The alarming prevalence of sudden cardiac death among Indigenous Australians aged under 40 in the Northern Territory is prompting calls for targeted screening to tackle the issue. 

A review of coronial data published in JSAMS Plus [link here] included 59 cases of sudden cardiac death between 2019 and 2023, giving rise to an estimated incidence of 19.8 per 100,000 Indigenous people. 

This figure is 15 times greater than the annual incidence in the Australian general population, which has been estimated in a previous study to sit at 1.3 cases per 100,000 persons. 

Of the cases reviewed, the most common cause of cardiac death was coronary artery disease (61%), followed by rheumatic heart disease (8.5%) and sudden arrhythmic dead syndrome (7%). 

The mean age of death was 32 and 61% of the cases reviewed were male. 

The authors highlighted three cases where sudden cardiac death had been related to sport or an exercise activity. 

“Large numbers of First Nations Australian young people are undertaking sporting and physical activity on a regular or professional basis and should be encouraged to do so,” the authors said. 

“However, for those with heart disease, avoidance of high intensity and prolonged exercise or competitive sports would be recommended.” 

They noted that awareness of warning symptoms and signs is important so those affected could stop exercising and seek medical help. 

The review concluded that current screening approaches were inadequate for young First Nations Australians who face a higher burden of cardiovascular disease than the broader population. 

“There is therefore a case for revising the current guidelines for screening to improve early detection of heart disease and risk factors in the First Nations Australians, at an earlier age of <16 years,” they said. 

“There should be ongoing close clinical evaluation for early diagnosis, effective treatment to prevent SCD and guide decisions on their participation in sports.” 

The authors acknowledged the study only used cases of recorded coronial autopsies and so may not be representative of the entire population. 

The study also did not include detailed information about the socioeconomic status of the cases, making it difficult to conclude that race is the predominant factor in the premature CAD, compared to socioeconomic disadvantage”, they said. 

Developing a culturally-safe strategy 

An editorial in response to the study said the paper contained “vital and concerning data” [link here]. 

It said a “culturally safe, well-resourced and co-ordinated strategy” was needed to assess risk factors and expand screening checks.

Sports could provide a novel setting for cardiac health checks, the editorial said.

“Programs must prioritise cultural authority and local knowledges including a clear pathway to care, and actively support trust and participation,” they said. 

“Health screening in First Nations communities must be more than accessible – it must be ethically and culturally sound and responsive to the communities it aims to serve.” 

They noted that screening through sport could be a novel approach, given cardiac screenings in professional settings like the AFL are routinely performed and widely accepted. 

“Screening in sport often occurs at the training ground in a convenient, familiar and inclusive setting. This approach could be translated and tailored for First Nations Australians,” they said.