LAUSR

Background: The Endocrine Society (ES) recommends the aldosterone-to-renin ratio (ARR) be used to screen high-risk patients (ie, those with drug-resistant hypertension, hypokalemia, and/or hypertension with adrenal incidentaloma) for possible primary aldosteronism (PA). The diagnostic workup for suspected PA is difficult because its prevalence is low among patients with hypertensive disorders, and numerous medications and comorbidities affect the test results. Failure to account for these factors may lead to an incorrect diagnosis and inappropriate or inadequate follow-up testing and/or treatment. We developed an endocrine diagnostic management team (DMT) consisting of clinical and laboratory medicine experts to facilitate appropriate diagnosis of patients being screened for PA, even in the context of interfering factors, by providing patient specific interpretive reports with all ARR results. Objectives: To determine the clinical impact of the endocrine DMT. Methods: A retrospective, cohort pilot study was performed to determine the clinical utility of the endocrine DMT. The study included 59 patients with ARR orders by a preselected subgroup of four primary care physicians (PCPs) before (April 14, 2011, to April 14, 2012) and after (November 7, 2012, to February 25, 2016) implementation of the endocrine DMT. 32 patients with ARRs ordered before and 27 after DMT implementation were included. Electronic medical records (EMRs) were reviewed to determine compliance with ES guidelines for clinical and laboratory workup of suspected PA, patient diagnoses, and outcomes. In order to assess adherence with requirements for ARR testing by all institutional physicians, EMRs from 200 hypertensive patients with orders between August 21, 2014, and February 25, 2016, were reviewed. Results: Of the 59 ARRs ordered in the pilot study, 46% were inappropriately ordered on low-risk patients. Before DMT implementation, four patients had unnecessary testing/ procedures (ie, imaging and laboratory testing) and eight may have had a delay in diagnosis. After the DMT was implemented, the four PCPs adhered closely to guidelines and DMT recommendations for all PA evaluations (i.e. appropriate repeat ARR, imaging, specialty consults, and/or confirmatory testing). In all five of the patients in which DMT interpretations recommended follow up testing for PA, PCPs showed completed additional testing or consultation. A majority (59%) of the pilot ARR samples were not collected as AJCP / MEETING ABSTRACTS