Skip to main content

Advertisement

Log in

The Burden of Australian Indigenous Cardiac Disease and the Emerging Role of Cardiac Imaging

  • Specific Populations and Emerging Markets (V. Dilsizian and T. Schindler, Section Editors)
  • Published:
Current Cardiovascular Imaging Reports Aims and scope Submit manuscript

Abstract

Cardiac imaging frequently serves as a gatekeeper to triage management decisions. Utilization trends differ not only globally but also within individual countries and may be directed by the presence of an indigenous population with unique needs. We reviewed the current state of Australian indigenous cardiovascular health, and contributing factors to outcome disparity with mainstream Australia are discussed. We also considered the utility of contemporary cardiac imaging modalities and their established and potential roles in the assessment of cardiovascular disease in both the indigenous and wider Australian community. An imaging-based approach to evaluate cardiovascular disease in the Australian indigenous population is suggested.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Australian Bureau of Statistics. Causes of death. Australia. 2013. Cat. no. 3303.0. Canberra: ABS; 2015.

    Google Scholar 

  2. Australian Institute of Health and Welfare. Health care expenditure on cardiovascular diseases 2008-09. Cat. no. CVD 65. Canberra: AIHW; 2014.

    Google Scholar 

  3. World Health Organization. WHO Mortality Database. Accessed 11 June 2015 at http://www.who.int/healthinfo/mortality_data/en/.

  4. Penm E. Cardiovascular disease and its associated risk factors in Aboriginal and Torres Strait Islander peoples 2004-05. Cardiovascular disease series 29. Cat. no. CVD 41. Canberra: AIHW; 2008.

    Google Scholar 

  5. Australian Institute of Health and Welfare. Expenditure on health for Aboriginal and Torres Strait Islander people 2010-11. Health and welfare expenditure series no. 48. Cat. no. HWE 57. Canberra: AIHW; 2013.

    Google Scholar 

  6. Australian Bureau of Statistics. Life tables for Aboriginal and Torres Strait Islander Australians, 2010-2012. cat. no. 3302.0.55.003. Canberra: ABS; 2013.

    Google Scholar 

  7. Australian Institute of Health and Welfare. Australia’s welfare 2013. Australia’s welfare no. 11. cat. no. AUS 174. Canberra: AIHW; 2013.

    Google Scholar 

  8. Brown A, Carrington MJ, McGrady M, Lee G, Zeitz C, Krum H, et al. Cardiometabolic risk and disease in indigenous Australians: the heart of the heart study. Int J Cardiol. 2014;171(3):377–83.

    Article  PubMed  Google Scholar 

  9. Australian Bureau of Statistics. Census of population and housing: characteristics of Aboriginal and Torres Strait Islander Australians, 2011. ABS cat. no. 2076.0. Canberra: ABS; 2012.

    Google Scholar 

  10. Australian Institute of Health and Welfare. Aboriginal and Torres Strait Islander Health Performance Framework 2012: detailed analyses. Cat. no. IHW 94. Canberra: AIHW; 2013.

    Google Scholar 

  11. Australian Bureau of Statistics. Estimates of Aboriginal and Torres Strait Islander Australians, June 2011. ABS cat. no. 3238.0.55.001. Canberra: ABS; 2013.

    Google Scholar 

  12. Australian Institute of Health and Welfare. End-stage kidney disease in Australia: total incidence, 2003-2007. Cat. no. PHE 143. Canberra: AIHW; 2011.

    Google Scholar 

  13. Go AS, Chertow GM, Fan D, McCulloch CE, Hsu CY. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med. 2004;351:1296–305.

    Article  CAS  PubMed  Google Scholar 

  14. Schiffrin EL, Lipman ML, Mann JF. Chronic kidney disease: effects on the cardiovascular system. Circulation. 2007;116:85–97.

    Article  PubMed  Google Scholar 

  15. Wang Z, Hoy WE. Is the Framingham coronary heart disease absolute risk function applicable to Aboriginal people? Med J Aust. 2005;182:66–9.

