Percutaneous Balloon Mitral Commissurotomy in Indigenous versus Non-Indigenous Australians

McCann, Andrew; Walters, D.; Aroney, Con

doi:10.1016/j.hlc.2007.10.018

Cited by 5 publications

(5 citation statements)

References 29 publications

(16 reference statements)

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“…Consistent with previous analyses are the differences in baseline characteristics of Indigenous patients presenting with symptomatic cardiovascular disease 18 . ‐ 20 Not only are there significant age differences, but the severity of heart disease appears different. Rheumatic valvular disease and premature coronary atherosclerosis are both major health problems in Indigenous populations and are responsible for the marked age discrepancy in our cohort presenting for cardiac surgery.…”

Section: Discussionsupporting

confidence: 79%

“…They have revealed high rates of morbidity and mortality following valve surgery, particularly after the implantation of mechanical prostheses 18 . ‐ 20 In addition, an excess in age‐adjusted mortality after percutaneous mitral commissurotomy has been found in an Indigenous cohort compared with a non‐Indigenous control group 20 . But, to our knowledge, ours is the first analysis of cardiac surgical outcomes in Indigenous people compared with non‐Indigenous people.…”

Section: Discussionmentioning

confidence: 87%

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Outcomes of cardiac surgery in Indigenous Australians

Lehman

Baker

Aylward

et al. 2009

Medical Journal of Australia

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Objective: To describe baseline characteristics, operative events and late mortality among Indigenous Australians undergoing cardiac surgery. Design, setting and participants: Prospective study of consecutive patients undergoing cardiac surgery at Flinders Medical Centre in Adelaide between January 2000 and December 2005. Main outcome measures: Operative (30‐day) mortality and late mortality after cardiac surgery. Results: Of 2635 patients undergoing cardiac surgery, 283 (10.7%) were Indigenous. Indigenous patients were substantially younger than non‐Indigenous patients (mean, 47 [SD, 14] years v 65 [SD, 12] years; P = 0.001) and were more likely to have diabetes (39.6% v 27.3%; P = 0.001), renal dysfunction (3.2% v 1.2%; P = 0.009), and valvular surgery (53.0% v 23.1%; P < 0.001). There was a non‐significant trend toward excess operative mortality in Indigenous patients (Indigenous 2.5% v non‐Indigenous 1.3%; hazard ratio [HR], 1.67 [95% CI, 0.74–3.75]). But in the under‐55‐years age cohort, the difference between the two groups was highly significant (Indigenous 3.3% v non‐Indigenous 0.4%; HR, 7.99 [95% CI, 1.66–38.50]), even after adjustment for euroSCORE (the European System for Cardiac Operative Risk Evaluation). Survival at 1 and 5 years was 94.0% and 80.6%, respectively, for Indigenous patients compared with 96.7% and 87.7%, respectively, for non‐Indigenous patients. There was an excess in euroSCORE‐adjusted mortality in the Indigenous cohort overall (HR, 1.46 [95% CI, 1.03–2.07]) that strengthened when restricted to the under‐55‐years cohort (HR, 6.9 [95% CI, 1.42–33.5]). Conclusion: Indigenous Australians present for cardiac surgery nearly 20 years earlier than non‐Indigenous Australians and experience excess age‐stratified operative and late mortality.

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Section: Discussionsupporting

confidence: 79%

Section: Discussionmentioning

confidence: 87%

Outcomes of cardiac surgery in Indigenous Australians

Lehman

Baker

Aylward

et al. 2009

Medical Journal of Australia

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“…Good clinical data. Pop: NHPI Data Source: Clinical database Period: 2004-2010 Setting: Hospital admissions from single tertiary hospital Sample size: 1,921 ischaemic strokes v. Rheumatic heart disease Title: Percutaneous balloon mitral commissurotomy in Indigenous versus non-Indigenous Australians McCann (2008) [ 52 ] Journal article Country: Australia Design: baseline descriptive (within cohort study) Crude AF prevalence: non-significantly lower in Indigenous Australians (44 % vs 29 %) NOS (adapted for cross-sectional): 7/10 Only 36 (11 %) of Indigenous Australians. Age-adjusted survival was worse in Indigenous Australians.…”

Section: Resultsmentioning

confidence: 99%

“…Two Australian studies provided data on AF among Indigenous subjects with rheumatic heart disease (RHD), but in neither of these was AF an outcome investigated. In a series of 327 patients (36 Indigenous) undergoing percutaneous balloon mitral commissurotomy, the measured difference in AF frequency between the two groups at baseline (44 % non-Indigenous; 29 % Indigenous) was not significant [ 52 ]. However, the average age of non-Indigenous subjects was substantially higher (52 versus 36 years).…”

Section: Resultsmentioning

confidence: 99%

Atrial fibrillation in the Indigenous populations of Australia, Canada, New Zealand, and the United States: a systematic scoping review

Katzenellenbogen

Woods

Teng

et al. 2015

BMC Cardiovasc Disord

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BackgroundThe epidemiology of atrial fibrillation (AF) among Indigenous minorities in affluent countries is poorly delineated, despite the high cardiovascular disease burden in these populations. We undertook a systematic scoping review examining the epidemiology of AF in the Indigenous populations of Australia, Canada, New Zealand (NZ) and the United States (US).MethodsPubMed, Scopus, EMBASE and CINAHL-Plus databases were systematically searched in May 2014. Supplementary full-text searches of Google Scholar and government website searches were also undertaken.ResultsKey findings from 27 publications with diverse aims and methods were included. Small studies from Canada and NZ suggest higher AF prevalence in Indigenous than other populations. However, this was not reflected in a large sample of US male military veterans. No data were identified on community-based incidence rates of AF in Indigenous populations. Australian and Canadian studies indicate higher first-ever and overall AF hospitalisation rates among Indigenous than other populations, at younger ages and with more comorbidity. Studies in stroke, heart failure and other clinical groups demonstrate AF as a common comorbidity, with AF possibly more prevalent at younger ages in Indigenous people. Indigenous patients have similar early post-hospitalisation adjusted mortality but higher 1-year risk-adjusted mortality than non-Indigenous patients.ConclusionsNo clear epidemiological pattern of AF frequency across the considered Indigenous populations emerges from the limited available evidence. AF should be included in key conditions reported in national surveillance reports, although Indigenous identifiers are required in administrative data from Canada and the US. Sufficiently powered, community-based studies of AF epidemiology in diverse Indigenous populations are needed.Electronic supplementary materialThe online version of this article (doi:10.1186/s12872-015-0081-6) contains supplementary material, which is available to authorized users.

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“…In the only follow-up study of Indigenous patients in Australia who have undergone percutaneous mitral valvuloplasty short-term outcome was similar to nonIndigenous patients but age adjusted long-term survival was significantly worse in the Indigenous group [6]. Most of the deaths occurred in patients who had had no regular medical follow-up.…”

Section: Percutaneous Mitral Balloon Valvuloplastymentioning

confidence: 85%

Medical Management of Chronic Rheumatic Heart Disease

Walsh

2010

Heart, Lung and Circulation

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Percutaneous Balloon Mitral Commissurotomy in Indigenous versus Non-Indigenous Australians

Cited by 5 publications

References 29 publications

Outcomes of cardiac surgery in Indigenous Australians

Outcomes of cardiac surgery in Indigenous Australians

Atrial fibrillation in the Indigenous populations of Australia, Canada, New Zealand, and the United States: a systematic scoping review

Medical Management of Chronic Rheumatic Heart Disease

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