Follow-up patterns after positive primary aldosteronism screening

Area of Science:

• Endocrinology
• Internal Medicine
• Clinical Diagnostics

Background:

• Primary aldosteronism (PA) screening is underdiagnosed, affecting less than 2% of eligible patients.
• Interpretation of positive PA screening results varies significantly across institutions, leading to inconsistent patient management.

Purpose of the Study:

• To investigate the adequacy of follow-up interventions for patients with positive primary aldosteronism screening test results.
• To identify factors associated with adequate and inadequate follow-up care after PA screening.

Main Methods:

• Assessed plasma renin activity (PRA) and aldosterone concentration (PAC) to calculate the aldosterone-to-renin ratio (ARR).
• Evaluated 237 patients meeting established PA screening criteria (PAC ≥ 10 ng/dL and PRA < 1 ng/mL/h; ARR ≥ 20 and PAC ≥ 10 ng/dL; or ARR ≥ 30 and PAC ≥ 10 ng/dL) between April 2018 and May 2023.
• Assessed follow-up care at least 6 months post-screening, defining adequate follow-up as documented abnormal results, further diagnostics, new mineralocorticoid receptor antagonist (MRA) treatment, or specialist referral.

Main Results:

• Inadequate follow-up was observed in 30-38% of patients across different screening criteria.
• Specifically, 37% (82/222) with PAC ≥ 10 ng/dL and PRA < 1 ng/mL/h, 38% (89/237) with ARR ≥ 20 and PAC ≥ 10 ng/dL, and 30% (53/180) with ARR ≥ 30 and PAC ≥ 10 ng/dL lacked appropriate care.
• Adequate follow-up was associated with a history of hypokalemia, English as the primary language, and higher socioeconomic status.

Conclusions:

• Significant gaps exist in the follow-up care for patients with positive primary aldosteronism screening results.
• There is a critical need for standardized screening criteria and automated alerts to improve the diagnostic and treatment pathway for PA.
• Addressing disparities in follow-up care based on clinical and socioeconomic factors is essential for equitable patient outcomes.