Time to develop guidelines for screening and management of atrial fibrillation in Indigenous Australians

Lowres, Nicole; Freedman, Ben

doi:10.5694/mja2.50513

Cited by 5 publications

(6 citation statements)

References 15 publications

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“…Even within HICs, pockets of social deprivation and poverty can produce disparities in OAC usage that may require a different approach. High AF risk at a younger age and low OAC utilization are seen in first nation peoples and minorities [170][171][172]. c. Strategies to increase OAC uptake and promote adherence and persistence, such as physician education, patient education, and enhanced health literacy Many of the strategies described in i to vii are equally applicable to risk-factor management and rate and rhythm control.…”

Section: B Implementation Of Oac Therapy For Non-valvular and Valvulamentioning

confidence: 99%

World Heart Federation Roadmap on Atrial Fibrillation – A 2020 Update

et al. 2021

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The World Heart Federation (WHF) commenced a Roadmap initiative in 2015 to reduce the global burden of cardiovascular disease and resultant burgeoning of healthcare costs. Roadmaps provide a blueprint for implementation of priority solutions for the principal cardiovascular diseases leading to death and disability. Atrial fibrillation (AF) is one of these conditions and is an increasing problem due to ageing of the world's population and an increase in cardiovascular risk factors that predispose to AF. The goal of the AF roadmap was to provide guidance on priority interventions that are feasible in multiple countries, and to identify roadblocks and potential strategies to overcome them.Since publication of the AF Roadmap in 2017, there have been many technological advances including devices and artificial intelligence for identification and prediction of unknown AF, better methods to achieve rhythm control, and widespread uptake of smartphones and apps that could facilitate new approaches to healthcare delivery and increasing community AF awareness.In addition, the World Health Organisation added the non-vitamin K antagonist oral anticoagulants (NOACs) to the Essential Medicines List, making it possible to increase advocacy for their widespread adoption as therapy to prevent stroke. These advances motivated the WHF to commission a 2020 AF Roadmap update. Three years after the original Roadmap publication, the identified barriers and solutions were judged still relevant, and progress has been slow.This 2020 Roadmap update reviews the significant changes since 2017 and identifies priority areas for achieving the goals of reducing death and disability related to AF, particularly targeted at low-middle income countries. These include advocacy to increase appreciation of the scope of the problem; plugging gaps in guideline management and prevention through physician education, increasing patient health literacy, and novel ways to increase access to integrated healthcare including mHealth and digital transformations; and greater emphasis on achieving practical solutions to national and regional entrenched barriers. Despite the advances reviewed in this update, the task will not be easy, but the health rewards of implementing solutions that are both innovative and practical will be great.

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Section: B Implementation Of Oac Therapy For Non-valvular and Valvulamentioning

confidence: 99%

World Heart Federation Roadmap on Atrial Fibrillation – A 2020 Update

et al. 2021

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“…To satisfy criteria for the implementation of a screening program, there must be evidence that the treatment of conditions identified through the screening leads to a reduction in morbidity and mortality, and results in more benefit than harm. Further studies that demonstrate implementation of effective interventions are needed [11], including use of nonvitamin K-dependent oral anticoagulants (NOACS) which are ideal for vulnerable and underserved populations where monitoring warfarin dose is difficult [32].…”

Section: Discussionmentioning

confidence: 99%

“…Given that AF is often asymptomatic, it is likely that these figures are an underestimation [6]. Antecedents for AF include infectious diseases [7] such as rheumatic heart disease [8], myocardial infarction, and hypertension and diabetes [9], many of which occur in a higher prevalence in Aboriginal communities [10] and contribute to an increased risk of AF in this population [11]. AF can lead to significant complications, with a five-fold increase in the risk of ischaemic stroke [6] more severe than strokes without AF [12] and a much higher overall stroke risk, particularly for those under 60 years of age [13] Aboriginal people have a higher burden of stroke than non-Aboriginal Australians [14] and the presence of clinically evident or silent AF may be a significant contributor.…”

Section: Introductionmentioning

confidence: 99%

Atrial Fibrillation in Indigenous Australians: A Multisite Screening Study Using a Single-Lead ECG Device in Aboriginal Primary Health Settings

