We already know that passive EHR alerts improve severe aortic stenosis management, but the DETECT AS II study now suggests a more forceful “opt-out” approach could substantially increase how many patients get timely valve replacement.
- Getting eligible patients to AV replacement within 90 days of severe AS diagnosis became an ACC/AHA-endorsed quality measure in 2024.
- This guideline shift created real institutional pressure to close the care gap, something which EHR-based algorithms have tried to improve.
Moving beyond standard passive notifications, DETECT AS II’s investigators built a valve care pathway that automatically screened transthoracic echocardiograms for severe AS findings, then routed alerts to the relevant physician’s EHR inbox.
- The key difference was that physicians could accept or decline a valve clinic referral — but if they didn’t act within two weeks, the patient was automatically referred anyway.
This small adjustment made a world of referral differences…
- The proportion of patients who saw a valve specialist within 30 days or underwent AVR within 90 days jumped from 21.8% before implementation to 47.0% after.
- Valve specialist evaluation within 30 days rose from 15.8% to 39.3%.
- AVR within 90 days climbed from 15.0% to 25.6%.
Perhaps the most important finding is where the benefit landed. The pathway improved care specifically in groups that have historically been undertreated for AS like older patients, women, nonwhite, and Hispanic individuals, and those with low mean gradients.
- That pattern suggests system-level, EHR-based automation may be a scalable way to mitigate long-standing disparities in AS care, a trend also supported by the ALERT trial.
It’s also worth noting that how the physicians responded to the alerts varied sharply by specialty, exposing a cultural divide in how ownership of these patients is perceived.
- Primary care physicians accepted the referral far more often than cardiologists (38.7% vs 16.3%) and declined it far less (19.4% vs 51.2%).
- Roughly a quarter of patients were auto-referred only because no physician acted within the two-week window.
- Cardiologists showed a notable reluctance to hand off patients to an automatic referral system.
The Takeaway
DETECT AS II is the latest EHR integration study to tell us that notifications help close the care gap in aortic stenosis. What makes its results even more important is the fact that a more aggressive notification approach might be what’s needed to truly close that gap.
