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

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

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 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.

Citation

Gwynn, J., Gwynne, K., Rodrigues, R., Thompson, S., Bolton, G., Dimitropoulos, Y., Dulvari, N., Finlayson, H., Hamilton, S., Lawrence, M., MacNiven, R., Neubeck, L., Rambaldini, B., Taylor, K., Wright, D., & Freedman, B. (2021). Atrial Fibrillation in Indigenous Australians: A Multisite Screening Study Using a Single-Lead ECG Device in Aboriginal Primary Health Settings. Heart, Lung and Circulation, 30(2), 267-274. https://doi.org/10.1016/j.hlc.2020.06.009

• Journal Article Type: Article
• Acceptance Date: Jun 15, 2020
• Online Publication Date: Jul 19, 2020
• Publication Date: 2021-02
• Deposit Date: Mar 18, 2021
• Journal: Heart, Lung and Circulation
• Print ISSN: 1443-9506
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 30
• Issue: 2
• Pages: 267-274
• DOI: https://doi.org/10.1016/j.hlc.2020.06.009
• Keywords: Atrial fibrillation, Australian Aboriginal, Indigenous, Screening, ECG
• Public URL: http://researchrepository.napier.ac.uk/Output/2753885