Gwynn

Gwynne

Rodrigues

et al. 2021

Heart, Lung and Circulation

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BackgroundCirculatory diseases continue to be the greatest cause of mortality for Australian Aboriginal and Torres Strait Islander people, and a major cause of persistently lower life expectancy compared with non-Aboriginal Australians. The limited information that exists on atrial fibrillation (AF) prevalence in Aboriginal and Torres Strait Islander communities is mostly based on hospital admission data. This shows AF as principal or additional admission diagnosis was 1.4 times higher compared to non-Aboriginal Australians, a higher incidence of AF across the adult life span after age 20 years and a significantly higher prevalence among younger patients. Our study estimates the first national community prevalence and age distribution of AF (including paroxysmal) in Australian Aboriginal people. A handheld single-lead electrocardiograph (ECG) device (iECG), known to be acceptable in this population, was used to record participant ECGs. MethodsThis co-designed, descriptive cross-sectional study was conducted in partnership with 16 Aboriginal Community Controlled Health organisations at their facilities and/or with their services delivered elsewhere. The study was also conducted at one state community event. Three (3) Australian jurisdictions were involved: New South Wales, Western Australia and the Northern Territory. Study sites were located in remote, regional and urban areas. Opportunistic recruitment occurred between June 2016 and December 2017. People ,45 years of age were excluded.

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“…Although there are limited data on the use of NOAC in this population, the lack of International Normalized Ratio monitoring and the significantly reduced risk of intracranial bleeding with NOAC make them an attractive treatment option to warfarin 3 . A greater appreciation of the high risk of stroke in young Aboriginal Australians with non‐rheumatic AF, along with enhanced screening and integrated care with culturally sensitive pathways to treatment, should lead to improved rates of OAC therapy for stroke prevention in this medically underserved population 6,19,20 …”

Section: Discussionmentioning

confidence: 99%

“…The risk model should not only discriminate well between low‐ and high‐risk patients, but also calibrate to predict accurately absolute risk, particularly in low‐risk patients 5 . Calibrating the risk model to the applicable population is especially important for Aboriginal people, 6 whose age‐adjusted stroke risk is threefold higher than the broader population with or without coexistent AF, 7–9 and whose hospitalised AF incidence is threefold higher in men and sixfold higher in women aged 20–54 years 10 …”

Section: Non‐aboriginal Aboriginal P‐valuementioning

confidence: 99%

Can the CHA₂DS₂‐VA schema be used to decide on anticoagulant therapy in Aboriginal and other Australians with non‐valvular atrial fibrillation?

Hung

Kelty

Nedkoff

et al. 2021

Internal Medicine Journal

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The Australasian guidelines recommend use of the CHA2DS2‐VA schema to stratify ischaemic stroke risk in patients with non‐valvular atrial fibrillation (N‐VAF) and determine risk thresholds for recommending oral anticoagulant (OAC) therapy. However, the CHA2DS2‐VA score has not been validated in a representative Australian population cohort with N‐VAF, including in Aboriginal people who are known to have a higher age‐adjusted stroke risk than other Australians. In a retrospective data‐linkage study of 49 114 patients aged 24–84 years with N‐VAF, 40.0% women and 2.5% Aboriginal, we found that patients with a CHA2DS2‐VA score >2 had high annual stroke rates (>2%) that would justify OAC therapy. This occurred regardless of Aboriginal status. Non‐Aboriginal patients with a CHA2DS2‐VA score of 0 had a mean annual stroke rate of 0.4%, and hence were not likely to benefit from antithrombotic therapy. However, Aboriginal patients with a zero CHA2DS2‐VA score had a significantly higher annual stroke rate of 0.9%, and could potentially obtain net clinical benefit from anticoagulation, primarily with the safer non‐vitamin K antagonist OAC. We conclude that clinicians can confidently use the CHA2DS2‐VA score to make decisions regarding anticoagulation in accordance with stroke risk in patients with N‐VAF, except in Aboriginal people in whom the risk score was unable to identify those at truly low risk of stroke.

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Time to develop guidelines for screening and management of atrial fibrillation in Indigenous Australians

Cited by 5 publications

References 15 publications

World Heart Federation Roadmap on Atrial Fibrillation – A 2020 Update

World Heart Federation Roadmap on Atrial Fibrillation – A 2020 Update

Atrial Fibrillation in Indigenous Australians: A Multisite Screening Study Using a Single-Lead ECG Device in Aboriginal Primary Health Settings

Can the CHA₂DS₂‐VA schema be used to decide on anticoagulant therapy in Aboriginal and other Australians with non‐valvular atrial fibrillation?

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Time to develop guidelines for screening and management of atrial fibrillation in Indigenous Australians

Cited by 5 publications

References 15 publications

World Heart Federation Roadmap on Atrial Fibrillation – A 2020 Update

World Heart Federation Roadmap on Atrial Fibrillation – A 2020 Update

Atrial Fibrillation in Indigenous Australians: A Multisite Screening Study Using a Single-Lead ECG Device in Aboriginal Primary Health Settings

Can the CHA2DS2‐VA schema be used to decide on anticoagulant therapy in Aboriginal and other Australians with non‐valvular atrial fibrillation?

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Can the CHA₂DS₂‐VA schema be used to decide on anticoagulant therapy in Aboriginal and other Australians with non‐valvular atrial fibrillation?