Abstract
BACKGROUND: Aortic stenosis (AS) and mitral regurgitation (MR) are common cardiac conditions associated with significant morbidity and mortality if left untreated. Despite the availability of effective therapies, many patients with severe AS and MR do not receive timely interventions, with disparities particularly affecting minority populations, women, and those in rural areas. METHODS: The Addressing undertreatment and heaLth Equity in aortic stenosis and mitral regurgitation using an integrated ehR plaTform (ALERT) study is a multicenter, prospective, cluster-randomized controlled trial designed to evaluate the impact of automated electronic health record notifications on the management of severe AS and MR. This cluster-randomized controlled trial involves at least 5 US hospital systems. Providers are randomized to receive automated notifications or not receive notifications, based on echocardiogram report findings. The primary end point is a hierarchical composite of transcatheter or surgical valve intervention (valve intervention) or multidisciplinary heart team clinic visit within 90 days. The study aims to randomize at least 600 providers and 1500 total patients 1:1 into each study arm, hypothesizing that automated notifications increase the proportion of patients receiving appropriate evaluation and treatment. RESULTS: The results of the study are pending completion of enrollment and should be available in Q2 2026. CONCLUSIONS: The ALERT study leverages integrated electronic health record platforms to address undertreatment in severe AS and MR, with the potential to improve patient outcomes and reduce disparities in care.