What are the outcomes of a dedicated hypertension program for patients with primary aldosteronism (PA)?
In this population-based cohort study in Alberta, Canada, substantial variation was noted in the investigation and treatment rates for PA. Receipt of screening, subtyping, and disease-targeted treatment was most strongly linked to certain geographic zones and clinician specialty, reflecting the resource-limited nature of adrenal vein sampling and adrenalectomy and underscoring the benefits of a dedicated hypertension program for patients with PA.
A system-level approach to assist with investigation and treatment of PA may be highly effective in closing care gaps and improving clinical outcomes.
Primary aldosteronism (PA) is one of the most common causes of secondary hypertension but remains largely unrecognized and untreated.
To understand the outcomes of a specialized clinic on rates of evaluation and treatment of PA in the context of secondary factors.
Design, Setting, and Participants
This population-based cohort study was conducted in Alberta, Canada, using linked administrative data between April 1, 2012, and July 31, 2019, on adults identified as having hypertension.
Main Outcomes and Measures
We evaluated each step of the diagnostic and care pathway for PA to determine the proportion of people with hypertension who received screening, subtyping, and targeted treatment for PA. Variations in diagnosis and treatment were examined according to individual-level, clinician-level, and system-level characteristics.
Of the 1.1 million adults with hypertension, 7941 people (0.7%) were screened for PA. Among those who were screened, 1703 (21.4%) had positive test results consistent with possible PA, and 1005 (59.0%) of these were further investigated to distinguish between unilateral and bilateral forms of PA. Only 731 individuals (42.9%) with a positive screen result received disease-targeted treatment. Geographic zones and clinician specialty were the strongest determinants of screening, subtyping, and treatment of PA, with the highest rates corresponding to the location of the provincial endocrine hypertension program.
Conclusions and Relevance
In this cohort, less than 1% of patients expected to have PA were ever formally diagnosed and treated. These findings suggest that a system-level approach to assist with investigation and treatment of PA may be highly effective in closing care gaps and improving clinical outcomes.
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Liu Y, King J, Kline GA, et al. Outcomes of a Specialized Clinic on Rates of Investigation and Treatment of Primary Aldosteronism. JAMA Surg. Published online March 31, 2021. doi:10.1001/jamasurg.2021.0254
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