Burden of atrial fibrillation in Māori and Pacific people in New Zealand: a cohort study

Gu, Yulong; Doughty, Robert N.; Freedman, Ben; Kennelly, John; Warren, Jim; Harwood, Matire; Hulme, Richard; Paltridge, Chris; Teh, Ruth; Rolleston, Anna; Walker, Natalie

doi:10.1111/imj.13648

Cited by 14 publications

(21 citation statements)

References 27 publications

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“…This recommendation is supported by: the higher burden of AF antecedents at a younger age coupled with higher AF stroke risk factor prevalence. A similar conclusion was reached by another study of AF among Indigenous peoples [28].…”

Section: Discussionsupporting

confidence: 87%

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

Gwynn

Gwynne

Rodrigues

et al. 2021

Heart, Lung and Circulation

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BackgroundCirculatory 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. MethodsThis 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.

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Section: Discussionsupporting

confidence: 87%

“…An increase in frequency of AF with age occurs in the general population [17] and other Indigenous populations including M aori and Pacific peoples residing in New Zealand [28]. However evidence regarding the magnitude of AF prevalence in older age among Indigenous people is conflicting [717].…”

Section: Discussionmentioning

confidence: 99%

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

Gwynn

Gwynne

Rodrigues

et al. 2021

Heart, Lung and Circulation

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“…While the risk of stroke after AF is higher for many indigenous peoples, comparative data on stroke incidence are limited. The risk of stroke (based on CHA 2 DS 2 ‐VASc scores) is reported to be twice as high in New Zealand for Māori and Pacific patients under 65 with AF as for non‐Māori/non‐Pacific patients. We found that the incidence of stroke (and its subtypes) was higher among Aboriginal than non‐Aboriginal patients with AF, particularly among patients under 60 years of age.…”

Section: Discussionmentioning

confidence: 99%

Differences in stroke risk and cardiovascular mortality for Aboriginal and other Australian patients with atrial fibrillation

Nedkoff

Kelty

Hung

et al. 2020

Medical Journal of Australia

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Objectives To assess the risks of stroke and cardiovascular mortality for Aboriginal and non‐Aboriginal Australians with atrial fibrillation. Design Retrospective data linkage cohort study. Setting, participants All people aged 20–84 years hospitalised with atrial fibrillation in Western Australia during 2000–2012. Main outcome measures Stroke incidence rates and mortality after hospitalisation for atrial fibrillation, and 10‐year risks of stroke and of cardiovascular and all‐cause mortality. Results Among 55 482 index admissions with atrial fibrillation, 7.7% of 20–59‐year‐old patients and 1.3% of 60–84‐year‐old patients were Aboriginal Australians. A larger proportion of Aboriginal patients aged 20–59 years had CHA2DS2‐VASc scores of 2 or more (59.8% v 21.8%). In 20–59‐year‐old Aboriginal patients, the incidence during follow‐up (maximum, 10 years; median, 7.1 years) of stroke (incidence rate ratio [IRR], 3.2; 95% CI, 2.5–4.1) and fatal stroke (IRR, 5.7; 95% CI, 3.9–8.9) were markedly higher than for non‐Aboriginal patients. Stroke incidence was higher for 60–84‐year‐old patients, but the difference between Aboriginal and non‐Aboriginal patients was smaller (IRR, 1.6; 95% CI, 1.3–2.0). Cardiovascular mortality during follow‐up was also higher for 20–59‐year‐old Aboriginal patients (IRR, 4.4; 95% CI, 4.3–5.9). The hazards of stroke (adjusted HR [aHR], 1.67; 95% CI, 1.22–2.28) and cardiovascular mortality (aHR, 1.47; 95% CI, 1.18–1.83) in younger Aboriginal patients remained significantly higher after multivariable adjustment; age/sex, principal diagnosis of atrial fibrillation, and CHA2DS2‐VASc score were the most influential factors. Conclusion Stroke risk and cardiovascular mortality are markedly higher for Aboriginal than non‐Aboriginal patients with atrial fibrillation, particularly for patients under 60. Strategies for providing evidence‐based therapies and cardiovascular prevention to Aboriginal people with atrial fibrillation must be improved.

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“…Even within HICs, pockets of social deprivation and poverty can produce disparities in OAC usage that may require a different approach. High AF risk at a younger age and low OAC utilization are seen in first nation peoples and minorities [170][171][172]. c. Strategies to increase OAC uptake and promote adherence and persistence, such as physician education, patient education, and enhanced health literacy Many of the strategies described in i to vii are equally applicable to risk-factor management and rate and rhythm control.…”

Section: B Implementation Of Oac Therapy For Non-valvular and Valvular Af In Hics And Lmicsmentioning

confidence: 99%

Section: Anticoagulant Therapy To Prevent Af-related Strokementioning

confidence: 99%

World Heart Federation Roadmap on Atrial Fibrillation – A 2020 Update

et al. 2021

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The World Heart Federation (WHF) commenced a Roadmap initiative in 2015 to reduce the global burden of cardiovascular disease and resultant burgeoning of healthcare costs. Roadmaps provide a blueprint for implementation of priority solutions for the principal cardiovascular diseases leading to death and disability. Atrial fibrillation (AF) is one of these conditions and is an increasing problem due to ageing of the world's population and an increase in cardiovascular risk factors that predispose to AF. The goal of the AF roadmap was to provide guidance on priority interventions that are feasible in multiple countries, and to identify roadblocks and potential strategies to overcome them.Since publication of the AF Roadmap in 2017, there have been many technological advances including devices and artificial intelligence for identification and prediction of unknown AF, better methods to achieve rhythm control, and widespread uptake of smartphones and apps that could facilitate new approaches to healthcare delivery and increasing community AF awareness.In addition, the World Health Organisation added the non-vitamin K antagonist oral anticoagulants (NOACs) to the Essential Medicines List, making it possible to increase advocacy for their widespread adoption as therapy to prevent stroke. These advances motivated the WHF to commission a 2020 AF Roadmap update. Three years after the original Roadmap publication, the identified barriers and solutions were judged still relevant, and progress has been slow.This 2020 Roadmap update reviews the significant changes since 2017 and identifies priority areas for achieving the goals of reducing death and disability related to AF, particularly targeted at low-middle income countries. These include advocacy to increase appreciation of the scope of the problem; plugging gaps in guideline management and prevention through physician education, increasing patient health literacy, and novel ways to increase access to integrated healthcare including mHealth and digital transformations; and greater emphasis on achieving practical solutions to national and regional entrenched barriers. Despite the advances reviewed in this update, the task will not be easy, but the health rewards of implementing solutions that are both innovative and practical will be great.

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Burden of atrial fibrillation in Māori and Pacific people in New Zealand: a cohort study

Abstract: AF screening and stroke thromboprophylaxis in Māori and Pacific people could start below the age of 65 years in NZ.

Cited by 14 publications

References 27 publications

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

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

Differences in stroke risk and cardiovascular mortality for Aboriginal and other Australian patients with atrial fibrillation

World Heart Federation Roadmap on Atrial Fibrillation – A 2020 Update

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