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Forward2023 Precision Medicine - Resistant Hypertension - Hyperaldosteronism PI CME Project
Relevance: Nearly half (46%) of adults in the United States have hypertension and are at risk for cardiovascular disease and up to one-fifth meet criteria for treatment-resistant hypertension. In a 2018 Scientific Statement, the American Heart Association defined resistant hypertension as blood pressures that exceed goals in patients despite concurrent use of antihypertensive drugs from 3 antihypertensive drug classes, e.g., a long-acting calcium channel blocker; an inhibitor of the renin-angiotensin system such as angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker; and a diuretic. Also, defined as resistant hypertension are those patients who are controlled on 4 or more agents (Carey 2018). Despite ongoing treatment, patients with resistant hypertension face increased risk for cardiovascular morbidity and mortality and end-organ disease (Carey 2018). Across the population of patients with hypertension, the prevalence of primary aldosteronism is recognized to range from 5% in patients with hypertension to 20% in patients with treatment-resistant hypertension (Young 2019); however, some have suggested that the prevalence could be as high as 45%-50% across all patients with hypertension (Funder 2020).
Carey RM, Calhoun DA, Bakris GL, Brook RD, Daugherty SL, Dennison-Himmelfarb CR, Egan BM, Flack JM, Gidding SS, Judd E, Lackland DT, Laffer CL, Newton-Cheh C, Smith SM, Taler SJ, Textor SC, Turan TN, White WB; American Heart Association Professional/Public Education and Publications Committee of the Council on Hypertension; Council on Cardiovascular and Stroke Nursing; Council on Clinical Cardiology; Council on Genomic and Precision Medicine; Council on Peripheral Vascular Disease; Council on Quality of Care and Outcomes Research; and Stroke Council. Resistant Hypertension: Detection, Evaluation, and Management: A Scientific Statement From the American Heart Association. Hypertension. 2018 Nov;72(5):e53-e90.
Funder JW. Primary aldosteronism: at the tipping point. Ann Intern Med 2020; 173:65–66.
Jaffe G, Gray Z, Krishnan G, et al. Screening Rates for Primary Aldosteronism in Resistant Hypertension: A Cohort Study. Hypertension 2020; 75:650.
Young WF Jr. Diagnosis and treatment of primary aldosteronism: practical clinical perspectives. J Intern Med. 2019 Feb;285(2):126-148.
Target Audience
Primary Care physicians
Learning Objectives
| STAGE A | STAGE B | STAGE C | |
|---|---|---|---|
| TIMELINE | September 3, 2023 - September 17, 2023Submission Timeline: No later than 11:59 PM September 17, 2023 Late submissions will not be accepted. | September 3 - December 3, 2023Submission Timeline: 12:01 AM 11/26/2023 - 11:59 PM 12/3/2023. Late submissions will not be accepted. | December 10 - December 20, 2023Submission Timeline: 12:01 AM 12/10/2023 - 11:59 PM 12/20/2023 Late submissions will not be accepted. |
| What physicians receive/do | Baseline data for individual physician practice based on best practice alert (BPA) will be provided as follows: % of visits with an associated diagnosis of hypertension with uncontrolled HTN % of visits with the BPA firing suggesting testing for hyperaldosteronism % of BPA firings where testing was actually completed on their patients | Over a 12-week period, physicians will first analyze the provided data, identifying any trends, and then develop and implement strategies for improved use of algorithm in work-up and management of patient hypertension.
| Follow up data for individual physician practice regarding impact of the intervention will be provided for comparison. |
| What is expected | Physicians will complete prerequisite course to familiarize themselves with algorithm | Physician will document analysis outcome(s) and strategies implemented to improve patient care and cooperation. | Physicians provide reflective response(s) about the success of their intervention and how they would plan to make changes based on their comparative data |
| Objective1 | Analyze data to determine how many (what percentage of) patients with resistant hypertension present in their practice setting | Engage in utilization of best practice alert (BPA) and integrate use of algorithm in practice for patient work up | Review data at the end of three-month period of engagement and identify trends, if any, that contributed to successful work-up and management of resistant hypertension |
| Objective 2 | Develop a plan of action based on data analysis for utilization of best practice alert and integration of algorithm | Develop and choose processes in their own workflow to ensure patient participation in the further work-up and management of hypertension | Write a 300-500 word reflective statement (to be reviewed by the CME Oversight Committee) citing data to report successful interventions for patients and planned opportunities for further improvement |
The purpose of this educational and system intervention is to increase screening rates for primary aldosteronism.