    PubMed  Google Scholar 

  16. Nelson MR, Doust JA. Primary prevention of cardiovascular disease: new guidelines, technologies and therapies. Med J Aust. 2013;198(11):606–10.

    Article  PubMed  Google Scholar 

  17. Australia National Vascular Disease Prevention Alliance. Guidelines for the management of absolute cardiovascular disease risk. 2012. Accessed 1 June 2015 at http://strokefoundation.com.au/site/media/AbsoluteCVD_GL_webready.pdf. Comprehensive review of cardiovascular risk management evidence adapted to Australian context.

  18. Seshasai SRK, Wijesuriya S, Sivakumaran R, et al. Effect of aspirin on vascular and nonvascular outcomes: meta-analysis of randomized controlled trials. Arch Intern Med. 2012;172(3):209–16.

    Article  CAS  PubMed  Google Scholar 

  19. U.S. Preventive Services Task Force. Aspirin for the prevention of cardiovascular disease: recommendation statement. AHRQ Publication No. 09-05129-EF-2, March 2009. Rockville: Agency for Healthcare Research and Quality. Accessed 25 May 2015 at http://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/aspirin-for-the-prevention-of-cardiovascular-disease-preventive-medication

  20. Taylor F, Huffman M D, Macedo A F, Moore T H M, Burke M, Davey Smith G, et al. Statins for the primary prevention of cardiovascular disease. Cochrane Database Syst Rev. 2013. Issue 1. Art. No.: CD004816. DOI:10.1002/14651858.CD004816.pub5.

  21. Stone NJ, Robinson JG, Lichtenstein AH, et al. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014;63:2889–934.

    Article  PubMed  Google Scholar 

  22. Den Ruijter HM, Peters SE, Anderson TJ, et al. Common carotid intima-media thickness measurements in cardiovascular risk prediction: a meta-analysis. JAMA. 2012;308(8):796–803.

    Article  Google Scholar 

  23. Sun Z, Ng KH. Multislice CT angiography in cardiac imaging. Part II: clinical applications in coronary artery disease. Singap Med J. 2010;51:282–9.

    CAS  Google Scholar 

  24. Ergün E, Koşar P, Oztürk C, Başbay E, Koç F, Koşar U. Prevalence and extent of coronary artery disease determined by 64-slice CTA in patients with zero coronary calcium score. Int J Cardiovasc Imaging. 2011;27(3):451–8.

    Article  PubMed  Google Scholar 

  25. Sarwar A, Shaw LJ, Shapiro MD. Diagnostic and prognostic value of absence of coronary artery calcification. J Am Coll Cardiol Img. 2009;2:675–88.

    Article  Google Scholar 

  26. Miedema MD, Duprez DA, Misialek JR, et al. Use of coronary artery calcium testing to guide aspirin utilization for primary prevention: estimates from the multi-ethnic study of atherosclerosis. Circ Cardiovasc Qual Outcomes. 2014;7(3):453–60. Observational analysis suggesting utility of calcium scoring in net benefit prediction with primary prevention aspirin use.

    Article  PubMed Central  PubMed  Google Scholar 

  27. Nasir K, Shaw LJ, Budoff MJ, Ridker PM, Peña JM. Coronary artery calcium scanning should be used for primary prevention: pros and cons. J Am Coll Cardiol Img. 2012;5(1):111–8. Balanced and comprehensive review of current evidence for and against calcium scoring in primary prevention.

    Article  Google Scholar 

  28. Min JK, Lin FY, Gidseg DS, Weinsaft JW, Berman DS, Shaw LJ, et al. Determinants of coronary calcium conversion among patients with a normal coronary calcium scan: what is the “warranty period” for remaining normal? J Am Coll Cardiol. 2010;55(11):1110–7.

    Article  PubMed  Google Scholar 

  29. Youssef G, Budoff MJ. Coronary artery calcium scoring, what is answered and what questions remain. Cardiovasc Diagn Ther. 2012;2(2):94–105.

