 0.99]; P = .02).
These relative effects represent an absolute reduction of 0.3 percentage points in the probability of a CVD event over 5 years (7.8% intervention vs 8.1%) and 0.4 percentage points in the probability of a CVD event or CVD death over 5 years (9.3% intervention vs 9.7% control).
