Electronic clinician notification alerts were shown to be effective in improving the timely evaluation and treatment of patients with severe aortic stenosis (AS) or mitral regurgitation (MR), according to the ALERT trial presented during a Featured Clinical Research session at ACC.26 in New Orleans and simultaneously published in JACC.

Wayne B. Batchelor, MD, FACC, et al., conducted a cluster-randomized superiority trial with enrollment from August 2024 to September 2025 at 35 hospitals across five U.S. health systems that evaluated whether automated electronic clinician notification alerts identifying significant AS or MR with accompanying care recommendations to clinicians' EHR inboxes improved adherence to guideline-based performance metrics, including timely multidisciplinary health team clinic evaluation and valve intervention among patients with significant AS or MR.

In the modified intention-to-treat analysis, 765 clinicians had been randomized to an Alert group or a No Alert group, with a total of 2,016 echocardiograms. Randomization was stratified by the number of echocardiograms ordered in a two-month pre-enrollment quality control period at each site. The 376 clinicians in the Alert group ordered 1,137 echocardiograms while the 389 clinicians in the No Alert group ordered 879 echocardiograms.

Baseline patient characteristics were generally similar between the two groups. There were slightly more women and non-Hispanic patients in the Alert group (54% and 70%) than the No Alert group (49% and 64%). The distribution of AS and MR was similar between groups but echocardiograms were ordered for 42% of patients in the Alert group vs. 33% of patients in the No Alert group.

The primary endpoint was a hierarchal composite of time to surgical or transcatheter valve intervention, followed by time to multidisciplinary health team evaluation within 90 days, using the win ratio.

During the 90-day follow-up, 61 patients died: 43 patients in the Alert group and 18 in the No Alert group.

The primary endpoint analysis through the 90-day follow-up showed the electronic clinician notification alert was superior to usual care (win ratio, 1.27; p=0.007), with higher rates of valve intervention (13% vs. 10%; p=0.005) and multidisciplinary health team evaluation (23% vs. 18%; p=0.005) in the Alert vs. No Alert groups; times to both endpoints components were also shorter. Of note, the effect sizes were similar for AS and MR patients (win ratio, 1.29 and 1.23, respectively), and results were similar across subgroups.

Results suggest that electronic clinician notification alerts may help reduce undertreatment of valvular heart disease and improve access to specialized valve care, according to the researchers.

"Automated [electronic clinician notification] alerts improved the timeliness of guideline-directed evaluation and valve intervention for clinically significant AS and MR across diverse patient populations, care settings and health systems. These findings suggest that EHR-integrated clinical decision support may represent a scalable strategy to reduce the undertreatment of [valvular heart disease] and improve timely access to specialized care," conclude the trial authors.

Clinical Topics: Valvular Heart Disease, Mitral Regurgitation

Keywords: ACC Annual Scientific Session, ACC26, New Orleans, Mitral Valve Insufficiency, Aortic Valve Stenosis, Patient Care Team, Quality Control