    PubMed Central  PubMed  Google Scholar 

  30. Gopal A, Nasir K, Liu ST, Flores FR, Chen L, Budoff MJ. Coronary calcium progression rates with a zero initial score by electron beam tomography. Int J Cardiol. 2007;117(2):227–31.

    Article  PubMed  Google Scholar 

  31. Rozanski A, Gransar H, Shaw LJ. Impact of coronary artery calcium scanning on coronary risk factors and downstream testing the EISNER (Early Identification of Subclinical Atherosclerosis by Noninvasive Imaging Research) prospective randomized trial. J Am Coll Cardiol. 2011;57:1622–32.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  32. Mowatt G, Cook JA, Hillis GS, et al. 64-Slice computed tomography angiography in the diagnosis and assessment of coronary artery disease: systematic review and meta-analysis. Heart. 2008;94:1386–93.

    Article  CAS  PubMed  Google Scholar 

  33. Abdulla J, Abildstrom SZ, Gotzsche O, et al. 64-multislice detector computed tomography coronary angiography as potential alternative to conventional coronary angiography: a systematic review and meta-analysis. Eur Heart J. 2007;28:3042–50.

    Article  PubMed  Google Scholar 

  34. Fazel P, Peterman MA, Schussler JM. Three-year outcomes and cost analysis in patients receiving 64-slice computed tomographic coronary angiography for chest pain. Am J Cardiol. 2009;104:498–500.

    Article  PubMed  Google Scholar 

  35. Aldrovandi A et al. Major adverse cardiac events and the severity of coronary atherosclerosis assessed by computed tomography coronary angiography in an outpatient population with suspected or known coronary artery disease. J Thorac Imaging. 2012;27(1):23–8.

    Article  PubMed  Google Scholar 

  36. Min JK et al. The prognostic value of multidetector coronary CT angiography for the prediction of major adverse cardiovascular events: a multicenter observational cohort study. Int J Cardiovasc Imaging. 2010;26(6):721–8.

    Article  PubMed  Google Scholar 

  37. Cho I, Chang HJ, Sung JM, et al. Coronary computed tomographic angiography and risk of all-cause mortality and nonfatal myocardial infarction in subjects without chest pain syndrome from the CONFIRM Registry (coronary CT angiography evaluation for clinical outcomes: an international multicenter registry). Circulation. 2012;126:304–13.

    Article  PubMed  Google Scholar 

  38. Taylor AJ, Cerqueira M, Hodgson JB, et al. ACCF/SCCT/ACR/AHA/ASE/ASNC/NASCI/SCAI/SCMR 2010 Appropriate Use Criteria for Cardiac Computed Tomography: a report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, the Society of Cardiovascular Computed Tomography, the American College of Radiology, the American Heart Association, the American Society of Echocardiography, the American Society of Nuclear Cardiology, the North American Society for Cardiovascular Imaging, the Society for Cardiovascular Angiography and Interventions, and the Society for Cardiovascular Magnetic Resonance. J Am Coll Cardiol. 2010;56(22):1864–94.

    Article  PubMed  Google Scholar 

  39. Liew GYH, Feneley MP, Worthley SG. Appropriate indications for computed tomography coronary angiography. Med J Aust. 2012;196(4):246–9.

    Article  PubMed  Google Scholar 

  40. Douglas PS, Hoffmann U, Lee KL, et al. Outcomes of anatomical versus functional testing for coronary artery disease. N Engl J Med. 2015;372:1291–300. Important large randomized trial comparing initial CTCA versus functional testing (mainly MPI) showing equipoise for outcomes.

    Article  CAS  PubMed  Google Scholar 

  41. Schinkel A, Bax J, Geleijnse M, Boersma E, Elhendy A, Roelandt J, et al. Noninvasive evaluation of ischemic heart disease: myocardial perfusion imaging or stress echocardiography? Eur Heart J. 2003;24:789–800.

