Addressing Under-treatment and Health Equity in AS and MR Using an Integrated EHR Platform
Purpose
This multi-center, prospective, cluster-randomized controlled trial will evaluate Tempus Next automated notifications as an intervention to support identification and evaluation of patients possibly indicated for Valve Intervention (VI). This study will evaluate the impact of Tempus Next's automated notifications on: (1) Transcatheter or surgical procedure for AS or MR; and (2) Clinic visit with at least one member of the Multidisciplinary Heart Team (including time to evaluation) for patients with definitive or possible severe AS or MR on echocardiogram. These endpoints will also be examined within and between assigned groups according to race, ethnicity, sex, and geography. The primary question that will be answered: Do automated alerts sent to clinical providers decrease under-treatment of severe aortic stenosis and severe mitral regurgitation? The study will compare the rate of clinical follow-up and aortic valve surgery in a control group (no alerts sent) to a treatment group (alerts sent to an appropriate care provider).
Conditions
- Aortic Valve Stenosis
- Mitral Regurgitation
Eligibility
- Eligible Ages
- Over 18 Years
- Eligible Genders
- All
- Accepts Healthy Volunteers
- No
Criteria
At least one of the following three options for aortic stenosis and/or the single option
for mitral regurgitation are determined from echocardiogram findings:
1. AVA or DI (Patients with either Aortic valve area (AVA) or Dimensionless Index (DI)
measured in their echo as well as at least one hemodynamic measure above the minimum
threshold)
a. Either: i. Aortic Valve Area ≤ 1.0 cm2 ii. Dimensionless Index ≤ 0.25 b. AND ANY
of i. Aortic Mean Gradient ≥ 15 mmHg ii. Aortic Peak Gradient ≥ 30 mmHg iii. Aortic
Jet Velocity ≥ 2.75 m/s
2. AVA + OTHER (Patients with AVA and at least 1 other echo measurement in their echo
above the threshold)
1. 1.0 cm2 < Aortic Valve Area ≤ 1.2 cm2
2. AND ANY of:
i. Aortic Mean Gradient ≥ 40 mmHg ii. Aortic Peak Gradient ≥ 64 mmHg iii. Aortic Jet
Velocity ≥ 4.0 m/s
3. POSSIBLE (Possible Aortic Stenosis but requires human review) a. Aortic Valve Area
is NULL OR >1.2 cm2 b. AND ANY of: i. Aortic Mean Gradient ≥ 40 mmHg ii. Aortic Peak
Gradient ≥ 64 mmHg iii. Aortic Jet Velocity ≥ 4.0 m/s OR a. EITHER i. Aortic Valve
Area ≤ 1.0 cm2 ii. Dimensionless Index ≤ 0.25 b. AND ALL are: i. Aortic Mean
Gradient < 15 mmHg ii. Aortic Peak Gradient < 30 mmHg iii. Aortic Peak Velocity <
2.75 m/s
ALERT Study Clinical Investigation Plan Version 2.1 page 12 of 54
Any patient flagged for "POSSIBLE" does not result in automatically alerting the
provider, instead a notification is sent to the Tempus research team for manual review in
conjunction with the site Principal Investigator (PI) and if requested by Tempus or site
PI, a Steering Committee member. If clinical confirmation is received for severe aortic
stenosis from the site PI, an alert is sent to the provider. 1. Mitral Regurgitation
a. Mention of severe mitral regurgitation or moderate- severe mitral regurgitation
Any patient mentioned with only moderate MR or a lesser severity will be excluded.
Exclusion Criteria:
1. Age < 18 years
2. Patient had evidence of a prior transcatheter or surgical repair or replacement of
the target valve
3. The echocardiogram was ordered by a cardiologist on the MHT or a cardiac surgeon
4. Patient already has a scheduled clinic visit with a member of the MHT or a recent
(since the start of the study at that site ) clinic visit with the MHT, or a
scheduled transcatheter or surgical VI in the future.
Study Design
- Phase
- N/A
- Study Type
- Interventional
- Allocation
- Randomized
- Intervention Model
- Parallel Assignment
- Primary Purpose
- Health Services Research
- Masking
- None (Open Label)
Arm Groups
Arm | Description | Assigned Intervention |
---|---|---|
Experimental Automated alert |
Providers that will receive an automated alert sent via the EHR. |
|
No Intervention Control |
Care providers in the control arm will not receive an automated alert. |
|
Recruiting Locations
Nashville, Tennessee 37235
Brian Lindman, M.D.
More Details
- Status
- Recruiting
- Sponsor
- Tempus AI