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(a) Frequency of atrial fibrillation in primary care consultations
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Title: Aboriginal and Torres Strait Islander Health Performance Framework 2012 - Detailed Analyses
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Australian Institute of Health and Welfare (2013) [40] Report
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Country: Australia
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Design: Cross-sectional
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Age-standardised rate (no. of encounters per 1,000 in which AF managed): Indigenous: 15.1 (CI 5.7-24.4) Other: 11.5 (CI 11.0-12.0) Rate ratio 1.3 (NS) Rate difference 3.5 (NS)
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NOS (adapted for cross-sectional): 5/10
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Pop: Aboriginal
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Data Source: BEACH (written questionnaire, random sample of GPs across Australia)
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Likely under-identification of Indigenous patients
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Period: 2006–07 to 2011-12
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Setting: General practice attendances
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Sample size: AF managed during 38 ‘Indigenous’ and 5548 ‘Other’ GP attendances
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(b) Frequency of atrial fibrillation in hospital admissions
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Title: Atrial fibrillation in Indigenous and non-Indigenous Australians: a cross-sectional study
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Wong (2014) [29] Conference abstract later published as a journal article
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Country: Australia
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Design: Retrospective cross-sectional study
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Indigenous vs non-Indigenous frequency of AF adjusted for age, sex & CVD comorbidity (odds ratio): 1.183 (CI 0.977-1.432; p = 0.085)
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NOS (adapted for cross-sectional): 5/10 Unclear definition of AF occurrence (throughout series of ≥1 potential admission per patient) No ‘lookback’ to establish age at 1st AF admission Representativeness of population uncertain from single institution Denominator for comparisons unclear
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Pop: Indigenous Australians (IA)
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Data Source: Administrative data
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Crude age-stratified frequency of AF Indigenous vs non-Indigenous: <60 yrs 2.57 vs 1.73 % p < 0.0001 ≥ 60 yrs 4.61 vs 9.26 % p < 0.0001
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Period: 2000-2009
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Setting: Single tertiary hospital (South Australia)
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Average age of patients with AF (years): Indigenous 55.4 (SD 13.2) vs Non-Indigenous 74.5 (SD 13.1) p < 0.001
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Sample size: 204668 persons admitted (5892 Indigenous [3.6 %]) 14373 patients with AF diagnosis (221 Indigenous)
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(c) Frequency of atrial fibrillation in specific diagnostic groups
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i. Heart failure
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Title: Incidence of first heart failure hospitalisation and mortality in Aboriginal and non-Aboriginal patients in Western Australia, 2000-2009
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Teng (2014) [44] Journal article
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Country: Australia
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Design: baseline descriptive (within cohort study) hospitalised HF patients
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Crude AF prevalence significantly higher in non-Aboriginal patients: 20–55 years
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NOS (adapted for cross-sectional): 9/10 15-year clearance period to identify first HF admission; codes validated; 5-year look back for history of AF
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Pop: Aboriginal
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Data Source: Linked hospital and death records
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Aboriginal = 17.2 % Non-Aboriginal = 26.6 % p < 0.001 55–84 years
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Period: 2000-2009
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Setting: Hospital
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Aboriginal = 24.6 %% Non-Aboriginal = 44.9 % p < 0.001
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Sample size: 1013 Aboriginal and 16,366 non-Aboriginal hospitalised HF patients
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Title: Mortality outcomes among status Aboriginals and Whites with Heart Failure
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Lyons (2014) [43] Journal article
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Country: Alberta, Canada
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Design: baseline descriptive (within cohort study)
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Crude prevalence of AF (as comorbidity): Aboriginals (18 %); Whites (34 %)
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NOS (adapted for cross-sectional): 8/10 Albertan Aboriginal population comprises 52 % First Nations, 45 % Métis & 3 % Inuit. Identification of Indigenous status in study based on registration—only First Nations are eligible, of whom 81 % are registered. Métis classified as White in this study.
