Automated Alerts to Improve Timely Evaluation and Treatment of Valvular Heart Disease: The ALERT Trial Issue (JACC June 2026-2)-Artice: Automated Alerts to Improve Timely Evaluation and Treatment of Valvular Heart Disease: The ALERT Trial

Pdf Summary

The ALERT trial tested whether automated electronic clinician notifications (ECN) built into the electronic health record could improve care for patients with significant aortic stenosis (AS) or mitral regurgitation (MR). This was a multicenter, cluster-randomized trial across 5 U.S. health systems and 35 hospitals, involving 765 clinicians and 1,905 patients in the primary analysis.<br /><br />Clinicians were randomized to receive alerts when echocardiograms showed significant AS or MR, along with guideline-based care recommendations, or to usual care without alerts. The main outcome was a hierarchical composite of timely valve intervention or multidisciplinary heart team (MHT) evaluation within 90 days.<br /><br />Results showed that ECN alerts were superior to usual care. Alerts increased the likelihood of the primary endpoint (win ratio 1.27; P=0.007), with more valve interventions (13.4% vs 9.6%) and more MHT evaluations (22.7% vs 17.9%). Time to both evaluation and treatment was shorter in the alert group. Benefits were similar for AS and MR, and there was no meaningful variation across subgroups defined by age, sex, race, social deprivation, inpatient/outpatient setting, provider specialty, or rurality.<br /><br />For AS, alerts clearly improved valve intervention, especially in high-gradient disease. For MR, alerts increased MHT evaluation but did not clearly increase intervention within the 90-day follow-up period, suggesting longer follow-up may be needed.<br /><br />Overall, the study concludes that automated, EHR-integrated alerts can improve timely guideline-directed care for valvular heart disease and may be a scalable tool to reduce undertreatment. However, alerts alone may not fully eliminate existing disparities or workflow barriers.

Meta Tag

Concept ALERT trial

Concept Automated electronic clinician notification

Concept Aortic Stenosis

Concept Mitral Regurgitation

Concept Guideline-Directed Care

Keywords

ALERT trial

electronic clinician notifications

aortic stenosis

mitral regurgitation

electronic health record

valve intervention

multidisciplinary heart team

cluster-randomized trial

guideline-directed care

valvular heart disease

ALERT trial

Automated electronic clinician notification

Aortic Stenosis

Mitral Regurgitation

Guideline-Directed Care