- Vita Christie, Nicole Lowres, Joseph Hung, Lee Nedkoff, Judith M. Katzenellenbogen, Jessica Orchard, Josephine D. Gwynn, Kai Nash
- Katrina D. Ward, Ben Freedman, Tom G. Briffa, Alena Haines, Connie Henson, Rekha Khatri, Prashanthan Sanders, David Brieger, Christopher X. J. Wong
- Kylie Gwynne
Correspondence: v.christie@unsw.edu.au
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Abstract
Objective
To determine whether the screening age for atrial fibrillation (AF) should be lowered for Indigenous Australians with the goal of reducing risk of stroke and other health burdens.
Study Design
Systematic review of medical databases identified 24 studies reporting outcome measures: AF incidence/prevalence, age of AF occurrence/diagnosis, cardiovascular risk factors and stroke risk. Risk of bias was evaluated using the Joanna Briggs Institute quality appraisal tools. Meta-analysis of mean age of AF onset was performed. An expert panel reviewed the evidence and formed consensus recommendations regarding screening for AF for Indigenous Australians.
Data Sources
MEDLINE, Embase, Scopus, Cochrane, CINAHL, Australian Indigenous HealthInfoNet and grey literature.
Data Synthesis
The review yielded five key findings. Indigenous Australians when compared with non-Indigenous Australians have: (i) higher AF rates at every age group, and meta-analysis showed onset of AF for Indigenous people at 15.9 years (95% CI, 11.5–20.4), younger than for other Australians; (ii) higher prevalence of cardiovascular risk factors; (iii) higher stroke rates (38%–47% vs. 10%–15% of all strokes occur before age of 55 years), higher mortality and other adverse outcomes after stroke and the nationally age standardised risk ratio of death from AF was 1.8 for 1997–2022; (iv) less likelihood of receiving optimal treatment; and (v) greater cost of care for stroke rehabilitation.
Conclusions
The evidence supports an amendment to the AF guideline to opportunistically screen Indigenous Australians from at least age 55 years, and when AF is found, follow guideline recommendations for management of rate, rhythm, stroke prevention and concomitant risk factors/comorbidities. Further, the logistics of care should be considered when deciding on the localised care pathway. National implementation of these recommendations should minimise missed diagnoses and ensure timely, accessible and appropriate care/treatment.
Registration
Prospective registration with PROSPERO (CRD42024514586) on 13 May 2024.