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Pop: Aboriginal
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Data Source: Health care administrative (HMD, ED, ambulatory care) databases linked to the insurance registry (with ethnicity recorded)
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Period: 2000-2008
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Setting: Hospital
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Sample size: 42,288 whites, 1158 Aboriginals
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ii. Ischaemic heart disease
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Title: Ischaemic heart disease in New Zealand Māori and non-Māori: an age adjusted incidence in hospitalised patients over 10 years with emphasis on clinical features in the Māori
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Dancaster (1982) [45] Journal article
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Country: NZ
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Design: Descriptive
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AF detected in 39 % of Māori versus 6 % of non-Māori cases
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NOS (adapted for cross-sectional): 3/10 No statistical inference data given for AF proportions Old study—contemporary relevance uncertain
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Pop: Māori
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Data Source: Hospital records
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Period: 1971-1980
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Setting: Single regional hospital CCU
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Sample size: 887 CCU-admitted IHD cases
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iii. Renal failure
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Title: Atrial fibrillation in haemodialysis patients: do the guidelines for anticoagulation apply?
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To (2007) [48] Journal article
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Country: NZ
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Design: baseline descriptive (within cohort study) Data Source: Subjects identified from identified from ANZ Dialysis and Transplant Registry; Hospital records—30 month follow-up
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Crude percentage AF: Caucasians 32.8 % Māori 28.6 % Pacific Islanders 19.6 % Asians 16.7 %
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NOS (adapted for cross-sectional): 6/10 Underpowered, therefore essentially descriptive study of AF prevalence
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Pop: Māori
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Setting: Single hospital haemodialysis unit
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Period: 2003
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Sample size: 155 haemodialysis patients; 28 (18 %) Māori, 51 (33 %) Pacific Islander
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Title: Trends in the incidence of atrial fibrillation in older patients initiating dialysis in the United States
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Goldstein (2012) [47] Journal article
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Country: US
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Design: Cohort study
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Crude incidence rate: 148/1000 person-years Compared to non-Hispanic whites, Blacks (−30 %), Asians (−29 %) & Native Americans have lower risk (−42 %) of incident AFCrude incidence rate: 148/1000 person-years Compared to non-Hispanic whites, Blacks (−30 %), Asians (−29 %) & Native Americans have lower risk (−42 %) of incident AF
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NOS (cohort): 9/9 Small sample size for Native Americans (1 %).
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Pop: Native Americans
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Data Source: US Renal Data System
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Period: 1995-2007
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Setting: Population-based (older Medicare beneficiaries)
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Sample size: 258,605 (1 % Native Americans)
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Title: The increasing prevalence of atrial fibrillation among hemodialysis patients
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Winkelmayer (2011) [46] Journal article
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Country: US
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Design: series of cross-sectional surveys
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Native American HD patients univariate RR for AF 0.38 (vs Causasian); adjusted RR 0.53 (CI 0.50-0.57)
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NOS (adapted for cross-sectional): 10/10
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Pop: Native American
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Data Source: United States Renal Data System
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Period: 1992-2006
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Setting: maintenance hemodialysis pts—whole of USA
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Sample size: >105 pts each year of study
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iv. Stroke
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Title: Prevalence of stroke and coexistent conditions: disparities between Indigenous and non-Indigenous Western Australians
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Katzenellenbogen (2014) [49] Journal article
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Country: Australia
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Design: baseline descriptive (within cohort study)
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AF more prevalent in Aboriginal than other stroke cases in all age groups <70 years. Crude AF rates were 20 % less in Aboriginal patients due to differing age distributions.
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NOS (adapted for cross-sectional): 7/10 (AF not focus of study) Long (20-year) look-back period to identify stroke and AF; AF codes not validated; no stroke type data
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Pop: Aboriginal
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Data Source: Linked hospital and death records
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Period: 2007-2011
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Setting: Hospital
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Sample size: Average 13,591 patients per year (5 % Aboriginal)
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Title: Racial disparities among Native Hawaiians and Pacific Islanders with intracerebral hemorrhage
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Nakagawa (2012) [50] Journal article
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Country: Hawaii, US
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Design: Cross-sectional
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Crude prevalence of AF: No significant difference between whites & NHPI (10 % vs 17 %)
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NOS (adapted for cross-sectional): 7/10
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Pop: Native Hawaiians & Pacific Islander (NHPI)
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Data Source: Clinical database
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Single-centre (referral bias). Good clinical data. Limited analysis, given small sample size
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Period: 2004-2010
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Setting: Hospital admissions from single tertiary hospital
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Sample size: 562 ICH cases
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Title: Disparities among Asians and native Hawaiians and Pacific Islanders with ischemic stroke
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Nakagawa (2013) [51] Journal article
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Country: Hawaii, USA
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Design: Cross-sectional
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AF prevalence: No significant difference between whites & NHPI Crude prevalence 15 % vs 19 % Adjusted OR 1.06 (0.64-1.75)
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NOS (adapted for cross-sectional): 8/10 Single-centre (referral bias). Good clinical data.
