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Atrial fibrillation in Indigenous and non-Indigenous Australians: a cross-sectional study
  1. Christopher X Wong1,
  2. Anthony G Brooks1,
  3. Yi-Han Cheng1,
  4. Dennis H Lau1,
  5. Geetanjali Rangnekar1,
  6. Kurt C Roberts-Thomson1,
  7. Jonathan M Kalman2,3,
  8. Alex Brown4,
  9. Prashanthan Sanders1
  1. 1Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
  2. 2Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia
  3. 3Department of Medicine, University of Melbourne, Melbourne, Australia
  4. 4Aborginal Health Research, South Australian Health and Medical Research Institute (SAHMRI) and School of Population Health, University of South Australia, Adelaide, Australia
  1. Correspondence to Dr Christopher X Wong; c.wong{at}adelaide.edu.au

Abstract

Objective To examine the prevalence of atrial fibrillation (AF) and cardiac structural characteristics in Indigenous and non-Indigenous Australians.

Design Retrospective cross-sectional study linking clinical, echocardiography and administrative databases over a 10-year period.

Setting A tertiary, university teaching hospital in Adelaide, Australia.

Participants Indigenous and non-Indigenous Australians.

Main outcome measures AF prevalence and echocardiographic characteristics.

Results Indigenous Australians with AF were significantly younger compared to non-Indigenous Australians (55±13 vs 75±13 years, p<0.001). As a result, racial differences in AF prevalence and left atrial diameter varied according to age. In those under 60 years of age, Indigenous Australians had a significantly greater AF prevalence (2.57 vs1.73%, p<0.001) and left atrial diameters (39±7 vs 37±7 mm, p<0.001) compared to non-Indigenous Australians. In those aged 60 years and above, however, non-Indigenous Australians had significantly greater AF prevalence (9.26 vs 4.61%, p<0.001) and left atrial diameters (39±7 vs 37±7 mm, p<0.001). Left ventricular ejection fractions were less in Indigenous Australians under 60 years of age (49±14 vs 55±11%, p<0.001) and not statistically different in those aged 60 years and above (47±11 vs 52±13, p=0.074) compared to non-Indigenous Australians. Despite their younger age, Indigenous Australians with AF had similar or greater rates of cardiovascular comorbidities than non-Indigenous Australians with AF.

Conclusions Young Indigenous Australians have a significantly greater prevalence of AF than their non-Indigenous counterparts. In contrast, older non-Indigenous Australians have a greater prevalence of AF compared to their Indigenous counterparts. These observations may be mediated by age-based differences in comorbid cardiovascular conditions, left atrial diameter and left ventricular ejection fraction. Our findings suggest that AF is likely to be contributing to the greater burden of morbidity and mortality experienced by young Indigenous Australians. Further study is required to elucidate whether strategies to prevent and better manage AF in Indigenous Australians may reduce this burden.

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

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