Findings from research out of the University of New South Wales indicate Aboriginal and Torres Strait Islander people should be screened for a common heart rhythm condition at least 10 years earlier than current national guidelines recommend.
The research published in the Medical Journal of Australia found Indigenous Australians develop atrial fibrillation (AF) nearly 16 years earlier on average than non-Indigenous Australians, contributing to substantially higher stroke rates at younger ages.
The common heart rhythm condition is characterised by an irregular heartbeat that can cause blood clots to form in the heart and travel to the brain.
It often has no symptoms – until a clot triggers a stroke.
AF-related strokes are typically more severe than other types, but AF itself can be detected through a pulse check or a 30-second recording using a portable single-lead ECG device.
Current Australian guidelines recommend AF screening from age 65.
Senior author Associate Professor Kylie Gwynne, director of UNSW’s co-design health research and innovation group said that threshold was based on population-wide data.
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“But Indigenous people in Australia experience stroke at around two to three times the rate of other Australians,” she said.
“These strokes occur younger, often result in long-term disability and are more likely to be fatal.”
The study recommended screening Indigenous Australians from at least age 55 – and earlier for those at elevated stroke risk.
“We now have strong evidence showing Indigenous Australians develop AF much earlier,” Assoc Prof Gwynne said.
She said medication and lifestyle changes could reduce stroke risk by up to 70%, “so, waiting until age 65 to screen misses a critical window for prevention.”
Lead author UNSW’s Dr Vita Christie said the review also found Indigenous Australians with AF were less likely to receive guideline-recommended therapies, which compounded the risk of preventable stroke.
“Under-treatment adds to the problem of under-diagnosis,” she said.
Assoc Prof Gwynne said stroke prevention required both earlier detection and timely access to treatment.
“If we can detect AF earlier and ensure appropriate treatment, we can prevent strokes and long-term disability.”
However she said technology alone could not prevent stroke.
“Systems of care do. Screening must be accompanied by timely follow-up, culturally responsive communication and access to care aligned to clinical guidelines,” Assoc Prof Gwynne said.
She encouraged primary care clinicians working with Aboriginal and Torres Strait Islander patients to consider opportunistic AF screening from age 55 – and earlier for those at higher risk.
If AF is identified, clinicians should follow established guidelines for managing heart rhythm, reducing stroke risk and addressing co-existing conditions.
A free five-minute online training module has been developed to help primary care clinicians detect and manage AF earlier.
Assoc Prof Gwynne is urging guideline bodies and cardiovascular organisations to formally review AF screening recommendations, considering the new evidence.
“Updating screening recommendations is a straightforward, low-cost and immediately actionable step to reduce preventable stroke and advance Closing the Gap,” Assoc Prof Gwynne said.
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