Table 2 Studies of antecedents and population-based occurrence of atrial fibrillation
Author (Year) Publication type | Country Indigenous population Calendar period | Methods | Key findings on Indigenous AF | Quality score (Newcastle-Ottawa Scale applied only to Indigenous AF data) Comments |
|---|---|---|---|---|
Antecedents of AF | ||||
Title: Association of Markers of Inflammation with New-Onset Atrial Fibrillation in a Population-Based Sample: The Strong Heart Study | ||||
Zacks (2006) [32] Conference abstract | Country: US | Design: Population-based cohort study | New-onset AF (n = 100 participants) independently predicted by serum CRP level (HR 1.44 per mg/L [95 % CI 1.17–1.77], p = 0.001), and by fibrinogen level (HR 1.31 per 83.44 mg/dL [=1 SD of mean][95 % CI 1.06–1.61], p = 0.013) | NOS: N/A (abstract) No non-American Indian comparison group; data presented as generalisable evidence that CRP & fibrinogen are additive risk factors for new-onset AF (independent of effects of gender, age, hypertension, BMI, and urinary albumin-creatinine ratio) |
Population: American Indians | Data Source: Strong Heart | |||
Period: enrolled 1993–1995 with 10 years follow-up | Study: prospectively collected population-based survey of risk factors | |||
Sample size: 3541 | Setting: 13 American Indian communities | |||
Sample size: 3541 | ||||
Title: Association of Left Ventricular Mass and Ejection Fraction with New-Onset Atrial Fibrillation in a Population-Based Sample: The Strong Heart Study | ||||
Zacks (2006) [33] Conference abstract | Country: US | Design: Population-based cohort study | New-onset AF (n = 91 participants) independently predicted by increased LV mass indexed for height (HR 1.49 per 11 gm/m2.7 [=1 SD of mean][95 % CI 1.24–1.78], p ≤ 0.0001), and (n = 88) by reduced LVEF (HR 0.65 per 14 % [=1 SD of mean][95 % CI 0.52–0.82], p ≤ 0.0001) | NOS: N/A (abstract) No non-American Indian comparison group; data presented as generalisable evidence that LV mass index and LVEF are additive risk factors for new-onset AF (independent of effects of gender, age, hypertension, BMI, urinary albumin-creatinine ratio, CRP and fibrinogen) |
Population: American Indians | Data Source: Strong Heart | |||
Period: enrolled 1993–1995 with 10 years follow-up | Study: prospectively collected population-based survey of risk factors | |||
Sample size: 3541 | Setting: 13 American Indian communities | |||
Sample size: 3541 | ||||
Incidence in population | ||||
Title: Cardiovascular Disease Rates, Outcomes, and Quality of Care in Ontario Métis: A Population-Based Cohort Study | ||||
Atzema (2015) [31] Journal article (this study has multiple outcomes) | Country: Canada (Ontario only) | Design: Retrospective cohort study (18 % of Métis population) | Age- & sex-adjusted incidence per 100 (CI): Métis0.62 (0.50–0.73) | NOS (cohort): 7/9 Incidence well-defined. Register not representative; Out-of-hospital cases not included; very small numbers of incident cases |
Population: Métis | Data Source: Ontario Métis register linked to emergency department (ED), in-patient hospital & mortality records | All Ontario 0.32 (0.32–0.32) | ||
Period: 2006-2011 | Setting: ED and hospital based cases | p < 0.001 | ||
Age: 20 years & over | Other: 5-year clearance period | |||
Sample size: 56 cases of 12,550 (7 % of provincial Métis population) | ||||
Title: Initial hospitalisation for atrial fibrillation in Aboriginal and non-Aboriginal populations in Western Australia | ||||
Katzenellenbogen (2015) [30] Conference abstract later published as a journal article (this study has multiple outcomes) | Country: Australia (Western Australia only) | Design: baseline data of retrospective cohort | Aboriginal age-specific rates higher than non-Aboriginal rates in all ages <70 years | NOS (adapted for cross-sectional): 10/10 Coverage of whole State with linked data but admitted hospital cases only; no data on diagnostic tests and medications; diagnostic codes not validated |
Population: Aboriginal | Data Source: Linked hospital and death records | ASRR: 20–54 years = 3.6 (males) and 6.4 (females) 55–84 years = 1.3 (males) and 1.8 (females) | ||
Age: 20–84 years | Setting: Western Australian hospital cases | |||
Period: 2000-09 | Other: 15-year clearance period | |||
Sample size: 37,097 AF cases, 923 Aboriginal | ||||
Prevalence in population | ||||
Title: Cardiovascular Disease Rates, Outcomes, and Quality of Care in Ontario Métis: A Population-Based Cohort Study | ||||
Atzema (2015) [31] Journal article (this study has multiple outcomes) | Country: Canada (Ontario only) | Design: Retrospective study | Age- & sex-adjusted prevalence per 100 (CI): Métis 2.08 (1.82–2.34) | NOS (adapted for cross-sectional): 8/10Prevalence not well-defined. Register not representative, out-of-hospital cases not included, numerators not provided and likely to be small numbers |
