Initial hospitalisation for atrial fibrillation in Aboriginal and non-Aboriginal populations in Western Australia

Katzenellenbogen, Judith M.; Teng, Tiew‐Hwa Katherine; Lopez, Derrick; Hung, Joseph; Knuiman, Matthew; Sanfilippo, Frank M; Hobbs, Michael; Thompson, Sandra C.

doi:10.1136/heartjnl-2014-306678

Cited by 34 publications

(34 citation statements)

References 25 publications

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“…We postulate that the lower identified rate of atrial fibrillation in the indigenous population may not only be due to their younger age, but also because they are less likely to have cardiac investigations requested and completed. As such, cardiac arrhythmias may be a modifiable risk factor contributing to increased indigenous stroke incidence …”

Section: Discussionmentioning

confidence: 99%

Management of stroke in the Australian Indigenous population: from hospitals to communities

Tiedeman

Suthers

Julien

et al. 2019

Internal Medicine Journal

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Background Ischaemic strokes lead to significant morbidity and mortality within the Australian Indigenous population, with known variances in the management of strokes between indigenous and non‐indigenous populations. Aims To compare investigations and management of indigenous and non‐indigenous patients presenting to a New South Wales rural referral hospital with an ischaemic stroke to the national stroke standards across inpatient and outpatient settings. Methods Historical cohort study of 43 indigenous and 167 non‐indigenous patients admitted to Tamworth Rural Referral Hospital with an ischaemic cerebrovascular accident. Results Indigenous patients were significantly less likely to have investigations completed, including carotid imaging (93.8% vs 100%, P = 0.012) and echocardiography (73.3% vs 97.7%, P = 0.004). Discharge follow up was significantly lower for the indigenous population (74.4% vs 87.4%, P = 0.034). Indigenous stroke patients were 15.8 years younger than non‐indigenous subjects (56.8 vs 72.6 years old; P < 0.001). Indigenous patients were more likely to have stroke risk factors, including smoking (51.2% vs 15.0%; P < 0.001), diabetes mellitus (37.2% vs 16.8%, P = 0.003) and past history of cerebrovascular accident or transient ischaemic attack (50.2% vs 31.1%, P = 0.032). Conclusions The investigation and post‐discharge care of indigenous ischaemic stroke patients is inferior to non‐indigenous patients. Indigenous patients within rural NSW have a higher prevalence of preventable disease, including those that confer a higher stroke risk. Further research is needed to investigate the cause of these discrepancies and to improving indigenous stroke care between hospitals and primary care providers.

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Section: Discussionmentioning

confidence: 99%

Management of stroke in the Australian Indigenous population: from hospitals to communities

Tiedeman

Suthers

Julien

et al. 2019

Internal Medicine Journal

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“…On average, Aboriginal people develop AF almost 20 years earlier than their non-Aboriginal counterparts, and even more concerning is the high rate of associated comorbidities found in this subset versus the wider Australian population 2021 Risk factors for AF such as hypertension, diabetes, obesity, physical inactivity, chronic kidney disease, acute rheumatic fever and rheumatic heart disease are all more common in Aboriginal people and at a younger age than in non-Aboriginal people 2021 23 This uneven burden of comorbidity results in CHA 2 DS 2 VASc scores (a score developed to indicate risk of stroke) of ≥2, indicating risk sufficient to recommend anticoagulation in 53% of Aboriginal people aged below 55 years, and 73% in those aged 55–64 years, compared to only 14% and 28%, respectively, in non-Aboriginal people of the same age 20.…”

Section: Introductionmentioning

confidence: 99%

“…In people with AF, both stroke and death are greatly reduced by treatment with oral anticoagulant (by ∼64% and 26% respectively) 1718 While AF can be associated with symptoms, it is frequently asymptomatic which may indicate that existing documented rates of AF in Australia are a significant underestimation of the scope of the problem 2021 To prevent strokes resulting from unknown AF, screening for asymptomatic AF could be helpful 22…”

