Atrial Fibrillation in Indigenous Australians: A Multisite Screening Study Using a Single-Lead ECG Device in Aboriginal Primary Health Settings

Josephine Gwynn; Kylie Gwynne; Rhys Rodrigues; Sandra Thompson; Graham Bolton; Yvonne Dimitropoulos; Norman Dulvari; Heather Finlayson; Sandra Hamilton; Monica Lawrence; Rona MacNiven; Lis Neubeck; Boe Rambaldini; Kerry Taylor; Darryl Wright; Ben Freedman

doi:10.1016/j.hlc.2020.06.009

Atrial Fibrillation in Indigenous Australians: A Multisite Screening Study Using a Single-Lead ECG Device in Aboriginal Primary Health Settings

Heart Lung Circ. 2021 Feb;30(2):267-274. doi: 10.1016/j.hlc.2020.06.009. Epub 2020 Jul 19.

Authors

Josephine Gwynn¹, Kylie Gwynne², Rhys Rodrigues³, Sandra Thompson⁴, Graham Bolton⁵, Yvonne Dimitropoulos³, Norman Dulvari⁶, Heather Finlayson⁵, Sandra Hamilton⁴, Monica Lawrence⁷, Rona MacNiven⁸, Lis Neubeck⁹, Boe Rambaldini³, Kerry Taylor⁷, Darryl Wright¹⁰, Ben Freedman¹¹

Affiliations

¹ Faculty of Health Sciences, University of Sydney, Sydney, NSW, Australia; Poche Centre for Indigenous Health, University of Sydney, Sydney, NSW, Australia. Electronic address: Josephine.gwynn@sydney.edu.au.
² Poche Centre for Indigenous Health, University of Sydney, Sydney, NSW, Australia; Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia.
³ Poche Centre for Indigenous Health, University of Sydney, Sydney, NSW, Australia.
⁴ WA Centre for Rural Health, University of Western Australia, Perth, WA, Australia.
⁵ Brewarrina Multipurpose Service, Brewarrina, NSW, Australia.
⁶ Albury Wodonga Aboriginal Health Service, Albury Wodonga, NSW, Australia.
⁷ Poche Centre for Indigenous Health, Flinders University, Adelaide, SA, Australia.
⁸ Poche Centre for Indigenous Health, University of Sydney, Sydney, NSW, Australia; University of New South Wales, Sydney, NSW, Australia.
⁹ Edinburgh Napier University, Edinburgh, UK.
¹⁰ Tharawal Aboriginal Corporation, Sydney, NSW, Australia.
¹¹ Poche Centre for Indigenous Health, University of Sydney, Sydney, NSW, Australia; Heart Research Institute, Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia.

PMID: 32807629
DOI: 10.1016/j.hlc.2020.06.009

Abstract

Background: Circulatory diseases continue to be the greatest cause of mortality for Australian Aboriginal and Torres Strait Islander people, and a major cause of persistently lower life expectancy compared with non-Aboriginal Australians. The limited information that exists on atrial fibrillation (AF) prevalence in Aboriginal and Torres Strait Islander communities is mostly based on hospital admission data. This shows AF as principal or additional admission diagnosis was 1.4 times higher compared to non-Aboriginal Australians, a higher incidence of AF across the adult life span after age 20 years and a significantly higher prevalence among younger patients. Our study estimates the first national community prevalence and age distribution of AF (including paroxysmal) in Australian Aboriginal people. A handheld single-lead electrocardiograph (ECG) device (iECG), known to be acceptable in this population, was used to record participant ECGs.

Methods: This co-designed, descriptive cross-sectional study was conducted in partnership with 16 Aboriginal Community Controlled Health organisations at their facilities and/or with their services delivered elsewhere. The study was also conducted at one state community event. Three (3) Australian jurisdictions were involved: New South Wales, Western Australia and the Northern Territory. Study sites were located in remote, regional and urban areas. Opportunistic recruitment occurred between June 2016 and December 2017. People <45 years of age were excluded.

Results: Thirty (30) of 619 Aboriginal people received a 'Possible AF' and 81 an 'Unclassified' result from a hand-held smartphone ECG device. A final diagnosis of AF was made in 29 participants (4.7%; 95%CI 3.0-6.4%), 25 with known AF (five paroxysmal), and four with previously unknown AF. Three (3) of the four with unknown AF were aged between 55-64 years, consistent with a younger age of AF onset in Aboriginal people. Estimated AF prevalence increased with age and was higher in those aged >55 years than the general population (7.2% compared with 5.4%). Slightly more men than women were diagnosed with AF.

Conclusions: This study is a significant contribution to the evidence which supports screening for AF in Aboriginal and Torres Strait Islander people commencing at a younger age than as recommended in the Australian guidelines (>65 years). We recommend the age of 55 years. Consideration should be given to the inclusion of AF screening in the Australian Government Department of Health annual 'Aboriginal and Torres Strait Islander Health Assessment'.

Clinical trial registration: ACTRN12616000459426.

Keywords: Atrial fibrillation; Australian Aboriginal; ECG; Indigenous; Screening.

Publication types

Multicenter Study

MeSH terms

Atrial Fibrillation / diagnosis
Atrial Fibrillation / ethnology*
Cross-Sectional Studies
Electrocardiography*
Female
Health Services, Indigenous / organization & administration*
Humans
Male
Mass Screening / methods*
Middle Aged
Native Hawaiian or Other Pacific Islander*
New South Wales / epidemiology
Prevalence