Automated EHR Alerts Improve Timely Valve Disease Evaluation

Automated electronic alerts sent to clinicians were associated with faster evaluation and treatment for patients with clinically significant aortic stenosis (AS) or mitral regurgitation (MR), according to findings from the ALERT trial published in JACC.

The trial examined whether electronic health record (EHR)-integrated electronic clinician notification (ECN) alerts could help address gaps in valve-care referral and treatment across multiple health systems. The authors noted that severe AS and MR are often undertreated, even though surgical and transcatheter valve therapies are available.

ALERT was a multisystem, cluster-randomized clinical trial involving clinicians who ordered echocardiograms across 5 U.S. health systems and 35 hospitals from August 2024 to September 2025. Clinicians were randomly assigned to receive an ECN alert when an echocardiogram identified significant AS or MR, along with care recommendations, or to continue usual care without an alert.

The modified intention-to-treat population included 765 clinicians and 2,016 echocardiograms performed in 1,905 patients. In the primary hierarchical composite endpoint, which prioritized time to surgical or transcatheter valve intervention followed by time to multidisciplinary heart team clinic evaluation within 90 days, ECN alerts were superior to usual care. The overall stratified win ratio was 1.27 (95% CI, 1.05-1.54; P = 0.007). Valve intervention occurred in 13.4% of patients in the ECN group vs 9.6% in the usual care group, and multidisciplinary heart team evaluation occurred in 22.7% vs 17.9%, respectively.

The authors concluded that automated ECN alerts improved the timeliness of evaluation and valve intervention for clinically significant AS and MR. They said EHR-based clinical decision support could help health systems identify patients who may otherwise experience delays in specialized valve care, while noting that digital alerts alone are unlikely to produce sustained improvement without local clinical pathways and institutional readiness.

Sources: Batchelor WB, Lindman BR, Coylewright M, et al. Automated alerts to improve timely evaluation and treatment of valvular heart disease: the ALERT trial. J Am Coll Cardiol. 2026;87(23):3335-3346. doi:10.1016/j.jacc.2026.03.037