Population: Métis | Data Source: Métis register linked to emergency department (ED), in-patient hospital & mortality records | All Ontario 1.42 (1.41–1.43) | ||
Period: 2006-2011 | Setting: ED and hospital based cases | p < 0.001 | ||
Age: 20 years & over | Sample size: 12,550 (17 % of provincial Métis population) | |||
Title: Racial differences in the prevalence of atrial fibrillation among males | ||||
Borzecki (2008) [34] Journal article | Country: US | Design: Cross-sectional | Prevalence in male Veterans higher among White than Native Americans Age-adjusted: White 5.7 % Native American 5.4 % Multivariate OR 1.15; 95 % CI 1.04-1.27 (adjusted for age, BMI and predisposing comorbidities) | NOS: (adapted for cross-sectional) 10/10 High quality whole-of-nation study. Survey response only 67 % Whites & 55 % Native Americans, but analyses of administrative data from non-respondents support lower prevalence of AF among Native Americans vs Whites. Restricted to male veterans: military recruiting may limit generalisability |
Population: Native American/Alaskan/Hawaiian | Data Source: administrative database plus health survey | |||
Period: 1997-1999 | Setting: population-based (male veterans) | |||
Age: 18 years & over | Sample size: 664,754 respondents (27,697 Native Americans) | |||
Titles: 1. Heart failure, ventricular dysfunction and risk factor prevalence in Australian Aboriginal peoples: the Heart of the Heart Study | ||||
2. Cardiometabolic risk and disease in Indigenous Australians: the Heart of the Heart Study | ||||
Country: Australia | Design: Cross-sectional | Crude prevalence of AF = 2.5 % Similar prevalence <40 and 40–55 years (1 %; n = 3), higher prevalence 56+ years (8 %; n = 8). Similar prevalence between remote and town communities. | NOS (adapted for cross sectional): 8/10 (AF not main outcome) Standardised measurements; out-of-hospital and undiagnosed cases included; small numbers; estimated 10 % enrolled, representativeness unknown, possible selection bias | |
Population: Aboriginal | Data Source: Community survey, including psycho-social, biological and clinical measures | |||
Age: 17+ years | Setting: 3 communities in Central Australia | |||
Period: 2008-09 | Sample size: 436 volunteers | |||
Title: Twelve Lead Electrocardiographic Findings Among Māori and non-Māori at Risk of Cardiovascular Disease in NZ | ||||
Martin (2013) [37] Conference abstract | Country: NZ | Design: baseline descriptive (within cohort study) | Atrial fibrillation frequencies: 2 % rural Māori 1.2 % urban Māori 0.4 % urban non-Māori | NOS: N/A (abstract) No data provided on age/sex distribution, no statistical inference |
Population: Māori | Data Source: ‘randomly selected’ community samples from the Hauora Manawa Community Heart Study cohort: 12-lead ECG | |||
Age: 20–64 years | Setting: two Māori Communities (rural, urban) and a non-Māori urban cohort | |||
Period: Not known | Sample size: 252 rural Māori, 243 urban Māori, 256 urban non- Māori | |||
Title: The Burden of Atrial Fibrillation in Octogenarians | ||||
Teh (2013) [38] Conference abstract | Country: NZ | Design: baseline descriptive (within cohort study) | 30 % Māori versus 21 % non-Māori had AF, either on ECG or NZHIS records 7 % Māori versus 4 % non-Māori had AF newly detected by study ECG | NOS: N/A (abstract) No statistical inferential data or eligibility exclusions reported Stroke reported as a comorbidity in 27 % of Māori and 35 % of non-Māori subjects |
Population: Māori | Data Source: Life and Living to Advanced Age (NZ) cohort: 12-lead ECG plus NZHIS | |||
Age: 80-90 | Setting: community | |||
Period: 2010-2011 | Sample size: Overall cohort: 421 Māori aged 80–90; 516 non- Māori all aged 85.615 (66 %) participants had ECG; 870 (93 %) consented to NZHIS record examination | |||
Admission Rates (unlinked) | ||||
Title: The Management of People with Atrial Fibrillation and Flutter: Evidence-based Best Practice Guideline | ||||
New Zealand Guidelines Group (2005) [39] Report | Country: NZ | Design: Descriptive | Hospital discharges with AF diagnosis: Age-standardised rate for Māori almost twice that of non-Māori (104 per 100,000 vs 57 per 100,000, p < 0.05) Standardised discharge ratio (observed versus expected) 1.945 for Māori & 0.972 for ‘others’ (where 1.0 is the national average) Modal age group: Māori 65–69 years, ‘other’ males 75–79 years, ‘other’ females >85 years | NOS: N/A (report with insufficient methodological detail published) Unlinked administrative data |
Population: Māori | Data Source: National minimum dataset | |||
Period: 2001-2002 | Setting: Hospital patients | |||
Age: unrestricted | Sample size: (whole of NZ data; sample size not stated) | |||