Professor Ben Freedman, Group Leader of the Heart Rhythm and Stroke Prevention Group at HRI, and collaborators have published research confirming a clear pattern between the incidence of atrial fibrillation (AF) and First Nations peoples, which includes Native Americans, Aboriginal Australians, and Māori and Pacific people in New Zealand. All experience higher levels of AF at an earlier age, which increases their risk of stroke.
Cardiovascular diseases have a high burden that sees a greater proportion of the population suffer from conditions such as heart attack, stroke, kidney failure and heart failure, and therefore go on to experience a higher mortality rate. AF is another of the cardiovascular morbidities that is seen in a greater proportion and at an earlier age. In Aboriginal Australians, for example, there is a much higher risk of stroke than in those of European origin when AF occurs below the age of 50.
"Uncovering the reasons behind the health discrepancy is complicated," Professor Freedman says.
"There are multiple possibilities, such as a genetic susceptibility to AF and cardiovascular disease. However, what is more likely is societal and lifestyle risk factors, which include obesity, diabetes, sleep disordered breathing, higher alcohol consumption and smoking rates and low physical activity. This is coupled with racism and social deprivation following colonisation by Europeans."
Ten per cent of strokes occur in people unaware they have AF. It is therefore essential to introduce early AF screening in the population and to help First Nations peoples lead healthier lifestyles.
In this research, Dr Stavrakis from the University of Oklahoma and Professor Freedman implemented opportunistic screening to detect silent AF in American Indians attending a tribal primary care clinic in Oklahoma, by using a mobile, single-lead electrocardiogram (ECG) device. Patients over the age of 50 with no history of AF underwent a 30-second ECG, and a cardiologist then reviewed the results to diagnose AF. It was found that 1.5 per cent of the patients were discovered to have AF, which would have otherwise gone undetected.
After diagnosis, the patients were fast-tracked for consultation and treatment, to prevent the onset of severe adverse effects associated with AF, especially severe stroke and premature death.
Professor Ben Freedman founded and leads the AF-SCREEN International Collaboration, a global group that is interested in the problems around detecting unknown atrial fibrillation, including those specific to First Nations peoples.
