Cardiologists and researchers are turning to their mobile phones in an effort to reduce the prevalence of atrial fibrillation-related stroke in Aboriginal people living in outback Australia.
Speaking to the limbic, cardiologist Professor Ben Freedman from the Charles Perkins Centre and Heart Research Institute at the University of Sydney said ischaemic stroke affects one in 25 Aboriginal people, often many years earlier than non-indigenous Australians.
“There isn’t a lot of published data about the prevalence of atrial fibrillation (AF) in people from Aboriginal and Torres Strait Islander backgrounds but a couple of publications point out that, at least in hospitalised patients, the age where people present with AF seems to be about 20 years younger in Aboriginal Australians.
“We know that Aboriginal Australians don’t live that long – they die early from cardiovascular disease principally – so knowing these two things I thought that if we went out and really looked for it [AF] we would be likely to find it in younger Aboriginal Australians.
Professor Freedman said the smartphone device, called iECG, was an ideal way to capture AF events. The process is a simple one, in which the patient places their fingers on connectors attached to the back of a phone and holds on for 30 seconds – a recording is processed by an app on the phone which gives results almost immediately.
The device can be used by someone with minimal health training and in areas where mobile phone signals are unreliable.
“We felt we could actually look for AF in remote and rural Australia with this device because even if you don’t have the signal where you’re recording you can still save the reading on the device and as soon as you get a signal you can transmit it to the server.”
Professor Freedman strongly believes that routine screening for AF will prevent stroke. He first became interested in the technology in 2012 while searching for a way to find asymptomatic AF in community settings.
When he discovered the iECG device, invented by Australians and an American, he immediately began testing it and was able to show that he could get a good recording and diagnosis from the device.
After conducting a number of trials to look at the effectiveness of using the device to screen for AF in asymptomatic patients in pharmacy and GP settings, he saw potential for its use out in the bush.
The device is a “no brainer”
Kylie Gwynne, Director of the Poche Centre for Indigenous Health at the University of Sydney told the limbic that when Professor Freedman introduced her to the technology, she thought it was a “no brainer.”
“[The device] was so obviously applicable to Aboriginal communities and particularly in rural and remote areas where we know the rate of stroke and CVD are disturbingly high.
Our research goals came together nicely – Ben’s interest was can we actually estimate the prevalence of AF for Aboriginal people and provide timely and effective treatment and my question in the research was can we utilise this device in Aboriginal communities to identify people early and facilitate access to treatment?”
Having commenced screening in Brewarrina this May, the researchers will conduct 1500 screens over the next 12 months in communities including Toomelah, Boggabilla, Mungindi, Moree, Inverell, Geraldton and Alice Springs.
Kylie said at the heart of the research is community consultation.
The programs and rollout have been designed with local Aboriginal people that work in the healthcare system because they are more in touch with what the community needed, she said.
All local healthcare workers involved in the study will receive training in how to use the device, how to consent people into the study and finally, how to inform people about CVD so that people being screened understand what the ECG reading is telling them.
Kylie said one of the big public health concerns about the study was that people who receive a ‘normal’ reading might think they are cleared of any CVD risk when they have other lifestyle risk factors that should be targeted.
“The concern was that there will be people screened who might smoke a pack of cigarettes a day for example and think that they’re totally fine if the screen doesn’t pick up AF so we’ve been very careful in our training for the screeners about informing people about what the test does and doesn’t tell them and what to do if they are worried about a person’s heart health.”
Effective referral pathway
Professor Freedman said a clear referral pathway has been established for people who do have AF or an abnormal rhythm picked up.
“Before you do anything with non-physician screening you have to have shown that you have an effective referral pathway in place to make sure that if something is diagnosed it will be acted upon – that’s crucial in all of this.”
Once an abnormality is picked up, the patient is either referred to a specialist in Sydney or they can book an appointment with visiting specialists who come to the area about once a month and who oversee ongoing treatment via regular skype or teleconference sessions.
Kylie added that a registered nurse connected to the study at each trial site would follow up on every single case where an abnormal result is found to get each person into the clinic for a 12-lead ECG.
“If we really want to make a difference in Aboriginal health we have to skill local Aboriginal health workers to be part of that solution … we don’t just want to estimate prevalence here we want to increase the skill of Aboriginal people working in the healthcare system in terms of CVD, that’s our secondary outcome.”