Table 4 Studies of frequency of atrial fibrillation in clinical groups
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 |
|---|---|---|---|---|
(a) Frequency of atrial fibrillation in primary care consultations | ||||
Title: Aboriginal and Torres Strait Islander Health Performance Framework 2012 - Detailed Analyses | ||||
Australian Institute of Health and Welfare (2013) [40] Report | Country: Australia | Design: Cross-sectional | 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) | NOS (adapted for cross-sectional): 5/10 |
Pop: Aboriginal | Data Source: BEACH (written questionnaire, random sample of GPs across Australia) | Likely under-identification of Indigenous patients | ||
Period: 2006–07 to 2011-12 | Setting: General practice attendances | |||
Sample size: AF managed during 38 ‘Indigenous’ and 5548 ‘Other’ GP attendances | ||||
(b) Frequency of atrial fibrillation in hospital admissions | ||||
Title: Atrial fibrillation in Indigenous and non-Indigenous Australians: a cross-sectional study | ||||
Wong (2014) [29] Conference abstract later published as a journal article | Country: Australia | Design: Retrospective cross-sectional study | 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) | 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 |
Pop: Indigenous Australians (IA) | Data Source: Administrative data | 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 | ||
Period: 2000-2009 | Setting: Single tertiary hospital (South Australia) | Average age of patients with AF (years): Indigenous 55.4 (SD 13.2) vs Non-Indigenous 74.5 (SD 13.1) p < 0.001 | ||
Sample size: 204668 persons admitted (5892 Indigenous [3.6 %]) 14373 patients with AF diagnosis (221 Indigenous) | ||||
(c) Frequency of atrial fibrillation in specific diagnostic groups | ||||
i. Heart failure | ||||
Title: Incidence of first heart failure hospitalisation and mortality in Aboriginal and non-Aboriginal patients in Western Australia, 2000-2009 | ||||
Teng (2014) [44] Journal article | Country: Australia | Design: baseline descriptive (within cohort study) hospitalised HF patients | Crude AF prevalence significantly higher in non-Aboriginal patients: 20–55 years | 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 |
Pop: Aboriginal | Data Source: Linked hospital and death records | Aboriginal = 17.2 % Non-Aboriginal = 26.6 % p < 0.001 55–84 years | ||
Period: 2000-2009 | Setting: Hospital | Aboriginal = 24.6 %% Non-Aboriginal = 44.9 % p < 0.001 | ||
Sample size: 1013 Aboriginal and 16,366 non-Aboriginal hospitalised HF patients | ||||
Title: Mortality outcomes among status Aboriginals and Whites with Heart Failure | ||||
Lyons (2014) [43] Journal article | Country: Alberta, Canada | Design: baseline descriptive (within cohort study) | Crude prevalence of AF (as comorbidity): Aboriginals (18 %); Whites (34 %) | 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. |
Pop: Aboriginal | Data Source: Health care administrative (HMD, ED, ambulatory care) databases linked to the insurance registry (with ethnicity recorded) | |||
Period: 2000-2008 | Setting: Hospital | |||
Sample size: 42,288 whites, 1158 Aboriginals | ||||
ii. Ischaemic heart disease | ||||
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 | ||||
Dancaster (1982) [45] Journal article | Country: NZ | Design: Descriptive | AF detected in 39 % of Māori versus 6 % of non-Māori cases | NOS (adapted for cross-sectional): 3/10 No statistical inference data given for AF proportions Old study—contemporary relevance uncertain |
Pop: Māori | Data Source: Hospital records | |||
Period: 1971-1980 | Setting: Single regional hospital CCU | |||
Sample size: 887 CCU-admitted IHD cases | ||||
iii. Renal failure | ||||
Title: Atrial fibrillation in haemodialysis patients: do the guidelines for anticoagulation apply? | ||||
To (2007) [48] Journal article | Country: NZ | Design: baseline descriptive (within cohort study) Data Source: Subjects identified from identified from ANZ Dialysis and Transplant Registry; Hospital records—30 month follow-up | Crude percentage AF: Caucasians 32.8 % Māori 28.6 % Pacific Islanders 19.6 % Asians 16.7 % | NOS (adapted for cross-sectional): 6/10 Underpowered, therefore essentially descriptive study of AF prevalence |
Pop: Māori | Setting: Single hospital haemodialysis unit | |||
Period: 2003 | Sample size: 155 haemodialysis patients; 28 (18 %) Māori, 51 (33 %) Pacific Islander | |||
Title: Trends in the incidence of atrial fibrillation in older patients initiating dialysis in the United States | ||||
Goldstein (2012) [47] Journal article | Country: US | Design: Cohort study | 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 | NOS (cohort): 9/9 Small sample size for Native Americans (1 %). |
Pop: Native Americans | Data Source: US Renal Data System | |||
Period: 1995-2007 | Setting: Population-based (older Medicare beneficiaries) | |||
Sample size: 258,605 (1 % Native Americans) | ||||
Title: The increasing prevalence of atrial fibrillation among hemodialysis patients | ||||
