Abstract
Background/objectivesLittle is known about trends in risk factors and mortality for Aboriginal Australians with heart failure (HF). This population-based study evaluated trends in prevalence of risk factors, 30-day and 1-year all-cause mortality following first HF hospitalization among Aboriginal and non-Aboriginal Western Australians in the decade 2000–2009.MethodsLinked-health data were used to identify patients (20–84 years), with a first-ever HF hospitalization. Trends in demographics, comorbidities, interventions and risk factors were evaluated. Logistic and Cox regression models were fitted to test and compare trends over time in 30-day and 1-year mortality.ResultsOf 17,379 HF patients, 1,013 (5.8 %) were Aboriginal. Compared with 2000–2002, the prevalence (as history) of myocardial infarction and hypertension increased more markedly in 2006–2009 in Aboriginal (versus non-Aboriginal) patients, while diabetes and chronic kidney disease remained disproportionately higher in Aboriginal patients. Risk factor trends, including the Charlson comorbidity index, increased over time in younger Aboriginal patients. Risk-adjusted 30-day mortality did not change over the decade in either group. Risk-adjusted 1-year mortality (in 30-day survivors) was non-significantly higher in Aboriginal patients in 2006–2008 compared with 2000–2002 (hazard ratio (HR) 1.44; 95 % CI 0.85-2.41; p-trend = 0.47) whereas it decreased in non-Aboriginal patients (HR 0.87; 95 % CI 0.78-0.97; p-trend = 0.01).ConclusionsBetween 2000 and 2009, the prevalence of HF antecedents increased and remained disproportionately higher in Aboriginal (versus non-Aboriginal) HF patients. Risk-adjusted 1-year mortality did not improve in Aboriginal patients over the period in contrast with non-Aboriginal patients. These findings highlight the need for better prevention and post-HF care in Aboriginal Australians.
Highlights
Indigenous minorities in affluent countries like Australia, Canada, New Zealand and the United States have considerably lower life expectancies compared with the non-Indigenous populations [1]
Compared to non-Aboriginal heart failure (HF), Aboriginal patients had a higher proportion of women and were younger (Table 1) with mean age remaining 16–18 years lower at first HF hospitalization over the period
Our study indicates that despite advances in medical therapies, the 1-year adjusted survival following first HF hospitalization did not improve in Aboriginal patients over the 10-year period, contrasting with the significant improvement seen in non-Aboriginal patients and previously reported for the Western Australian population [13]
Summary
Indigenous minorities in affluent countries like Australia, Canada, New Zealand and the United States have considerably lower life expectancies compared with the non-Indigenous populations [1]. In Australia, CVD accounts for about a quarter of the differential disease burden in the Aboriginal population [7]. Many modifiable lifestyle risk factors (smoking, physical inactivity, poor nutrition) and CVD risk factors (diabetes, chronic kidney disease, overweight/obesity, hypertension) are more common in Aboriginal than non-Aboriginal populations [2, 3], predisposing them to the development of CVD [8]. Heart failure (HF) is a common, morbid and costly disease with poor prognosis [9]. It is a chronic, progressive clinical syndrome that is characterised by underlying structural or functional impairment of ventricular filling or ejection of blood [10]. The cardinal manifestations are fatigue and dyspnoea at rest or during physical activity, and often fluid retention, pulmonary congestion and/ or peripheral oedema [10]
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