Prevention & lipidsRandomised controlled trial
Effects of the Million Hearts Model on Myocardial Infarctions, Strokes, and Medicare Spending
- Randomised controlled trial
- pragmatic
- cluster-randomized
Authors' conclusion
The Million Hearts Model, which encouraged and paid for CVD risk assessment and reduction, reduced first-time MIs and strokes.
Study context
- Population
- Medicare fee-for-service beneficiaries aged 40 to 79 years, no previous MI or stroke, high or medium cardiovascular disease (CVD) risk (CVD risk score ≥15%), 2017–2018516 organizations randomised
- Participants
- 130,578 vs 88,286
- Comparison
- Million Hearts Model intervention vs standard care
- Interventionn = 130,578
- Standard caren = 88,286reference
- Primary endpoint
- First-time CVD events (myocardial infarctions (MIs), strokes, TIAs) in Medicare claims
- Follow-up
- Up to 5 years
Primary result
First-time CVD event
Adjusted hazard ratio
0.97
90% CI 0.93–1.00
P = 0.09
Intervention vs Standard care
adjusted HR 0.97 (90% CI 0.93–1.00); P = 0.09
As reported in the abstract
Further findings
| Outcome | HR (90% CI) | P value | |
|---|---|---|---|
| Combined first-time CVD events and CVD deaths · up to 5 years · 0.4 percentage points lower; 4.2% relative effect | 0.96 (0.93–0.99) | P = 0.02 | |
| 0.512Hazard ratio (log scale) |
Medicare spending for CVD events
- Similar between the groups; effect estimate per beneficiary per month
- -$1.83 (90% CI, -$3.97 to -$0.30); P = .16
Overall Medicare spending incl. model payments
- Similar between the groups; effect estimate per beneficiary per month
- $2.11 (90% CI, -$16.66 to $20.89); P = .85
Original publication
Effects of the Million Hearts Model on Myocardial Infarctions, Strokes, and Medicare Spending. JAMA. Published 17 October 2023. doi:10.1001/jama.2023.19597
Summarised from the published abstract; every number is checked against it