    Article  CAS  PubMed  Google Scholar 

  42. Nesto RW, Kowalchuk GJ. The ischemic cascade: temporal sequence of hemodynamic, electrocardiographic and symptomatic expressions of ischemia. Am J Cardiol. 1987;57:23C–30.

    Article  Google Scholar 

  43. Gibbons RJ, Balady GJ, Bricker JT, et al. ACC/AHA 2002 guideline update for exercise testing: summary article. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1997 Exercise Testing Guidelines). J Am Coll Cardiol. 2002;40:1531.

    Article  PubMed  Google Scholar 

  44. Korshunov VA, Schwartz SM, Berk BC. Vascular remodeling: hemodynamic and biochemical mechanisms underlying Glagov's phenomenon. Arterioscler Thromb Vasc Biol. 2007;27(8):1722–8.

    Article  CAS  PubMed  Google Scholar 

  45. Douglas PS, Khandheria B, Stainback RF, Weissman NJ. ACCF/ASE/ACEP/AHA/ASNC/SCAI/SCCT/SCMR 2008 Appropriateness Criteria for Stress Echocardiography: a report of the American College of Cardiology Foundation Appropriateness Criteria Task Force, American Society of Echocardiography, American College of Emergency Physicians, American Heart Association, American Society of Nuclear Cardiology, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, and Society for Cardiovascular Magnetic Resonance Endorsed by the Heart Rhythm Society and the Society of Critical Care Medicine. J Am Coll Cardiol. 2008;51(11):1127–47.

    Article  PubMed  Google Scholar 

  46. Brindis RG, Douglas PS, Hendel RC, et al. ACCF/ASNC Appropriateness Criteria for Single-Photon Emission Computed Tomography Myocardial Perfusion Imaging (SPECT MPI). J Am Coll Cardiol. 2005;46(8):1587–605.

    Article  PubMed  Google Scholar 

  47. Australian Institute of Health and Welfare. Rheumatic heart disease and acute rheumatic fever in Australia: 1996-2012. Cardiovascular disease series no. 36. Cat. no. CVD 60. Canberra: AIHW; 2013.

    Google Scholar 

  48. Marijon E, Ou P, Celermajer DS, et al. Prevalence of rheumatic heart disease detected by echocardiographic screening. N Engl J Med. 2007;357:470–6.

    Article  CAS  PubMed  Google Scholar 

  49. Gewitz MH et al. Revision of the Jones Criteria for the diagnosis of acute rheumatic fever in the era of Doppler echocardiography. A scientific statement from the American Heart Association. Circulation. 2015;131:1806–18. Inclusion of Doppler echocardiography for diagnosis of subclinical carditis as a major criterion of acute rheumatic fever will likely influence change in clinical practice.

    Article  PubMed  Google Scholar 

  50. Cortigiana L et al. Prediction of mortality by stress echocardiography in 2835 diabetic and 11305 nondiabetic patients. Circ Cardiovasc Imaging. 2015;8:e002757.

    Article  Google Scholar 

  51. Young LH et al. Cardiac outcomes after screening for asymptomatic coronary artery disease in patients with type 2 diabetes: the DIAD study: a randomized controlled trial. JAMA. 2009;301(15):1547–55.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  52. Lièvre MM, Moulin P, Thivolet C, et al. Detection of silent myocardial ischemia in asymptomatic patients with diabetes: results of a randomized trial and meta-analysis assessing the effectiveness of systematic screening. Trials. 2011;12:23.

    Article  PubMed Central  PubMed  Google Scholar 

  53. Zellweger MJ, Maraun M, Osterhues HH, et al. Progression to overt or silent CAD in asymptomatic patients with diabetes mellitus at high coronary risk: main findings of the prospective multicenter BARDOT trial with a pilot randomized treatment substudy. J Am Coll Cardiol Img. 2014;7(10):1001–10. Interesting randomized prospective study suggesting potential benefit of MPI screening in asymptomatic diabetics.

