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Original Investigation
March 31, 2021

Outcomes of a Specialized Clinic on Rates of Investigation and Treatment of Primary Aldosteronism

Author Affiliations
  • 1Department of Medicine, University of Calgary, Calgary, Alberta, Canada
  • 2Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
  • 3Alberta SPOR SUPPORT Unit Data Platform, Alberta Health Services, Calgary, Alberta, Canada
  • 4Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
  • 5Department of Surgery, University of Calgary, Calgary, Alberta, Canada
  • 6Department of Radiology, University of Calgary, Calgary, Alberta, Canada
  • 7Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Alberta, Canada
  • 8Alberta Precision Laboratories, Alberta Health Services, Calgary, Alberta, Canada
  • 9Division of Endocrinology & Metabolism, University of Calgary, Calgary, Alberta, Canada
JAMA Surg. 2021;156(6):541-549. doi:10.1001/jamasurg.2021.0254
Key Points

Question  What are the outcomes of a dedicated hypertension program for patients with primary aldosteronism (PA)?

Findings  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.

Meaning  A system-level approach to assist with investigation and treatment of PA may be highly effective in closing care gaps and improving clinical outcomes.

Abstract

Importance  Primary aldosteronism (PA) is one of the most common causes of secondary hypertension but remains largely unrecognized and untreated.

Objective  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.

Results  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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