A Closer Look at Atrial Fibrillation and Stroke Risk
Atrial fibrillation (AF) is the most common type of arrhythmia, or irregular heartbeat. The condition affects approximately one in ten Australians over the age of 70 and can increase an individual's risk of stroke by up to five times.
Roughly one-third of all strokes in Australia are linked to AF.
A key challenge in managing the condition is that many individuals are unaware they have it, as AF often presents without noticeable symptoms until a major event, such as a stroke, occurs.
National Screening Trial for General Population
Scientists from the Heart Research Institute and the University of Sydney are conducting a trial to assess the feasibility of a national screening program for AF, similar to existing programs for bowel and breast cancer. More than 600 Australians aged 70 and above have participated in this study.
Preliminary findings from the trial have identified previously undiagnosed cases of AF. Professor Ben Freedman OAM, the chief investigator, stated that earlier detection of AF presents an opportunity to prevent strokes, which could benefit individuals, families, and the healthcare system.
Case Study: Managing Atrial Fibrillation
Maryanne Bawden, a participant in the study, experienced a stroke after initially mistaking her symptoms for the flu. Following her diagnosis, she manages her AF through regular blood pressure monitoring, medication, and supervision by a cardiologist.
Earlier Screening Recommended for Indigenous Australians
A separate systematic review published in the Medical Journal of Australia found that Indigenous Australians develop AF nearly 16 years earlier on average than non-Indigenous Australians. The review, which analyzed 24 Australian studies, reported that in some studies, almost half of AF cases among Indigenous people occurred before the age of 55.
Indigenous Australians experience stroke at two to three times the rate of other Australians.
The research also found that strokes occur at younger ages and often result in long-term disability and higher fatality rates. Additionally, Indigenous Australians with AF are less likely to receive guideline-recommended therapies and have higher rates of other stroke risk factors, including diabetes, hypertension, kidney disease, and rheumatic heart disease.
Based on these findings, a panel of experts unanimously recommended screening Indigenous Australians for AF from at least age 55 —rather than the current national guideline of age 65—and earlier for those with elevated stroke risk.
Lead author Dr. Vita Christie (UNSW) stated that the systematic review analyzed 24 Australian studies on AF onset, stroke incidence, treatment patterns, and outcomes. Associate Professor Kylie Gwynne (UNSW) noted that waiting until age 65 to screen may miss a critical window for prevention.
The study’s authors suggest that earlier detection combined with appropriate management, including anticoagulant therapy and lifestyle changes, could reduce stroke risk by 60-70%.
The study included cardiologists, epidemiologists, Aboriginal health leaders, and policy experts. Researchers have developed a free online training module for primary care clinicians on AF detection and management and are calling for national guideline bodies to review their screening recommendations.