    Article  Google Scholar 

  54. Acampa W et al. Incremental prognostic value of stress myocardial perfusion imaging in asymptomatic diabetic patients. Atherosclerosis. 2013;227:307–12.

    Article  CAS  PubMed  Google Scholar 

  55. Acampa W et al. Prognostic value of normal stress myocardial perfusion imaging in diabetic patients: a meta-analysis. J Nucl Cardiol. 2014;21:893–902. Meta analysis of 13,493 diabetic patients with negative MPI to offer insights into ‘warranty period’.

    Article  PubMed  Google Scholar 

  56. Kannel WB, Abbott RD. Incidence and prognosis of unrecognized myocardial infarction. An update on the Framingham study. N Engl J Med. 1984;311(18):1144–7.

    Article  CAS  PubMed  Google Scholar 

  57. Kwong RY, Chan AK, Brown KA, Chan CW, Reynolds HG, Tsang S, et al. Impact of unrecognized myocardial scar detected by cardiac magnetic resonance imaging on event-free survival in patients presenting with signs or symptoms of coronary artery disease. Circulation. 2006;113(23):2733–43.

    Article  PubMed  Google Scholar 

  58. Kramer CM. Detecting unrecognized myocardial infarction: the importance of imaging. Curr Cardiol Rep. 2010;12(1):3–5.

    Article  PubMed Central  PubMed  Google Scholar 

  59. Australian Institute of Health and Welfare. Housing circumstances of indigenous households: tenure and overcrowding. Cat. no. IHW 132. Canberra: AIHW; 2014.

    Google Scholar 

  60. Australian Bureau of Statistics. National Aboriginal and Torres Strait Islander Health Survey: Australia, 2004-05. Cat. no. 4715.0. Canberra: ABS; 2006.

    Google Scholar 

  61. de Winter RJ, Windhausen F, Cornel JH. Early invasive versus selectively invasive management for acute coronary syndromes. N Engl J Med. 2005;353:1095–104.

    Article  PubMed  Google Scholar 

  62. Damman P, Hirsch A, Windhausen F, Tijssen JGP, de Winter RJ. 5 year Clinical Outcomes in the ICTUS (Invasive versus Conservative Treatment of Unstable coronary Syndromes) Trial. J Am Coll Cardiol. 2010;55(9):858–64.

    Article  PubMed  Google Scholar 

  63. Australian Government, Department of Human Services. 2015. Medicare Australia Statistics. Accessed 01 June 2015 at http://medicarestatistics.humanservices.gov.au/statistics/mbs_item.jsp.

  64. Australasian Association of Nuclear Medicine Specialists. 2015. Education and Training. Accessed 29 May 2015 at http://www.anzapnm.org.au/index.php?option=com_content&view=article&id=18&Itemid=6.

  65. Ward M, et al. Proposed Recommendations for Myocardial Revascularisation. Heart Lung Circ. 2015. DOI http://dx.doi.org/10.1016/j.hlc.2015.04.160 Comprehensive review of evidence surrounding revascularisation, adapted to an Australian context.

  66. Murray R. Prescribing issues for Aboriginal people. Aust Prescr. 2003;26:106–9.

    Google Scholar 

  67. Humphery K, Weeramanthri T, Fitz J. Forgetting compliance: Aboriginal health and medical culture. Darwin: Northern Territory University Press; 2001.

    Google Scholar 

Download references

Compliance with Ethics Guidelines

Conflict of Interest

Kai’En Leong, Subodh Joshi, Jonathan E. Shaw, and Nathan Better declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Nathan Better.

Additional information

This article is part of the Topical Collection on Specific Populations and Emerging Markets

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Leong, K., Joshi, S., Shaw, J.E. et al. The Burden of Australian Indigenous Cardiac Disease and the Emerging Role of Cardiac Imaging. Curr Cardiovasc Imaging Rep 8, 37 (2015). https://doi.org/10.1007/s12410-015-9353-x

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s12410-015-9353-x

Keywords

Navigation