For this Performance Improvement CME activity, the physician will engage in practice improvement to improve blood pressure control and attempt to increase appropriate diagnosis of primary hyperaldosteronism. Physicians will accomplish this by engaging in an EMR best practice alert (BPA) that is activated during a routine primary care visit for patients who are on 3 or more antihypertensive medications with a blood pressure of 140/90 averaged over the last 3 encounters OR a patient with a potassium value < 3.5 on 2 different occasions in the past 365 days. Based on the BPA, the physician can follow the protocol to initiate a workup appropriate for refractory hypertension that would lead toward ruling out primary hyperaldosteronism as a diagnosis or select the option to refer to either endocrinology or nephrology for further evaluation.
This activity is structured to follow the AMA PI CME activity 3-stage process by which a physician or group of physicians learns about specific performance measures, assesses their practice using the selected performance measures, implements interventions to improve performance related to these measures over a useful interval of time and then reassesses their practice using the same performance measures.
Click here for more information about AMA PI CME.
- By enrolling in this course, you are providing to the A. Webb Roberts Center for Continuing Medical Education your permission to transmit your records to the ACCME for transfer to the American Board of Internal Medicine.
- Feedback will be provided to the learner by the CME Oversight Committee. Learners will be notified of awarded credit.
CME Oversight Committee - none of the members of the CME Oversight Committee for this activity have relevant financial relationships to disclose with ineligible companies whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.
| TRESA MCNEAL, MD |
| MICHAEL MCNEAL, MD |
| JASON RAMM, MD |
| F DAVID WINTER, MD |
| MOHANRAM NARAYANAN, MD |
| JACOB MINOR, MD |
None of the participants of this PI-CME activity have relevant financial relationships to disclose with ineligible companies whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.
The A. Webb Roberts Center for Continuing Medical Education of Baylor Scott & White Health is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians
The A. Webb Roberts Center for Continuing Medical Education of Baylor Scott & White Health designates this PI CME activity for a maximum of 20 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity
Physicians completing Stage A are awarded five (5) AMA PRA Category 1 Credits™; Stages A and B, 10 credits; A, B and C, 20 credits.
This activity has been approved by the American Board of Family Medicine (ABFM) for Family Medicine Certification credit. Term of approval is for 08/24/2023 to 03/31/2024.
Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 20 MOC points in the American Board of Internal Medicine’s (ABIM) Maintenance of Certification (MOC) program. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.
This activity has been approved as an accredited CME Improvement Activity. Credits will be awarded based on completion of Stage A, B, C as described above. Credit will be awarded after the activity end date of 12/20/2023 and no later than 12/31/2023 unless you are notified otherwise.
Available Credit
- 20.00 AMA PRA Category 1 Credit™The A. Webb Roberts Center for Continuing Medical Education of Baylor Scott & White Health is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
- 20.00 Attendance
TO VIEW THE PREREQUISITE VIDEO AND PROCEED THROUGH STAGES WHEN AVAILABLE, YOU MUST CLICK THE LINKS IN THE OUTLINES ABOVE FOR THE PROJECT SECTION YOU NEED TO COMPLETE.
All participants must view the course video prior to accessing Stage A.
By enrolling in this course, you are providing to the A. Webb Roberts Center for Continuing Medical Education your permission to transmit your records to the ACCME for transfer to the American Board of Internal Medicine.
Feedback will be provided to the learner by the CME Oversight Committee. Learners will be notified of awarded credit.