General Cardiovascular Risk Assessment Scores

SMART-REACH Calculator

Clinical calculation support · Verify results before clinical use

Recurrent Cardiovascular Risk Assessment

Enter the patient's clinical profile to estimate recurrent cardiovascular risk and event-free life expectancy.

—10-year risk

Patient characteristics

The original SMART-REACH model was developed for adults with established coronary, cerebrovascular, and/or peripheral artery disease.

Age (years; 45–89)

Sex

Reference population

Systolic blood pressure (mmHg)

Total cholesterol (mmol/L)

Serum creatinine (µmol/L)

Number of vascular disease locations

Clinical history and risk factors

Select all conditions that apply. At least one established vascular disease location is required by the model.

Current smoker Diabetes mellitus History of atrial fibrillation History of congestive heart failure

10-year recurrent cardiovascular risk—Adjusted for competing non-cardiovascular mortality

Lifetime recurrent cardiovascular risk—Estimated from current age through age 90

Event-free life expectancy—Median age at which event-free survival reaches 50%

About the SMART-REACH Model

SMART-REACH (Secondary Manifestations of Arterial Disease–Reduction of Atherothrombosis for Continued Health) estimates the risk of recurrent major cardiovascular events and life expectancy free from recurrent cardiovascular events in people with established vascular disease.

The original model defines recurrent cardiovascular events as myocardial infarction, stroke, or cardiovascular death. Non-cardiovascular mortality is handled as a competing event using two Fine and Gray competing-risk models.

Model predictors

Age and sex
Current smoking and diabetes mellitus
Systolic blood pressure, total cholesterol, and serum creatinine
Number of vascular disease locations: coronary, cerebrovascular, and peripheral artery disease
History of atrial fibrillation and congestive heart failure

Population and interpretation

The original model was developed in the REACH Western Europe cohort and externally validated in the SMART (Dutch) and REACH North American cohorts. Geographic adjustment is available for the Dutch and North American validation populations. The base model is not specifically recalibrated for Indonesia.

Risk estimates are prognostic estimates, not deterministic predictions. They should support, not replace, clinical assessment and shared decision-making.

References

Kaasenbrood L, Bhatt DL, Dorresteijn JAN, et al.Estimated Life Expectancy Without Recurrent Cardiovascular Events in Patients With Vascular Disease: The SMART-REACH Model. J Am Heart Assoc. 2018;7(16):e009217. DOI: 10.1161/JAHA.118.009217.

Visseren FLJ, Mach F, Smulders YM, et al.2021 ESC Guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J. 2021;42(34):3227–3337. DOI: 10.1093/eurheartj/ehab484.

Dwiputra B, Desandri DR, Hartopo AB, et al.Risk estimation for recurrent cardiovascular events using the SMART-REACH model and direct inpatient cost profiling in Indonesian ASCVD patients: a large-scale multicenter study. Front Cardiovasc Med. 2024;11:1425703. DOI: 10.3389/fcvm.2024.1425703.

Clinical disclaimer: This calculator is intended for healthcare professionals as a clinical decision-support aid. SMART-REACH was developed and validated in specific European and North American cohorts; estimates may not be calibrated for other populations, including Indonesia. Do not use this estimate as the sole basis for treatment decisions. Confirm input data, assess comorbidities and current clinical status, and apply appropriate clinical judgement.