The Public-Private Initiative Changing America's Cardiovascular Health
In 2012, faced with this staggering burden, the U.S. Department of Health and Human Services launched an audacious initiative called Million Hearts® with a single, clear goal: prevent 1 million heart attacks and strokes within five years 1 . What made this initiative different was its innovative approach—uniting public and private sectors in a coordinated attack on cardiovascular disease from multiple fronts 2 .
Annual deaths from cardiovascular disease
Annual cost in healthcare and lost productivity
Heart attacks and strokes to prevent
Cardiovascular disease remains the leading cause of death in the United States for men and women across all races and ethnicities 7 . Despite having effective tools for prevention and treatment, these interventions remained significantly underutilized .
Million Hearts® emerged as a coordinated response, co-led by the Centers for Disease Control and Prevention (CDC) and the Centers for Medicare & Medicaid Services (CMS) 3 . The initiative's strength comes from its ability to align diverse partners—including federal agencies, state and local health departments, health care systems, clinicians, pharmacists, insurers, community organizations, and consumer groups—around a shared aim and evidence-based strategies 2 7 .
This network approach creates opportunities to leverage more resources, reduce costs, and create solutions that would be impossible for any single organization to tackle alone 2 .
The initiative's strategy focuses on implementing a small set of priorities known to have outsized impact on cardiovascular health 1 . These are organized into two complementary approaches:
Million Hearts® supports strategies that help communities become healthier, including decreasing tobacco use, increasing physical activity, and reducing exposure to particle pollution 1 . Early initiatives included efforts to eliminate artificial trans fat from the food supply and reduce sodium consumption 7 .
In clinical settings, the initiative promotes what's known as the ABCS of heart attack and stroke prevention . This clinical focus has expanded over time to include increasing participation in cardiac rehabilitation programs and promoting team-based care models 1 .
When appropriate for at-risk patients
Managing hypertension effectively
Controlling lipid levels with statins when indicated
Supporting tobacco use prevention and quitting
Million Hearts® maintains a committed focus on specific populations experiencing inequities, including pregnant and postpartum women with hypertension, people from racial/ethnic minority groups, people with behavioral health issues who use tobacco, those with lower incomes, and people living in rural areas or other 'access deserts' 1 3 .
This health equity focus recognizes that cardiovascular disease is a primary contributor to racial disparities in life expectancy 7 . Recent campaigns like "Live to the Beat" specifically empower Black adults to pursue heart-healthy lifestyles on their own terms 6 .
One of the most innovative components of the Million Hearts® initiative is the Cardiovascular Disease Risk Reduction Model, a pragmatic, cluster-randomized trial that represented a paradigm shift in how cardiovascular risk is measured and managed 8 9 .
From 2017 to 2021, the Centers for Medicare & Medicaid Services conducted this large-scale experiment involving 516 U.S.-based primary care and specialty practices, health centers, and hospital-based outpatient clinics 9 . These organizations were randomly assigned to either an intervention group or a standard care control group.
Participating practices in the risk reduction model
Traditional quality measures typically reward clinical practices for the proportion of patients who reach specific clinical targets like blood pressure or cholesterol goals. The Million Hearts Model instead shifted the incentive focus to mean risk reduction, concentrating on treating medium- to high-risk patients who may need care the most 8 .
Organizations received performance-based payments tied to reducing the calculated cardiovascular risk scores of their high-risk patients, not just managing individual risk factors 9 .
The model demonstrated significant success over a five-year period:
| Outcome Measure | Effect Size | Statistical Significance |
|---|---|---|
| First-time CVD events (MI/stroke) | 0.3 percentage points lower | P = 0.09 |
| Combined first-time CVD events and CVD deaths | 0.4 percentage points lower | P = 0.02 |
| All-cause mortality | 4.5% reduction | Not specified |
| CHD-related mortality | 11.9% reduction | Not specified |
| Process Measure | Intervention Group | Control Group |
|---|---|---|
| CVD risk assessment completion | 69% of clinicians | 41% of clinicians |
| Appropriate medication initiation/intensification | 10% higher | Baseline rate |
Perhaps most notably, the program achieved these outcomes while being cost-neutral—program payments were offset by modest savings from reductions in health care use 8 .
| Spending Category | Effect Estimate per Beneficiary Per Month | Statistical Significance |
|---|---|---|
| CVD event spending | -$1.83 | P = 0.16 |
| Overall Medicare spending including model payments | +$2.11 | P = 0.85 |
The Million Hearts® initiative relies on a sophisticated array of data and implementation tools to track progress, identify disparities, and support evidence-based interventions:
Provides county-level maps of heart disease and stroke. Displays social determinants of health and health services data; supports geographic analysis of disparities 5 .
Promotes data-driven decision making. Provides access to detailed mortality data; includes timeliness and public accessibility 5 .
Enables tracking of state-level chronic disease data. Includes 124 indicators covering social determinants, behavioral risk factors, and health outcomes 5 .
Helps practices calculate performance measures. Allows tracking of blood pressure control, smoking cessation, and aspirin use over time 5 .
| Tool | Function | Key Features |
|---|---|---|
| Interactive Atlas of Heart Disease and Stroke | Provides county-level maps of heart disease and stroke | Displays social determinants of health and health services data; supports geographic analysis of disparities |
| CDC WONDER Database | Promotes data-driven decision making | Provides access to detailed mortality data; includes timeliness and public accessibility |
| Chronic Disease Indicators | Enables tracking of state-level chronic disease data | Includes 124 indicators covering social determinants, behavioral risk factors, and health outcomes |
| Agency for Healthcare Research Cardiovascular Treatment Outcomes Dashboard | Helps practices calculate performance measures | Allows tracking of blood pressure control, smoking cessation, and aspirin use over time |
The results of the Million Hearts® initiative speak for themselves. In its first five-year cycle (2012-2016), Million Hearts® prevented an estimated 135,000 heart attacks, strokes, and related acute cardiovascular events and saved $5.6 billion in direct medical costs 4 .
Cardiovascular events prevented (2012-2016)
Direct medical costs saved
Private partner organizations
Identified over 27,000 people with undiagnosed hypertension 4
Provided 2,260 new statin prescriptions in 12 months through cholesterol projects 4
Helped over 20,000 African Americans with uncontrolled hypertension achieve an average 10-mmHg reduction in systolic blood pressure 4
As Million Hearts® continues into its next phase (Million Hearts® 2027), the initiative remains dedicated to its founding vision while adapting to new challenges and opportunities 3 . The COVID-19 pandemic highlighted significant gaps and vulnerabilities in the nation's cardiovascular health, creating increased urgency to improve prevention efforts 4 .
The initiative continues to evolve, exploring how emerging fields like genomics and precision medicine might complement current population-based approaches to help identify high-risk individuals earlier and tailor interventions more effectively 7 .
Million Hearts® represents a powerful model of what's possible when diverse stakeholders align around common goals, evidence-based strategies, and a shared commitment to health equity. As the initiative demonstrates, preventing a million heart attacks and strokes isn't just a bold aspiration—it's an achievable goal when a nation commits to working together, one heart at a time.