An automated reminder embedded in echocardiography reports increases follow-up care rates for asymptomatic severe aortic stenosis patients, helping close the gap between diagnosis and appropriate guideline-recommended surveillance without disrupting clinical workflows.
- The automated nudge increased guideline-recommended surveillance echocardiography by 7.4% and one-year cumulative follow-up incidence by 11.7%
- Follow-up echocardiography within 6 to 12 months rose from 30.8% to 38.2% with the automated nudge intervention
- The American College of Cardiology and American Heart Association recommend follow-up echocardiography six to 12 months after diagnosis for asymptomatic severe aortic stenosis
- This low-cost, scalable intervention requires no change in clinical workflow and can be implemented across diverse healthcare settings
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%.
Follow-up echocardiography adherance with, without automated nudge on initial echo reports | ||
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.
![Examples of ultrasound findings and techniques. (A) Images in a 39-year-old male patient with a mass in the left thigh. The mass is heterogeneous on the B-mode US image (compared with the patient in D) and showed increased microvascularity (superb microvascular imaging [SMI]) and shear-wave elastography (SWE) values. Undifferentiated pleomorphic sarcoma was diagnosed at biopsy (with pleomorphic rhabdomyosarcoma in surgical specimen). (B) Images in an 18-year-old male patient with a mass in the left leg. The mass is hypoechoic on the B-mode image, with no other findings suggestive of malignancy. The lesion is in contact with the cortex of the tibia, which is slightly irregular. CT revealed a doubtful anteromedial tibial erosion. The microvascular study demonstrated high vascularization, suggestive of malignancy. Periosteal Ewing sarcoma was diagnosed with both histologic and immunohistochemical confirmation. (C) Images in a 69-year-old female patient with a lump growing on the outside of the left leg. Multiple SWE examinations were performed (please note the high values obtained in the measurements, whereas the color map highlights the stiffness relative to adjacent tissues). SMI showed areas of increased vascularization to target for sampling. Undifferentiated spindle cell sarcoma was diagnosed at biopsy, with residual leiomyosarcoma in the surgical specimen after neoadjuvant therapy. (D) Images in a 56-year-old female patient with a mass in the right thigh. The mass is heterogeneous at both B-mode ultrasound (similar to patient A) and MRI (coronal T2-weighted spectral attenuated inversion recovery [SPAIR]; T1-weighted pre-contrast and postcontrast imaging), which even shows uptake after the administration of paramagnetic contrast material, which is traditionally suggestive of malignancy. Low values at SMI and elastography are suggestive of benignity. Spindle cell lipoma was diagnosed at biopsy, with atypical spindle cell lipomatous tumor in the surgical specimen.](https://img.auntminnie.com/mindful/smg/workspaces/default/uploads/2026/08/images-radiol250278fig2.APCFLSvX6p.jpg?auto=format%2Ccompress&fit=crop&h=100&q=70&w=100)
![Examples of ultrasound findings and techniques. (A) Images in a 39-year-old male patient with a mass in the left thigh. The mass is heterogeneous on the B-mode US image (compared with the patient in D) and showed increased microvascularity (superb microvascular imaging [SMI]) and shear-wave elastography (SWE) values. Undifferentiated pleomorphic sarcoma was diagnosed at biopsy (with pleomorphic rhabdomyosarcoma in surgical specimen). (B) Images in an 18-year-old male patient with a mass in the left leg. The mass is hypoechoic on the B-mode image, with no other findings suggestive of malignancy. The lesion is in contact with the cortex of the tibia, which is slightly irregular. CT revealed a doubtful anteromedial tibial erosion. The microvascular study demonstrated high vascularization, suggestive of malignancy. Periosteal Ewing sarcoma was diagnosed with both histologic and immunohistochemical confirmation. (C) Images in a 69-year-old female patient with a lump growing on the outside of the left leg. Multiple SWE examinations were performed (please note the high values obtained in the measurements, whereas the color map highlights the stiffness relative to adjacent tissues). SMI showed areas of increased vascularization to target for sampling. Undifferentiated spindle cell sarcoma was diagnosed at biopsy, with residual leiomyosarcoma in the surgical specimen after neoadjuvant therapy. (D) Images in a 56-year-old female patient with a mass in the right thigh. The mass is heterogeneous at both B-mode ultrasound (similar to patient A) and MRI (coronal T2-weighted spectral attenuated inversion recovery [SPAIR]; T1-weighted pre-contrast and postcontrast imaging), which even shows uptake after the administration of paramagnetic contrast material, which is traditionally suggestive of malignancy. Low values at SMI and elastography are suggestive of benignity. Spindle cell lipoma was diagnosed at biopsy, with atypical spindle cell lipomatous tumor in the surgical specimen.](https://img.auntminnie.com/mindful/smg/workspaces/default/uploads/2026/08/images-radiol250278fig2.APCFLSvX6p.jpg?auto=format%2Ccompress&dpr=2&fit=crop&h=167&q=70&w=250)
