The American Heart Association (AHA) has identified a key metric in the management of aortic stenosis: the percentage of patients undergoing aortic valve replacement (AVR) for symptomatic severe aortic stenosis within 90 days of diagnosis. Despite this, there is a clear unmet need for effective, low-cost, and scalable tools to bolster guideline-driven management of severe aortic stenosis. **A New Approach to Aortic Valve Care**
A new study published in Circulation has shown that a personalized alert system can improve the quality of aortic valve care. The DETECT-AS study, conducted within the Massachusetts General Hospital academic health system, found that the alert increased the rate of AVR and reduced treatment disparities, including in elderly patients and women. The study, which was presented at the American College of Cardiology (ACC) 2025 Scientific Session, involved 496 patients with severe aortic stenosis on echocardiography. The patients were randomly assigned to either receive a personalized alert via the electronic medical record (EMR) and email or usual care. For the intervention group, 144 clinicians enrolling 496 patients were sent a notification highlighting the detection of severe or potentially severe aortic stenosis. The type of aortic stenosis was clarified by subtype, and guideline-based recommendations for management and further evaluation were provided. The alert was customized to provide specific guideline-based recommendations for further diagnostic testing, referral, and treatment where appropriate. Four versions of the notifications were generated based on thresholds for mean valve gradients and left ventricular ejection fraction. **Key Findings**
The study found that the rate of AVR at 1 year was significantly higher with the electronic notification than with usual care (48.2% vs 37.2%; P = 0.009). In symptomatic patients, more than 60% underwent valve replacement by 1 year compared with 47% in the usual care group (P = 0.001). Within 90 days of TTE, 25.8% of patients in the electronic notification arm underwent AVR compared with 19.0% in the usual-care group (P = 0.02). Among symptomatic patients, the respective 90-day rates were 37.7% and 26.6% in the intervention and usual-care groups (P = 0.04). **Impact on Treatment Disparities**
The alert led to higher rates of valve replacement at 1 year in all subgroups, but the gains were more pronounced in patients older than 80 years and in women. The study also found that the alert led to more patients receiving an ICD-10 billing code indicative of clinically recognized aortic stenosis at both 90 and 180 days. Among primary-care physicians and other noncardiologists, a cardiology referral was more common when clinicians received the alert than it was with usual care (63.4% vs 39.5%; P = 0.004). Similarly, cardiologists who received the alert were more likely to refer to valve specialists, although the difference wasn’t statistically significant (41.2% vs 34.3% with usual care; P = 0.09). **Limitations and Future Directions**
The study was not powered for survival, and there was no difference between the two groups at 1 year. However, there was a strong trend suggesting prolonged survival in patients being cared for by notified providers. Despite these limitations, the study demonstrates the potential of personalized alerts to improve aortic valve care. The results may not be generalizable to less integrated health care systems, and the ongoing trial may have influenced referral patterns. Still, the researchers observed “robust improvement” in referrals for aortic valve replacement by 1 year, and the findings suggest that the alert may be a useful tool in bolstering guideline-driven management of severe aortic stenosis. **A Call to Action**
As Dr. Sammy Elmariah said, “We are still only treating 60% of patients with symptomatic severe stenosis at 1 year. We’re nowhere close to getting the types of results in 90 days advocated by the AHA and ACC with their initiatives. As a result, an alert that is a little more robust may be needed.”
To improve aortic valve care, more effective and scalable tools are needed to bolster guideline-driven management of severe aortic stenosis. The personalized alert system demonstrated in the DETECT-AS study has the potential to play a key role in this effort. Example of a Personalized Alert
The alert system used in the DETECT-AS study was a passive alert sent to the physician’s inbox or EMR.

“The future of healthcare is not just about treating patients, but also about ensuring that they receive the right care at the right time. Personalized alerts can play a critical role in this effort.” – Dr. Sammy Elmariah

Key Takeaways
* A personalized alert system can improve the quality of aortic valve care. * The alert increased the rate of AVR and reduced treatment disparities, including in elderly patients and women. * The study found that the alert led to higher rates of valve replacement at 1 year in all subgroups, but the gains were more pronounced in patients older than 80 years and in women. * The study demonstrates the potential of personalized alerts to improve aortic valve care, but more effective and scalable tools are needed to bolster guideline-driven management of severe aortic stenosis.