Automated Alerts to Improve Timely Evaluation and Treatment of Valvular Heart Disease: The ALERT Trial.

Whether automated electronic clinician notification (ECN) alerts improve the evaluation and treatment of AS and MR across health systems is unknown.

自动化电子临床通知（ECN）警报是否能改善健康系统中AS和MR的评估和治疗尚不清楚。

The purpose of this study was to evaluate whether ECN alerts improve guideline-directed evaluation and treatment of significant AS and MR across multiple health systems.

本研究的目的是评估ECN警报是否能改善在多个卫生系统中对显著主动脉瓣狭窄(AS)和二尖瓣反流(MR)的指南导向评估和治疗。

Methods

ALERT is a multisystem, cluster-randomized clinical trial including clinicians ordering echocardiograms across 5 U.S. health systems encompassing 35 hospitals between August 2024 and September 2025.

ALERT是一项多系统、群组随机临床试验，包括在美国5个卫生系统中的35家医院，涉及在2024年8月至2025年9月期间开具心脏超声检查的临床医生。

Clinicians were randomized 1:1 to receive an ECN alert identifying significant AS or MR with accompanying care recommendations or to no alert with usual care.

临床医生被随机分为1:1，一组接收ECN警报，该警报识别重要的主动脉瓣或二尖瓣疾病，并附带相应的护理建议；另一组则不接收警报，进行常规护理。

The primary endpoint was a hierarchical composite of time to surgical or transcatheter valve intervention, followed by time to multidisciplinary heart team clinic evaluation within 90 days, analyzed using the stratified win-ratio method.

主要终点是一个分层的复合终点，首先是手术或经导管瓣膜干预的时间，其次是90天内多学科心脏团队诊所评估的时间，使用分层胜率比方法进行分析。

Secondary outcomes included individual components of the composite.

次要结果包括复合指标的各个组成部分。

Results

A total of 765 clinicians ordering 2,016 echocardiograms were included.

共有765名临床医生开具了2016次超声心动图检查。

In the win-ratio analysis of the primary endpoint, ECN alert was superior to usual care (win ratio: 1.27; 95% CI: 1.05-1.54; P = 0.007), including higher rates of valve intervention (13.4% vs 9.6%; P = 0.005) and multidisciplinary heart team evaluation (22.7% vs 17.9%; P = 0.005) and shorter times to both endpoint components.

在主要终点的胜率分析中，ECN警报优于常规护理（胜率：1.27；95%置信区间：1.05-1.54；P = 0.007），包括更高的瓣膜干预率（13.4%对9.6%；P = 0.005）和多学科心脏团队评估率（22.7%对17.9%；P = 0.005），以及两个终点成分的到达时间更短。

Effect sizes were similar in AS (win ratio: 1.29) and MR patients (win ratio: 1.23).

AS患者（胜率：1.29）和MR患者（胜率：1.23）的效果大小相似。

No evidence of heterogeneity was noted by valve pathology (Pint = 0.821) or across prespecified subgroups (age, sex, race, social deprivation index, inpatient vs outpatient setting, provider specialty, and rurality; Pint > 0.100 for all) and sensitivity analyses yielded consistent results across modified intention-to-treat, intention-to-treat, and per-protocol populations.

在这项多系统群组随机试验中，自动化ECN警报改善了对临床显著主动脉瓣狭窄（AS）和二尖瓣反流（MR）的及时指南指导评估和瓣膜干预。

Conclusions

In this multisystem cluster randomized trial, automated ECN alerts improved timely guideline-directed evaluation and valve intervention for clinically significant AS and MR.

在这项多系统群组随机试验中，自动化ECN警报改善了对临床显著主动脉瓣狭窄(AS)和二尖瓣反流(MR)的及时指南指导评估和瓣膜干预。

These findings suggest that electronic health record-integrated clinical decision support may represent a scalable strategy to reduce undertreatment and improve access to specialized valve care.

这些发现表明，集成到电子健康记录中的临床决策支持可能代表了一种可扩展的策略，以减少治疗不足并改善对专业瓣膜护理的获取。

(Addressing Under-treatment and Health Equity in AS and MR Using an Integrated EHR Platform; NCT06099665).

(使用集成EHR平台解决主动脉瓣狭窄和二尖瓣关闭不全的治疗不足和健康公平问题; NCT06099665)。