Yuan-Yuan Liu1, James King1,2,3, Gregory A Kline1, Raj S Padwal4, Janice L Pasieka5, Guanmin Chen2, Benny So6, Adrian Harvey5, Alex Chin7,8, Alexander A Leung1,2,9. 1. Department of Medicine, University of Calgary, Calgary, Alberta, Canada. 2. Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada. 3. Alberta SPOR SUPPORT Unit Data Platform, Alberta Health Services, Calgary, Alberta, Canada. 4. Department of Medicine, University of Alberta, Edmonton, Alberta, Canada. 5. Department of Surgery, University of Calgary, Calgary, Alberta, Canada. 6. Department of Radiology, University of Calgary, Calgary, Alberta, Canada. 7. Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Alberta, Canada. 8. Alberta Precision Laboratories, Alberta Health Services, Calgary, Alberta, Canada. 9. Division of Endocrinology & Metabolism, University of Calgary, Calgary, Alberta, Canada.
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.
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.
Authors: Alexander A Leung; Christopher J Symonds; Gregory L Hundemer; Paul E Ronksley; Diane L Lorenzetti; Janice L Pasieka; Adrian Harvey; Gregory A Kline Journal: Hypertension Date: 2022-06-02 Impact factor: 9.897
Authors: Fengjie Tang; Lih M Loh; Roger S Foo; Wann J Loh; Dawn S T Lim; Meifen Zhang; Pei T Tan; Du S Swee; Joan Khoo; Donovan Tay; Lynette Lee; Sarah Y Tan; Ling Zhu; Shui B Soh; Eberta Tan; Peng C Kek; Troy H Puar Journal: J Endocr Soc Date: 2021-08-31
Authors: Van Nguyen; Tian Ming Tu; Marlie Jane B Mamauag; Jovan Lai; Seyed Ehsan Saffari; Tar Choon Aw; Lizhen Ong; Roger S Y Foo; Siang Chew Chai; Shaun Fones; Meifen Zhang; Troy H Puar Journal: Front Endocrinol (Lausanne) Date: 2022-04-19 Impact factor: 6.055
Authors: Davis Sam; Gregory A Kline; Benny So; Gregory L Hundemer; Janice L Pasieka; Adrian Harvey; Alex Chin; Stefan J Przybojewski; Cori E Caughlin; Alexander A Leung Journal: Am J Hypertens Date: 2022-04-02 Impact factor: 2.689