Adding a simple “nudge” to echocardiography reports could help improve care for patients with asymptomatic severe aortic stenosis, according to research presented June 29 at the American Society of Echocardiography annual meeting in Aurora, CO.
In his talk, Azin Vakilpour, MD, from the University of Pennsylvania in Philadelphia presented his team’s findings, showing that their automated non-interruptive reminder on initial imaging reports led to higher one-year follow-up rates for guideline-recommended surveillance echocardiography.
“Echocardiography is the cornerstone diagnostic tool for severe aortic stenosis, and our study demonstrates that a simple, automated alert embedded directly into the echocardiogram report can meaningfully increase rates of timely referral and follow-up care, especially among non-cardiology providers,” said Vakilpour in a prepared statement.
For asymptomatic patients with severe aortic stenosis, the American College of Cardiology and the American Heart Association recommend follow-up echocardiography six to 12 months after diagnosis. However, Vakilpour noted that guideline adherence remains inconsistent. Previous research suggests that nearly half of patients do not receive guideline-recommended care.
He and colleagues studied the effectiveness of an automated, non-interruptive reminder embedded within initial echocardiogram reports diagnosing severe aortic stenosis. Their goal included finding out whether this nudge would lead to better rates of guideline-recommended follow-up echocardiography.
Final analysis included 619 patients, including 467 who were analyzed without the automated nudge and 152 with the nudge intervention. The patients did not yet receive aortic valve replacement. Vakilpour said that baseline age, sex, race, and major comorbidities did not differ between the two cohorts.
The automated nudge led to guideline-recommended surveillance echo increasing by 7.4%. And in competing-risk analysis accounting for mortality, the one-year cumulative incidence of follow-up echocardiography increased by 11.7%.
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Follow-up echocardiography adherance with, without automated nudge on initial echo reports |
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|
Measure |
No nudge |
Nudge |
|
Frequency of echo within 6 to 12 months |
30.8% |
38.2% |
|
One-year cumulative incidence of follow-up echo |
48.8% |
60.5% |
The researchers also found no difference in the cumulative incidence of death between the two cohorts.
Vakilpour said these report-based nudges could be a scalable strategy to improve longitudinal surveillance in aortic stenosis patients.
“This scalable, low-cost intervention requires no change in clinical workflow and has the potential to bridge the persistent gap between diagnosis and appropriate care across diverse healthcare settings,” he said.