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Comparative Study
. 2020 Mar;212(5):215-221.
doi: 10.5694/mja2.50496. Epub 2020 Feb 6.

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

Lee Nedkoff #  1 , Erin A Kelty #  1 , Joseph Hung  1 , Sandra C Thompson  2 , Judith M Katzenellenbogen  1   3
Affiliations
Comparative Study

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

Lee Nedkoff et al. Med J Aust. 2020 Mar.

Abstract

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 CHA2 DS2 -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 CHA2 DS2 -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.

Keywords: Atrial fibrillation; Indigenous health; Stroke.

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References

    1. Chugh SS, Havmoeller R, Narayanan K, et al. Worldwide epidemiology of atrial fibrillation: a Global Burden of Disease 2010 study. Circulation 2014; 129: 837-847.
    1. Katzenellenbogen JM, Woods JA, Teng TH, Thompson SC. Atrial fibrillation in the indigenous populations of Australia, Canada, New Zealand, and the United States: a systematic scoping review. BMC Cardiovasc Disord 2015; 15: 87.
    1. Krum H, Carrington MJ, Stewart S, et al. Heart failure, ventricular dysfunction and risk factor prevalence in Australian Aboriginal peoples: the Heart of the Heart Study. Heart 2012; 98: 1562-1567.
    1. Katzenellenbogen JM, Teng TH, Lopez D, et al. Initial hospitalisation for atrial fibrillation in Aboriginal and non-Aboriginal populations in Western Australia. Heart 2015; 101: 712-719.
    1. Australian Institute of Health and Welfare. The health and welfare of Australia's Aboriginal and Torres Strait Islander peoples: 2015 (Cat no. IHW 147). Canberra: AIHW, 2015.

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