Electronic Provider Notification Mitigates Age Disparities in the Treatment of Severe Aortic Stenosis: Insights from the DETECT AS Trial
Presenter
Sammy Elmariah, M.D., FSCAI, The University of California, San Francisco, Corte Madera, CA
Sammy Elmariah, M.D., FSCAI1, Roukoz Abou-Karam, MD2, Fangzhou Cheng, BS2, Rong Duan, MS3, Mohammad Forouzannia3 and Varsha Tanguturi, MD2, (1)The University of California, San Francisco, Corte Madera, CA, (2)Massachusetts General Hospital, Boston, MA, (3)The University of California, San Francisco, San Francisco, CA
Keywords: Diversity Equity and Inclusion (DEI), Quality and TAVI/TAVR/Aortic Valve
Background
. Age-related disparities limit access to aortic valve replacement (AVR) for severe aortic stenosis (AS) and disproportionately expose older patients to adverse outcomes. While electronic provider notifications (EPN) improve AVR utilization, their impact on age-based disparities is unknown.
Methods
. DETECT AS was a pragmatic, cluster-randomized trial conducted across a multicenter health system. Clinicians caring for patients with severe AS (aortic valve area ≤1.0 cm²) were randomized to receive electronic provider notifications (EPN) or usual care. Notifications delivered via email and the electronic medical record highlighted severe AS and relevant guideline recommendations. The primary endpoint was receipt of AVR within 1 year of index transthoracic echocardiography, with analyses stratified by age (<65, 65–80, >80 years).
Results
. We enrolled 285 providers caring for 939 patients with severe AS; 47% were aged 65-80 and 41% >80 years. AVR rates did not differ in patients <65 years (53.8% EPN vs. 50.0% usual care; p=0.61). In contrast, EPN was associated with higher AVR rates in patients aged 65-80 (53.9% vs. 42.6%; p=0.07) and >80 years (40.7% vs. 26.0%; p=0.01). Multivariable adjustment demonstrated greater EPN efficacy in older patients (age <65: OR 1.28, p=0.39; age 65-80: OR 1.38, p=0.05; age >80: OR 1.89, p=0.007; Figure). EPN also improved specialist referral for AS and survival in older patients.
Conclusions
. In patients with severe AS, electronic provider notification associated with higher rates of AVR and improved survival, with the greatest benefit observed in older patients. 