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Follow-up patterns after positive primary aldosteronism screening.

Raul Herrera1, Michael Salim1, Meng Xu2

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Primary aldosteronism screening has low diagnosis rates, and many patients with positive results do not receive adequate follow-up care. Standardized criteria and alerts are needed to improve diagnosis and treatment for this condition.

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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.