Heart rhythm helping to take pulse on Aboriginal health

Aboriginal health experts at the Heart Research Institute (HRI) are sounding the alarm on atrial fibrillation (AF), a leading cause of stroke, as a pilot study aims to help prevent cardiovascular disease (CVD) in this at-risk population by encouraging people to take a greater role in their own healthcare.

Assoc Prof Uncle Boe Rambaldini, a proud Bundjalung Elder and associate with the Djurali Centre for Aboriginal and Torres Strait Islander Health Research, said Aboriginal people are more likely to suffer cardiac problems like heart disease and stroke, due to the prevalence of AF or an irregular heartbeat, with too many people falling through the cracks of the health system.

“Aboriginal people experience higher levels of AF at an earlier age than the general population, and research shows we are also experiencing catastrophic strokes at a much younger age,” said Assoc Prof Rambaldini. “We want to close the gap when it comes to healthcare, and we can do this by helping Aboriginal people be more actively involved in their own health. Checking for AF is one simple way,” Assoc Prof Rambaldini continues.

Assoc Prof Rambaldini said the ultimate goal is for every Aboriginal person to be checked for AF every time they step into a health clinic.

“It’s a pulse test that takes 30 seconds. It should be part of routine care. Life-saving screening is available for people over 65, but that‘s often too late for Aboriginal people who need to be screened from age 55 years,” Assoc Prof Rambaldini said.

The Djurali Centre officially joined HRI in December 2023, after a 10-year partnership, to further collaborate on world-leading research into CVD and Aboriginal peoples.

The centre is piloting wearable technology for AF detection for Aboriginal people into primary care. Over the next two years, 100 people will take part in the study across New South Wales, including in the Aboriginal community at Brewarrina in the northwest of the state.

“Digital technology is changing how we care for our health, and it has the potential to provide cost-effective services for underserved populations,” said HRI’s Djurali Centre Director of Research, Assoc Prof Kylie Gwynne. “We have already completed Phase 1, resulting in the development of a culturally safe protocol for AF screening in primary care, establishing an evidence-based care pathway, embedding early screening for AF into primary care, and establishing acceptability of using wearable technology like smart watches.

“This study is about assessing what data Aboriginal people are prepared to share with their healthcare service and what data the health service wants. These devices have so much data, and clearly the health service doesn’t need to record all of it. So while it’s great for a doctor to know a patient’s heart rate and blood pressure to inform a better treatment plan, a person’s step count may not need to be recorded in the healthcare system.

“So wearing this watch will help patients understand their own health status and how they can improve it. At the same time, it will assist health professionals to better manage people's care, especially for those who might have additional risk factors,” Assoc Prof Gwynne added.

The half a million Australians unknowingly suffering from AF is projected to increase by 150 per cent over the next four decades – leading to a sharp increase in stroke and heart failure.

“In AF, blood circulates in the heart in an abnormal way, so there is a tendency for clots to develop. These clots can break off and travel to all areas of the body in the bloodstream, and if a clot blocks the brain artery, this can cause a stroke,” Assoc Prof Rambaldini said.

AF-related strokes tend to be larger, more severe, and harder to survive than strokes due to other causes.

“The watches in this pilot study are another tool really to engage patients in finding what their AF status is, and engaging their health professionals in that. This study is all about finding problems as early as possible and facilitating access to the best available treatment to try and close the gap in life expectancy and quality of life for Aboriginal people.

“AF occurs more commonly in Aboriginal people at an earlier age, and when AF is found earlier, the risk of stroke is much higher than for non-Aboriginal people.”

For Aunty Mary Waites, a proud Ngemba woman from Brewarrina, the research ended up saving her husband's life.

After signing up to take part in the research trial herself, she went home and mentioned it to her husband, Lindsay. Returning home from her weekly women’s group with a smartwatch to monitor her risk factors, the 55-year-old told him she had had her blood pressure checked at the local Aboriginal Medical Centre, prompting him to do the same.

"Lindsay's results came up with an abnormal reading, so he was referred straight to a doctor and had more tests done," Aunty Mary recalls. "He ended up being admitted to Orange hospital. I was really amazed at how quickly everything happened."

As it turned out, Lindsay had four blocked arteries and needed immediate life-saving surgery at Sydney's Royal Prince Alfred Hospital.

"He had no symptoms and no pain. Nothing. He had no idea this was going on with his heart," she explains. "And it all took was just 30 seconds on a little machine and it saved his life.

"I recommend it to all my people. It’s just a few seconds that could save your life”.

The risk of AF is also increased by heart disease, high blood pressure, type two diabetes and sleep apnoea, as well as the use of stimulants like tobacco smoking.

One of the challenges with the study has been selecting wearable technology that’s attractive and easy to use.

“We had to pick a device that was easy to use and attractive to people over 55, but not attractive to their 13-year-old grandchildren. We want data from a 58-year-old, not their grandson,” Assoc Prof Gwynne said. “We chose a Withings Scanwatch, which is a really beautiful, stylish watch. It looks like an analog watch, but it has all the functionality that we need for the kind of biometric information we want to collect.

“Each participant will be given a watch and a patch, which is a bit bigger than a post-it note, to monitor their heartbeat over a five to seven day period. Participants will wear the watch for a month,” Assoc Prof Gwynne said.

AF claims the lives of six Australians every day, and the estimated cost of AF on the national economy is more than $1.25 billion dollars through medical costs, the cost of long term care for those with a stroke related disability, and lost productivity.