Early detection and better management of atrial fibrillation in Aboriginal People

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia. AF is often asymptomatic and commonly associated with debilitating stroke and heart failure.

Hospitalisation rates from AF are outpacing those for coronary disease and heart failure. Frequent or more intense AF screening has been highlighted as required to define the total burden of paroxysmal AF, a major factor defining complication risk.

Furthermore, current management emphasises: (1) Early detection and management; (2) the importance of drug therapies, especially oral anticoagulants, and lifestyle interventions; (3) how wearables can be embedded into healthcare systems; and (4) the need for improved health literacy and understanding about AF among the community of high relevance for Indigenous patients. AF health outcomes can be greatly enhanced by targeted strategies to enhance patient understanding and build self-efficacy to promote positive health behaviour.

Indigenous Australians are more likely to have untreated AF and are consequently exposed to an increased risk of AF-related stroke. Among survivors of AF-related stroke, Indigenous Australians have greater mortality and more serious health consequences than non-Indigenous Australians. Furthermore, the stroke risk attributable to AF is significantly higher among Indigenous people and significantly contributes to the higher stroke incidence than non-Indigenous people. Indigenous Australians develop AF at a younger age, requiring earlier screening at 55 years. Health outcomes in rural and remote areas are impacted by limited access to healthcare. There is considerable evidence that group-based, online and digital health strategies for detecting and managing chronic disease are of great value among Indigenous populations. There is also emerging literature about high interest among Indigenous people in digital health technologies.

Impact

This co-conceived and co-designed research program included consumers with lived experience (Indigenous people aged 55 years) from the inception. We have completed Phase 1 (Heart Foundation Vanguard Grant 2016 (CIA Gwynne) and philanthropic donation (CIA Freedman)) resulting in the development of a culturally safe protocol, established the feasibility and acceptability for using the Alivecor/Kardia handheld AF screening tool in primary care, determined prevalence for over 55s and establishing the need for early AF screening, identified issues with AF management in primary care including systems enablers and barriers for effective detection and management of AF in Indigenous people. We are currently implementing phase 2 (CIA Gwynne MRFF 2015841 + Macquarie University), a culturally safe screening and treatment pathway for Indigenous people aged over 55 years on every clinic visit. Our pilot study for wearables identified an interest in and acceptability of using wearable technology. Pilot data for social media commences shortly.

Current status

We are currently delivering the Early AF Screening for Indigenous People Study, which is about embedding early AF screening into primary care.

Grants

This project has received funding and in-kind assistance from the MRFF, Pfizer/BMS, private donors, Heart Foundation and the Heart Research Institute.

Publications

1. How older Indigenous women living in high-income countries use digital health technology: systematic review. Henson, C., Chapman, F., Shepherd, G., Carlson, B., Rambaldini, B. & Gwynne, K., 18 Apr 2023, In: Journal of Medical Internet Research. 25, p. 1-12 12 p., e41984.
2. Mature aged Aboriginal and Torres Strait Islander adults are using digital health technologies (original research). Henson, C., Chapman, F., Shepherd, G., Carlson, B., Chau, J. Y., Gwynn, J., McCowen, D., Rambaldini, B., Ward, K. & Gwynne, K., 14 Dec 2022, In: Digital Health. 8, p. 1-12 12 p.
3. One size does not fit all: a realist review of screening for asymptomatic atrial fibrillation in Indigenous communities in Australia, Canada, New Zealand and United States. Nahdi, S., Skinner, J., Neubeck, L., Freedman, B., Gwynn, J., Lochen, M. L., Poppe, K., Rambaldini, B., Rolleston, A., Stavrakis, S. & Gwynne, K., 14 Oct 2021, In: European Heart Journal. 42, Supplement 1, p. 461 1 p.
4. Atrial fibrillation in Indigenous Australians: a multisite screening study using a single-lead ECG device in Aboriginal primary health settings. Gwynn, J., Gwynne, K., Rodrigues, R., Thompson, S., Bolton, G., Dimitropoulos, Y., Dulvari, N., Finlayson, H., Hamilton, S., Lawrence, M., MacNiven, R., Neubeck, L., Rambaldini, B., Taylor, K., Wright, D. & Freedman, B., 1 Feb 2021, In: Heart Lung and Circulation. 30, 2, p. 267-274 8 p.
5. Feasibility and acceptability of opportunistic screening to detect atrial fibrillation in Aboriginal adults. Macniven, R., Gwynn, J., Fujimoto, H., Hamilton, S., Thompson, S. C., Taylor, K., Lawrence, M., Finlayson, H., Bolton, G., Dulvari, N., Wright, D. C., Rambaldini, B., Freedman, B. & Gwynne, K., Aug 2019, In: Australian and New Zealand Journal of Public Health. 43, 4, p. 313-318 6 p.
6. Atrial fibrillation among indigenous populations globally. Poppe, K., Rambaldini, B., Rolleston, A., Løchen, M-L., Stavrakis, S., Einarsson, S. B., Freedman, B. & Gwynne, K., 2019, In: Heart, Lung and Circulation. 28, Supplement 2, p. S39-S40 2 p., O02.
7. Applying collective impact to wicked problems in Aboriginal health. Gwynne, K. & Cairnduff, A., 2017, In: Metropolitan Universities Journal. 28, 4, p. 115-130 16 p.
8. Opportunistic screening to detect atrial fibrillation in Aboriginal adults in Australia. Gwynne, K., Flaskas, Y., O'Brien, C., Jeffries, T. L., McCowen, D., Finlayson, H., Mar;n, T., Neubeck, L. & Freedman, B., 15 Nov 2016, In: BMJ Open. 6, 11, p. 1-6 6 p., e013576.