Abstract
Introduction: The epidemiology of atrial fibrillation (AF) is poorly described for Aboriginal Australians, despite AF being a major determinant of heart failure and stroke. Objectives: To compare the epidemiological profile of first-ever hospitalised AF between Aboriginal and non-Aboriginal Western Australians aged 20-84 years (2000-09) with respect to incidence, demography, co-morbidity, 28-day and 1-year mortality. Methods: Incident public and private hospital AF admissions (AF hospital admission-free for 15 years) were identified from all diagnosis fields, and subsequent mortality determined using person-based linked hospital and mortality data. Comorbidity histories of specific chronic conditions were ascertained using a 10-year look-back from index AF admission. Age-standardised incidence rates were estimated using the WHO standard and the adjusted risk of 28-day and 1-year mortality calculated using logistic and Cox regression. Results: Aboriginal patients comprised 923 (2.5%) of the 37,097 incident AFs. Compared with non-Aboriginal patients, Aboriginal patients had lower proportions of AF diagnoses in the primary diagnosis field (24% vs 33%) but higher emergency presentations (85% vs 65%); lower mean age (54.8 vs 69.3 years); more females (45.9% vs 40.8%) and rural admissions (50% vs 14%); higher comorbidity prevalence of heart failure, diabetes and CKD (all p<1⁄40.001). Age-specific AF incidence rates were higher in Aboriginals than nonAboriginal in all age groups <70 years. The Aboriginal to non-Aboriginal age-standardised AF incidence rate ratios for men and women 20-54 years were 3.6 and 6.4 respectively and 1.3 and 1.8 respectively for 55-84 years. Crude and adjusted 28-day mortality was similar in both groups. Crude 1-year mortality in 28-day survivors with a primary AF diagnosis was significantly higher in Aboriginal patients (7.5% vs 3.5%), while fully adjusted mortality was significantly higher in Aboriginal women (HR1⁄41.7: CI 1.23-2.34) but not men (HR1⁄41.28: CI 0.93-1.76). The adjusted HR for 1-year mortality in Aboriginal patients with a secondary AF diagnosis was 1.30 (CI 1.02-1.65). Conclusion: The incidence of hospitalised AF is significantly higher in Aboriginal people, particularly at younger ages. The high proportion being admitted with AF as a secondary diagnosis and as an emergency suggests that AF is under-diagnosed and undertreated in this population. The higher 1-year mortality implies the need for better post-discharge management. Disclosure of Interest: None Declared
Published Version
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call