Severe aortic stenosis (AS) and mitral regurgitation (MR) remain undertreated despite established therapies, with persistent disparities across demographic and healthcare access factors. A multisystem, cluster-randomized clinical trial published in the Journal of American College of Cardiology assessed whether electronic clinician notification (ECN) alerts embedded in electronic health records could enhance guideline-directed evaluation and intervention.

The ALERT trial enrolled clinicians ordering echocardiograms across five United States health systems, including 35 hospitals, between August 2024 and September 2025. A total of 765 clinicians and 2,016 echocardiograms were analyzed. Clinicians were randomized 1:1 to receive ECN alerts identifying significant AS or MR with care recommendations or to usual care without alerts. 

The primary endpoint was a hierarchical composite of time to valve intervention (surgical or transcatheter), followed by time to multidisciplinary heart team evaluation within 90 days, assessed using a stratified win-ratio approach.

ECN alerts demonstrated superiority over usual care for the primary endpoint (win ratio 1.27; 95% CI 1.05–1.54; P=0.007). Patients in the alert group had higher rates of valve intervention (13.4% vs 9.6%; P=0.005) and multidisciplinary evaluation (22.7% vs 17.9%; P=0.005), along with shorter times to both outcomes. Consistent effects were observed in AS (win ratio 1.29) and MR (win ratio 1.23), with no heterogeneity across prespecified subgroups (Pint >0.100).

Automated ECN alerts improved timely evaluation and intervention for significant valvular disease. These findings support electronic decision support as a scalable approach to optimize valve care delivery.