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Pop: NHPI
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Data Source: Clinical database
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Period: 2004-2010
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Setting: Hospital admissions from single tertiary hospital
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Sample size: 1,921 ischaemic strokes
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v. Rheumatic heart disease
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Title: Percutaneous balloon mitral commissurotomy in Indigenous versus non-Indigenous Australians
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McCann (2008) [52] Journal article
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Country: Australia
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Design: baseline descriptive (within cohort study)
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Crude AF prevalence: non-significantly lower in Indigenous Australians (44 % vs 29 %)
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NOS (adapted for cross-sectional): 7/10 Only 36 (11 %) of Indigenous Australians. Age-adjusted survival was worse in Indigenous Australians.
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Pop: Indigenous Australians
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Data Source: Clinical database
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Period: 1990-2006
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Setting: two tertiary hospitals
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Sample size: 327
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Title: A review of valve surgery for rheumatic heart disease in Australia
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Russell (2014) [53] Journal article
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Country: Australia
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Design: Cross-sectional
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Crude frequency of perioperative AF (%): Indigenous 33.3 Non-Indigenous 41.6 (p = 0.039) n.b., difference in mean age: Indigenous 37.4 years Non-Indigenous 65.1 year
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NOS: N/A (descriptive study) Comparison of crude frequencies of AF in the two ethnic categories is markedly confounded by age disparity
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Pop: Aboriginal & Torres Strait Islander
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Data Source: National Cardiac Surgery Database
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Period: 2001-2012
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Setting: Hospitalised surgery patients
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Sample size: 1384 RHD (174 Indigenous) compared with 15843 non-RHD valvular surgery patients
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vi. Other cardiac surgery
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Title: Incidence, secular trends, and outcomes of cardiac surgery in Aboriginal peoples
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Sood (2013) [54] Journal article
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Country: Canada
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Design: baseline descriptive (within cohort study)
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No significant difference in AF prevalence at baseline (10.1 % non-Aboriginal v 12.0 % Aboriginal)
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NOS (cohort): 9/9 Main aims were to compare Aboriginal vs non-Aboriginal patients for incidence, secular trends & outcomes of cardiac surgery. Limited info on AF: crude baseline prevalence in a cohort with known selection bias (demonstrated disparity in selection for surgery)
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Pop: Canadian Aboriginal
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Data Source: Provincial Cardiac Surgery registry
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Period: 1995-2007
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Setting: Whole of Manitoba
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Age: >15 years
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Sample size: 12170 (Aboriginal 574; 4.7 %)
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vii. Paediatric patients
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Title: Excellent cardiac surgical outcomes in paediatric indigenous patients, but follow-up difficulties
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Rohde (2010) [55] Journal article
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Country: Brisbane, AUS
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Design: Retrospective review
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New atrial arrhythmia as post-surgical complication: 2.4 %
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NOS (adapted for cross-sectional): 7/10 Atrial arrhythymia was one endpoint (complication) of follow-up after cardiac surgery.
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Pop: Indigenous Australians (paediatric)
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Data Source: Cardiothoracic database, chart review
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Period: 2002-2009
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Setting: Single tertiary hospital
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Sample size: 112 cases (123 operations)
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Title: Preoperative risk factors for long-term survival following cardiac surgery for rheumatic heart disease in the young
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Remenyi (2012) [56] Conference abstract
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Country: Auckland, NZ
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Design: Retrospective cohort study
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Pre-operative AF independently predicted mortality in multivariate analysis (HR 5.2, p < 0.01)
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NOS: N/A (abstract) No Causasian comparison group
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Pop: Māori & PI
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Data Source: Cardiothoracic database, chart review
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Period: 1990-2006
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Setting: Single tertiary hospital
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Sample size: 212 cases
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