JMIR Publications

ABSTRACT

Background:

The 2025 American Society of Echocardiography (ASE) guidelines incorporate multiple diagnostic pathways for assessing left ventricular diastolic function, increasing the complexity of guideline application. Digital decision support may facilitate more efficient navigation of these recommendations during routine echocardiography.

Objective:

To evaluate whether a digital decision-support tool improves diastolic assessment efficiency compared with manual guideline navigation.

Methods:

In this prospective, single-centre randomised workflow study, 266 diastolic assessments performed by four accredited cardiac sonographers were allocated to manual guideline application (n=132) or digital decision support (n=134). The primary outcome was electronically recorded assessment completion time. Two-way analysis of variance examined the effects of study arm, diastolic classification, and their interaction.

Results:

Mean assessment time was lower with digital decision support than manual guideline application (34.7 vs 49.7 seconds). The difference was greater among abnormal assessments (49.5 vs 77.4 seconds; P=0.02) than normal assessments (23.1 vs 27.9 seconds; P=0.17). Two-way analysis of variance demonstrated a significant effect of study arm (P=0.006) and an interaction between study arm and diastolic classification (P=0.034). Following log transformation, the main effect of study arm was no longer statistically significant (P=0.47), whereas the interaction remained significant (P=0.024), consistent with greater efficiency gains in abnormal assessments.

Conclusions:

Digital implementation of the 2025 ASE diastolic function guidelines was associated with shorter mean assessment times, particularly in abnormal assessments. These findings suggest that structured digital decision support may be most beneficial when navigating complex guideline-based pathways during routine echocardiography.