Valvular & structural heart diseaseRandomised controlled trial
Electronic Provider Notification to Facilitate the Recognition and Management of Severe Aortic Stenosis: A Randomized Clinical Trial
- Randomised controlled trial
- pragmatic
- cluster
- multicentre
Authors' conclusion
In this first study of EPNs for valvular heart disease, EPNs increased rates of AVR for severe AS, lessened sex and age disparities in AVR use, and improved survival time.
Study context
- Population
- Providers who ordered a TTE with findings potentially indicative of severe aortic stenosis (AS) (aortic valve area ≤1.0 cm²), multicenter academic health system, March 2022–November 2023
- Participants
- 285 providers
- Comparison
- Electronic provider notifications vs usual care
- Electronic provider notifications (EPNs)n = 144 providers; 496 patients
- Usual caren = 141 providers; 443 patientsreference
- Primary endpoint
- Proportion of patients with severe AS receiving AVR
- Follow-up
- Within 1 year of the index TTE
Primary result
AVR within 1 year · 1 year
Odds ratio
1.62
95% CI 1.13–2.32
P = 0.009
By group
EPNs vs Usual care
OR 1.62 (95% CI 1.13–2.32); P = 0.009
As reported in the abstract
Further findings
| Outcome | EPNs | Usual care | OR (95% CI) | P value | |
|---|---|---|---|---|---|
| AVR within 1 year, symptomatic patients (subgroup) | 60.7% | 46.5% | 1.77 (1.17–2.65) | P = 0.006 | |
| AVR, by subgroup (age >80 years, women, inpatient index TTE) · age >80 years | 2.00 (1.17–3.41) | P = 0.01 | |||
| AVR, by subgroup (age >80 years, women, inpatient index TTE) · women | 2.78 (1.69–4.57) | P < 0.001 | |||
| AVR, by subgroup (age >80 years, women, inpatient index TTE) · inpatient index TTE | 2.49 (1.44–4.31) | P < 0.001 | |||
| 0.20.5125Odds ratio (log scale) |
| Outcome | difference (days) | P value |
|---|---|---|
| Restricted mean survival time · 1 year · all patients | 12 | P = 0.04 |
| Restricted mean survival time · 1 year · symptomatic patients | 23 | P = 0.01 |
Original publication
Electronic Provider Notification to Facilitate the Recognition and Management of Severe Aortic Stenosis: A Randomized Clinical Trial. Circulation. Published 30 March 2025. doi:10.1161/circulationaha.125.074470
Summarised from the published abstract; every number is checked against it