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

Atrial Fibrillation / diagnosis 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
Atrial fibrillation Australian Aboriginal ECG Indigenous Screening

Journal

Heart, lung & circulation
ISSN: 1444-2892
Titre abrégé: Heart Lung Circ
Pays: Australia
ID NLM: 100963739

Informations de publication

Date de publication:
Feb 2021
Historique:
received: 12 01 2020
revised: 12 06 2020
accepted: 15 06 2020
pubmed: 19 8 2020
medline: 15 7 2021
entrez: 19 8 2020
Statut: ppublish

Résumé

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. 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. 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. 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'. ACTRN12616000459426.

Sections du résumé

BACKGROUND 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 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 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 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 BACKGROUND
ACTRN12616000459426.

Identifiants

DOI: 10.1016/j.hlc.2020.06.009 PMID: 32807629
pubmed: 32807629
pii: S1443-9506(20)30345-0
doi: 10.1016/j.hlc.2020.06.009
pii:
doi:

Types de publication

Journal Article Multicenter Study

Langues

eng

Sous-ensembles de citation

IM

Pagination

267-274

Informations de copyright

Copyright © 2020 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). All rights reserved.

Auteurs

Josephine Gwynn (J)

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.

Kylie Gwynne (K)

Poche Centre for Indigenous Health, University of Sydney, Sydney, NSW, Australia; Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia.

Rhys Rodrigues (R)

Poche Centre for Indigenous Health, University of Sydney, Sydney, NSW, Australia.

Sandra Thompson (S)

WA Centre for Rural Health, University of Western Australia, Perth, WA, Australia.

Graham Bolton (G)

Brewarrina Multipurpose Service, Brewarrina, NSW, Australia.

Yvonne Dimitropoulos (Y)

Poche Centre for Indigenous Health, University of Sydney, Sydney, NSW, Australia.

Norman Dulvari (N)

Albury Wodonga Aboriginal Health Service, Albury Wodonga, NSW, Australia.

Heather Finlayson (H)

Brewarrina Multipurpose Service, Brewarrina, NSW, Australia.

Sandra Hamilton (S)

WA Centre for Rural Health, University of Western Australia, Perth, WA, Australia.

Monica Lawrence (M)

Poche Centre for Indigenous Health, Flinders University, Adelaide, SA, Australia.

Rona MacNiven (R)

Poche Centre for Indigenous Health, University of Sydney, Sydney, NSW, Australia; University of New South Wales, Sydney, NSW, Australia.

Lis Neubeck (L)

Edinburgh Napier University, Edinburgh, UK.

Boe Rambaldini (B)

Poche Centre for Indigenous Health, University of Sydney, Sydney, NSW, Australia.

Kerry Taylor (K)

Poche Centre for Indigenous Health, Flinders University, Adelaide, SA, Australia.

Darryl Wright (D)

Tharawal Aboriginal Corporation, Sydney, NSW, Australia.

Ben Freedman (B)

Poche Centre for Indigenous Health, University of Sydney, Sydney, NSW, Australia; Heart Research Institute, Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia.

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Classifications MeSH

questionsmedicales.fr › États, signes et symptômes pathologiques › Processus pathologiques › Troubles du rythme cardiaque › Fibrillation auriculaire › Atrial Fibrillation in Indigenous Australians:...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études transversales › Atrial Fibrillation in Indigenous Australians:...
questionsmedicales.fr › Diagnostic › Techniques et procédures diagnostiques › Électrodiagnostic › Électrocardiographie › Atrial Fibrillation in Indigenous Australians:...
questionsmedicales.fr › Établissements, main d'oeuvre et services de soins de santé › Services de santé › Services de santé pour autochtones › Atrial Fibrillation in Indigenous Australians:...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Atrial Fibrillation in Indigenous Australians:...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Pratiques en santé publique › Dépistage de masse › Atrial Fibrillation in Indigenous Australians:...
questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Adulte d'âge moyen › Atrial Fibrillation in Indigenous Australians:...
questionsmedicales.fr › Personnes › Populations d'Océanie › Populations d'Australasie › Population originaire des îles du Pacifique › Hawaïen autochtone ou autre insulaire du Pacifique › Atrial Fibrillation in Indigenous Australians:...
questionsmedicales.fr › Régions géographiques › Océanie › Australasie › Australie › Nouvelle-Galles du Sud › Atrial Fibrillation in Indigenous Australians:...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Collecte de données › Registre civil › Morbidité › Prévalence › Atrial Fibrillation in Indigenous Australians:...