Aboriginal and Torres Strait Islander people are more than twice as likely to have a stroke as non-Indigenous Australians.
These strokes occur younger, are more likely to be fatal, and often result in long-term disability. Around one-third are linked to atrial fibrillation - a condition that causes an irregular and often very rapid heartbeat. But these strokes are largely preventable if diagnosed and treated early.
In Australia, screening for atrial fibrillation is generally recommended for people aged 65 and over.
But our new research , published today in the Medical Journal of Australia, shows screening Indigenous people at least ten years earlier can reduce their risk of stroke. Here's why.
How can atrial fibrillation cause strokes?
Atrial fibrillation can cause blood to pool and clots to form in the heart. If a clot travels to the brain, it can trigger a stroke.
Strokes linked to atrial fibrillation are often more severe than other types of stroke.
Unfortunately, atrial fibrillation often has no symptoms and many people don't know they have it until they have a stroke.
But a simple pulse check or 30-second recording of the heartbeat can detect atrial fibrillation quickly and accurately. This recording can be done by holding a single-lead electrocardiogram (ECG), a USB-sized device linked to an app on a smartphone, which can accurately diagnose the condition.
Improving detection for Indigenous people
Our research over the past decade has focused on improving early detection of atrial fibrillation for Indigenous Australians.
We began by co-designing the research with local health practitioners and community members in Brewarrina - a small town in northern New South Wales where Aboriginal people make up more than half of the population - about how, when and who to test.
One of our team, Katrina, is a descendant of the Ngiyampaa people of the Wongaibon nation and led the project. Community members, clinicians and health service leaders shaped the approach to ensure it was culturally responsive, acceptable and practical in the real world.
Our previous research has demonstrated that screening for atrial fibrillation in Aboriginal Community Controlled Health Services and other primary care services is an effective way to catch the condition early.
We also partnered with 16 Aboriginal Community Controlled Health Services across the country and screened 619 participants 45 years and older. We found staff and patients found the devices easy to use and screening identified 29 cases of atrial fibrillation.
When atrial fibrillation was detected, people were more likely to be referred for further assessment and treatment .
After the successful pilot in Brewarrina, we are currently expanding the screening program nationally.
Why screening should happen earlier
Our new study makes a compelling case for screening Indigenous Australians at least ten years earlier than current national guidelines recommend.
Australian guidelines recommend screening for atrial fibrillation from age 65. That threshold is based on population-wide data.
But our new systematic review of 24 studies found Indigenous Australians develop atrial fibrillation nearly 16 years earlier than other Australians. They have a higher risk than the general population, linked to intergenerational trauma, racism in the health-care system and associated higher rates of chronic disease.
We also found that Indigenous people with atrial fibrillation are more likely to have additional conditions that increase stroke risk, including:
- diabetes
- hypertension
- kidney disease
- rheumatic heart disease.
So screening from at least age 55, and earlier for people with additional risk factors, will be an effective way to diagnose and treat atrial fibrillation early.
Treatment gaps must be addressed
Early screening alone does not prevent stroke. Screening must be accompanied by timely follow-up, culturally responsive communication, and access to care.
Treatments for atrial fibrillation include dietary changes, increased physical activity and medication.
But our review found Indigenous Australians with atrial fibrillation are less likely to receive guideline-recommended therapies.
Under-treatment compounds the problem of under-diagnosis. Stroke prevention requires both earlier detection and timely access to treatment.
When atrial fibrillation is identified, clinicians should follow established guidelines for managing heart rhythm, reducing stroke risk and addressing co-existing conditions.
Cost and distance can prevent people seeking treatment, especially in remote and rural areas, and sometimes prevent follow-up. So care planning should involve local consultation.
Indigenous people are more likely to access health care and follow clinical advice when services are welcoming and free from racism . This is important for timely detection and effective management of atrial fibrillation.
What needs to happen now
We need to amend atrial fibrillation screening recommendations in light of this evidence.
In the meantime, primary care clinicians working with Aboriginal and Torres Strait Islander patients should consider atrial fibrillation screening from at least age 55.
Where patients have higher stroke risk, this should be done even younger. Screening for atrial fibrillation can be done in just 30 seconds and at the same time as other routine tests such as blood pressure.
We have developed a free, five-minute online training module to help primary care clinicians understand the evidence and implement earlier screening in practice.
Stroke is not inevitable
Atrial fibrillation-related stroke can be reduced by around 60-70% with therapies such as changes to diet, more physical activity and medication.
But applying a single screening age across all groups assumes they have an equal risk when, in fact, we know risk is not equal.
Adjusting the screening age for Indigenous Australians enables evidence-based care tailored to risk. Earlier screening represents a practical, achievable step to reduce strokes, prevent disability, preserve independence and close part of the heart health gap.
As Aunty Mary from Brewarrina tells us
I would encourage all our people to get tested - it's just a few seconds that could save your life.
Kylie Gwynne receives funding from the National Health and Medical Research Council, Medical Research Future Fund, National Heart Foundation, Love Your Sister Foundation and Ian Potter Foundation. She is a Fellow of the European Cardiac Society.
Katrina Ward is Chief Operations Manager, Walgett & Brewarrina Aboriginal Medical Services.
Vita Christie does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.
