Email alerts boost valve replacement rates in older patients with aortic stenosis

New data finds older patients with severe aortic stenosis (AS) were more likely to receive aortic valve replacement (AVR) and survive when clinicians received automated email notifications with abnormal heart ultrasound results detecting AS. Researchers presented the late-breaking data today at the Society for Cardiovascular Angiography & Interventions (SCAI) 2026 Scientific Sessions & Canadian Association of Interventional Cardiology/Association Canadienne de cardiologie d'intervention (CAIC-ACCI) Summit in Montreal.

AS occurs when calcium gradually builds up, restricting blood flow. AS is one of the most common and serious valve diseases, affecting more than 2.5 million Americans over the age of 75. Symptoms of AS, including shortness of breath, difficulty walking, and fatigue, are frequently mistaken for normal signs of aging, leading to underdiagnosis and undertreatment. The standard treatment for AS is AVR, performed either through minimally invasive catheter-based procedures (TAVR) or open-heart surgery (SAVR). However, only about half of patients with severe symptomatic AS receive AVR, leaving many older patients at increased risk for heart failure and death. 

DETECT-AS is a pragmatic, cluster-randomized trial conducted within a multicenter health system. The trial enrolled 285 providers caring for 939 patients with severe AS (defined as aortic valve area ≤1.0 cm²). Among participants, 47% were 65-80 years old, and 41% were older than 80 years old. All patients underwent a routine ultrasound scan of the heart called a transthoracic echocardiography (TTE), and clinicians were randomly assigned to receive an electronic provider notification (EPN) when test results detected AS. These automated email alerts included a digital medical record that highlighted severe AS, summarized recommended management steps, and encouraged referral to specialized heart valve teams. Researchers evaluated the study's primary endpoint - aortic valve replacement within one year of the initial echocardiogram - across three age groups: younger than 65, ages 65–80, and older than 80. 

The study results suggest EPNs increase the likelihood of AVR treatment rates in patients over the age of 65. In patients younger than 65, one-year AVR rates did not differ between groups, with 53.8% of patients receiving treatment when providers received an EPN compared with 50% under usual care (p=0.61; OR 1.23). In patients ages 65-80, providers who received an EPN treated more patients with AVR within one year (53.9%) compared with providers who did not receive a notification (42.6%) (p=0.07; OR 1.38). The largest improvement occurred in patients over age 80, where AVR rates increased from 26% without notifications to 40.7% when providers received an EPN (p=0.01; OR: 1.89). 

Aortic stenosis is undertreated across many patient groups, and older adults experience some of the largest gaps in care. Our findings show that electronic alerts increased valve replacement rates, improved referrals to valve specialists, and improved survival among older patients. A simple email notification can help clinicians recognize severe disease earlier and connect patients with lifesaving care."

Sammy Elmariah, MD, MPH, FSCAI; Leone-Perkins Family Endowed Professor of Medicine; Chief, Interventional Cardiology; and Director of the Cardiac Catheterization Laboratory at the University of California, San Francisco

Researchers plan to explore more proactive strategies in future analyses to further increase specialist referrals and improve AVR treatment rates.