Primary Aldosteronism (PA) is a leading cause of secondary hypertension(1). Patients with PA have a 3.5x greater risk of developing atrial fibrillation (AF) compared with those with essential hypertension(2), and a recent prospective study found that 42% of non-valvular AF patients have PA(3). However, it is unclear what proportion of AF patients are screened for and diagnosed with PA in clinical practice. This study aimed to assess the proportion of AF patients who have an Endocrine Society indication for PA screening(4), and the rate of screening and diagnosis.
Data was collected from medical records of patients who attended cardiology rhythm clinics in one of two tertiary hospitals in Melbourne, Australia between July 2021, and June 2022. Patients with pre-diagnosed PA or non-AF/multiple arrhythmias were excluded. Recorded data included details of AF, comorbidities, family, and medical history.
Of the 390 patients with AF (median age 64, 42% female), 60 (15%) had an indication for PA screening. However, no patients were screened for PA. The most frequent indications for PA screening were hypertension controlled with ≥ 4 medications (20/60, 33%), then hypertension resistant to 3 medications (18/60, 30%). Compared to those without, those with an indication for PA screening were significantly older (p=0.02), had higher BMI (p=0.001), and a higher prevalence of ischaemic heart disease (p=0.01), type II diabetes (p=0.01), and persistent or permanent AF (p=0.02). Among the 192 patients with both AF and hypertension, 56 (29%) had an indication for PA screening. No patients who met screening criteria had hypertension with hypokalaemia (0/60).
Screening for PA in patients with AF, particularly those with hypertension, is underutilised in routine practice. Implementing PA screening in cardiology rhythm clinics could offer substantial benefits in facilitating earlier diagnosis and lead to better clinical outcomes for the cardiovascular sequelae of untreated PA.