Screening for atrial fibrillation in high-risk Māori and Pacific populations

Research Updates

Life-saving screening for atrial fibrillation is taking place in high-risk Māori and Pacific populations

Screening for asymptomatic atrial fibrillation (AF) in Māori and Pacific Islander people aged 55 and over and treating it with anticoagulant medications could greatly reduce the risk of stroke and premature death, new research has found.

AF is an extremely common abnormal heart rhythm that poses the risk of blood clots forming inside the heart. When blood clots break off they usually travel to the brain, causing severe strokes. 

While AF data is limited, it seems Māori and Pacific Islander populations are particularly prone to developing the abnormal heart rhythm. A recent cohort study investigating AF in New Zealand octogenarians using both electrocardiography (ECG) and medical record review found a 30 per cent prevalence of AF in Māori aged 80 to 90, and only a 21 per cent prevalence in non-Māori aged 85. 1

While AF may be associated with symptoms such as palpitations, chest pain, shortness of breath, or fatigue, it is often asymptomatic.

Stroke can be an unexpected and serious first sign of AF.

In a national first, the Heart Research Institute is collaborating with the University of Auckland to screen Māori and Pacific Islanders using a simple handheld ECG device that can diagnose AF in 30 seconds. The cost-effective and accurate heart monitor snaps onto the back of an iPhone and wirelessly communicates with an app on the phone.

In New Zealand – where community pharmacists are the health professionals seen most often by adults, colleagues from the University of Auckland and the Heart Research Institute – piloted the study at the All Seasons Pharmacy in Te Atatu, Auckland.  

Professor Ben Freedman, from the Heart Research Institute and Charles Perkins Centre in Sydney collaborated with Professor Rob Doughty, Dr Natalie Walker and Dr Katrina Poppe from the University of Auckland to conduct the research. 

“Given such easy ways to detect AF, and demonstration of the poor outcomes that can be substantially modified by treatment, we believe there is a reasonable, cost-effective case to screen for this abnormal heart rhythm in the population, as well as in the clinic,” says Ben Freedman, University of Sydney and Heart Research Institute Cardiology Professor.

The plan is to expand the screening of Māori and Pacific Islanders to general practice and the community in culturally appropriate ways.

“Widespread screening for asymptomatic atrial fibrillation could cost-effectively reduce strokes and their associated disability, and help save lives,” says Professor Freedman. 

AF greatly increases the risk of stroke, usually severe, and doubles the risk of dying. AF is the cause of one third of all strokes. In 27 per cent of AF-related strokes, the person was unaware they had AF until the stroke happened. 

Anticoagulants – such as Warfarin or the newer oral anticoagulants – are extremely effective in preventing stroke, and also reduce the risk of dying in those with AF. If silent AF could be detected in the asymptomatic phase and treated early, then many strokes could be prevented.

This whole area will be the focus of research planned in the near future in New Zealand.

Sources:

1. Teh R, Martin A, Kerse N, et al. The burden of atrial fibrillation in octogenarians. Heart Lung Circ. 2013;22(7):580–1.

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