Winkelmayer (2011) [46] Journal article | Country: US | Design: series of cross-sectional surveys | Native American HD patients univariate RR for AF 0.38 (vs Causasian); adjusted RR 0.53 (CI 0.50-0.57) | NOS (adapted for cross-sectional): 10/10 |
Pop: Native American | Data Source: United States Renal Data System | |||
Period: 1992-2006 | Setting: maintenance hemodialysis pts—whole of USA | |||
Sample size: >105 pts each year of study | ||||
iv. Stroke | ||||
Title: Prevalence of stroke and coexistent conditions: disparities between Indigenous and non-Indigenous Western Australians | ||||
Katzenellenbogen (2014) [49] Journal article | Country: Australia | Design: baseline descriptive (within cohort study) | 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. | 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 |
Pop: Aboriginal | Data Source: Linked hospital and death records | |||
Period: 2007-2011 | Setting: Hospital | |||
Sample size: Average 13,591 patients per year (5 % Aboriginal) | ||||
Title: Racial disparities among Native Hawaiians and Pacific Islanders with intracerebral hemorrhage | ||||
Nakagawa (2012) [50] Journal article | Country: Hawaii, US | Design: Cross-sectional | Crude prevalence of AF: No significant difference between whites & NHPI (10 % vs 17 %) | NOS (adapted for cross-sectional): 7/10 |
Pop: Native Hawaiians & Pacific Islander (NHPI) | Data Source: Clinical database | Single-centre (referral bias). Good clinical data. Limited analysis, given small sample size | ||
Period: 2004-2010 | Setting: Hospital admissions from single tertiary hospital | |||
Sample size: 562 ICH cases | ||||
Title: Disparities among Asians and native Hawaiians and Pacific Islanders with ischemic stroke | ||||
Nakagawa (2013) [51] Journal article | Country: Hawaii, USA | Design: Cross-sectional | AF prevalence: No significant difference between whites & NHPI Crude prevalence 15 % vs 19 % Adjusted OR 1.06 (0.64-1.75) | NOS (adapted for cross-sectional): 8/10 Single-centre (referral bias). Good clinical data. |
Pop: NHPI | Data Source: Clinical database | |||
Period: 2004-2010 | Setting: Hospital admissions from single tertiary hospital | |||
Sample size: 1,921 ischaemic strokes | ||||
v. Rheumatic heart disease | ||||
Title: Percutaneous balloon mitral commissurotomy in Indigenous versus non-Indigenous Australians | ||||
McCann (2008) [52] Journal article | Country: Australia | Design: baseline descriptive (within cohort study) | Crude AF prevalence: non-significantly lower in Indigenous Australians (44 % vs 29 %) | NOS (adapted for cross-sectional): 7/10 Only 36 (11 %) of Indigenous Australians. Age-adjusted survival was worse in Indigenous Australians. |
Pop: Indigenous Australians | Data Source: Clinical database | |||
Period: 1990-2006 | Setting: two tertiary hospitals | |||
Sample size: 327 | ||||
Title: A review of valve surgery for rheumatic heart disease in Australia | ||||
Russell (2014) [53] Journal article | Country: Australia | Design: Cross-sectional | 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 | NOS: N/A (descriptive study) Comparison of crude frequencies of AF in the two ethnic categories is markedly confounded by age disparity |
Pop: Aboriginal & Torres Strait Islander | Data Source: National Cardiac Surgery Database | |||
Period: 2001-2012 | Setting: Hospitalised surgery patients | |||
Sample size: 1384 RHD (174 Indigenous) compared with 15843 non-RHD valvular surgery patients | ||||
vi. Other cardiac surgery | ||||
Title: Incidence, secular trends, and outcomes of cardiac surgery in Aboriginal peoples | ||||
Sood (2013) [54] Journal article | Country: Canada | Design: baseline descriptive (within cohort study) | No significant difference in AF prevalence at baseline (10.1 % non-Aboriginal v 12.0 % Aboriginal) | 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) |
Pop: Canadian Aboriginal | Data Source: Provincial Cardiac Surgery registry | |||
Period: 1995-2007 | Setting: Whole of Manitoba | |||
Age: >15 years | Sample size: 12170 (Aboriginal 574; 4.7 %) | |||
vii. Paediatric patients | ||||
Title: Excellent cardiac surgical outcomes in paediatric indigenous patients, but follow-up difficulties | ||||
Rohde (2010) [55] Journal article | Country: Brisbane, AUS | Design: Retrospective review | New atrial arrhythmia as post-surgical complication: 2.4 % | NOS (adapted for cross-sectional): 7/10 Atrial arrhythymia was one endpoint (complication) of follow-up after cardiac surgery. |
Pop: Indigenous Australians (paediatric) | Data Source: Cardiothoracic database, chart review | |||
Period: 2002-2009 | Setting: Single tertiary hospital | |||
Sample size: 112 cases (123 operations) | ||||
Title: Preoperative risk factors for long-term survival following cardiac surgery for rheumatic heart disease in the young | ||||
Remenyi (2012) [56] Conference abstract | Country: Auckland, NZ | Design: Retrospective cohort study | Pre-operative AF independently predicted mortality in multivariate analysis (HR 5.2, p < 0.01) | NOS: N/A (abstract) No Causasian comparison group |
Pop: Māori & PI | Data Source: Cardiothoracic database, chart review | |||
Period: 1990-2006 | Setting: Single tertiary hospital | |||
Sample size: 212 cases | ||||