Section: Introductionmentioning

confidence: 99%

“…21 Risk factors for AF such as hypertension, diabetes, obesity, physical inactivity, chronic kidney disease, acute rheumatic fever and rheumatic heart disease are all more common in Aboriginal people and at a younger age than in non-Aboriginal people 2021 23 This uneven burden of comorbidity results in CHA 2 DS 2 VASc scores (a score developed to indicate risk of stroke) of ≥2, indicating risk sufficient to recommend anticoagulation in 53% of Aboriginal people aged below 55 years, and 73% in those aged 55–64 years, compared to only 14% and 28%, respectively, in non-Aboriginal people of the same age 20. Aboriginal people therefore face a double jeopardy of increased AF incidence at a younger age and an increased risk of stroke when AF occurs 20…”

Section: Introductionmentioning

confidence: 99%

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Opportunistic screening to detect atrial fibrillation in Aboriginal adults in Australia

et al. 2016

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IntroductionThere is a 10-year gap in life expectancy between Aboriginal and non-Aboriginal Australians. The leading cause of death for Aboriginal Australians is cardiovascular disease, including myocardial infarction and stroke. Although atrial fibrillation (AF) is a known precursor to stroke there are no published studies about the prevalence of AF for Aboriginal people and limited evidence about AF in indigenous populations globally.Methods and analysisThis mixed methods study will recruit and train Aboriginal health workers to use an iECG device attached to a smartphone to consecutively screen 1500 Aboriginal people aged 45 years and older. The study will quantify the proportion of people who presented for follow-up assessment and/or treatment following a non-normal screening and then estimate the prevalence and age distribution of AF of the Australian Aboriginal population. The study includes semistructured interviews with the Aboriginal health workers about the effectiveness of the iECG device in their practice as well as their perceptions of the acceptability of the device for their patients. Thematic analysis will be undertaken on the qualitative data collected in the study. If the device and approach are acceptable to the Aboriginal people and widely adopted, it may help prevent the effects of untreated AF including ischaemic stroke and early deaths or impairment in Aboriginal people.Ethics and disseminationThis mixed methods study received ethics approval from the Aboriginal Health and Medical Research Council (1135/15) and the Australian Health Council of Western Australia (HREC706). Ethics approval is being sought in the Northern Territory. The findings of this study will be shared with Aboriginal communities, in peer reviewed publications and at conferences. There are Aboriginal investigators in each state/territory where the study is being conducted who have been actively involved in the study. They will also be involved in data analysis, dissemination and research translation.Trial registration numberACTRN12616000459426.

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“…On average, Aboriginal people develop AF approximately 20 years earlier than non-Aboriginal people and have a higher rate of associated co-morbidities than the wider Australian population (Katzenellenbogen et al, 2015;Wong et al, 2014). Risk factors for AF such as hypertension, diabetes, chronic kidney disease, and rheumatic heart disease are all more common in Aboriginal people and at a younger age than in non-Indigenous people (AIHW, 2014).…”

Section: Description/analysis/methodsmentioning

confidence: 99%

Applying Collective Impact to Wicked Problems in Aboriginal Health

Gwynne¹,

Cairnduff²

2017

MUJ

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Aboriginal people fare worse than other Australians in every measure of health, including in a ten-year gap in life expectancy, infant mortality, cardiovascular disease, dental disease, mental health, chronic disease and maternal health. Despite sustained government effort, progress to improve Aboriginal health has been very slow. The collective impact tool may offer a solution. This paper provides examples of the application of collective impact, to address the significant gap in Aboriginal health and as a tool to enable community control. Three case studies in Aboriginal health demonstrate the stages and phases of collective impact to facilitate positive change.

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Initial hospitalisation for atrial fibrillation in Aboriginal and non-Aboriginal populations in Western Australia

Abstract: The incidence (particularly at young ages) and long-term mortality following hospitalised AF is significantly higher in Aboriginal people. Better control of the antecedent risk factors for AF, improved detection and management of AF itself and prevention of its complications are needed.

Cited by 34 publications

References 25 publications

Management of stroke in the Australian Indigenous population: from hospitals to communities

Management of stroke in the Australian Indigenous population: from hospitals to communities

Opportunistic screening to detect atrial fibrillation in Aboriginal adults in Australia

Applying Collective Impact to Wicked Problems in Aboriginal Health

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