Ratwatte, Seshika

Costello, Benedict

Kangaharan, Nadarajah

Bolton, Katrina

Kaur, Amrina

Corkill, Wendy

Kuepper, Bernhard

Pitman, Bradley

Sanders, Prashanthan

Wong, Christopher X

2020-12-01

BACKGROUND: Remote Central Australia has a large Indigenous population and a significant burden of cardiovascular disease. Stress echocardiography has been previously validated as a useful investigation for long-term prognostication. However, there are no prior studies assessing its utility in remote or Indigenous populations. METHOD: Consecutive individuals undergoing stress echocardiography in Central Australia between 2007 and 2017 were included. Stress echocardiography was performed and reported via standard protocols. Individuals were followed up for all-cause mortality. RESULTS: One-thousand and eight patients (1,008) (54% Indigenous Australian) were included. After a mean follow-up of 3.5±2.4 years, 54 (5%) patients were deceased. Overall, 797 (79%) patients had no abnormalities during rest or stress echocardiography, with no difference according to ethnicity (p>0.05). In patients with a normal test, annual mortality averaged 1.3% over 5 years of follow-up, with annual mortality significantly higher in Indigenous compared to non-Indigenous individuals (1.8% vs 0.6% respectively). In those with an abnormal test, annual mortality was 4.4% vs 1.3% in Indigenous and non-Indigenous individuals respectively. Increasing age, Indigenous ethnicity and cardiometabolic comorbidities were associated with mortality in univariate analyses (p<0.05 for all). In multivariate models, only chronic kidney disease remained predictive of mortality, with other associations (including Indigenous ethnicity) becoming attenuated. CONCLUSION: This is the first study to report on the use of stress echocardiography in a remote or Indigenous population. A normal stress echocardiogram in remote Indigenous individuals was able to identify a lower risk group of patients in this setting. Although Indigenous individuals with a normal test still had a higher annual rate of mortality compared to non-Indigenous individuals, this association appeared to be mediated by cardiometabolic comorbidities.

University of Newcastle, Concord Repatriation and General Hospital, and Royal Prince Alfred Hospital, Sydney, NSW, Australia.

Baker IDI Heart & Diabetes Institute and Alfred Hospital, Melbourne, Vic, Australia.

Department of Cardiology, Alice Springs Hospital, Alice Springs, NT, Australia.

University of Adelaide, Royal Adelaide Hospital, and South Australian Health & Medical Research Institute, Adelaide, SA, Australia.

University of Adelaide, Royal Adelaide Hospital, and South Australian Health & Medical Research Institute, Adelaide, SA, Australia. Electronic address: c.wong@adelaide.edu.au.

Heart Lung Circ. 2020 Dec;29(12):1808-1814. doi: 10.1016/j.hlc.2020.04.013. Epub 2020 Jun 7.

https://pubmed.ncbi.nlm.nih.gov/32586728/?otool=iaurydwlib

https://hdl.handle.net/10137/11526

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Clinical Utility of Stress Echocardiography in Remote Indigenous and Non-Indigenous Populations: A 10-Year Study in Central Australia.

Journal Article

Publication