Prevalence and Risk Factors in Indigenous Populations
Relative to the Hispanic and Latino demographics, there is an even greater need for further research into the effects of cardiac ion channelopathies in Native American and Aboriginal populations. A 2015 article by Jeffrey Reading highlighted how the shift from the hunter-gatherer lifestyle in Canadian Aboriginal culture increased the risk of developing CVD and led to a less physically active population overall.13 In a 2015 review, Arbour et al. noted that some Inuit and First Nations communities in Canada exhibit higher rates of congenital heart malformations and LQTS, highlighting the relevance of genetic predispositions in specific groups of Aboriginals.12 A more recent 2023 population-based cohort study by Eberly et al. involved 220,598 American Indian and Alaska Native Medicare beneficiaries with a median age of 72.5 years and found that the prevalence of AF in this population was 9%.11 A systematic scoping review published in 2015 by Katzenellenbogen et al. examined the contemporary studies on AF epidemiology in the Indigenous populations of Australia, the United States, and New Zealand but found no clear patterns in the prevalence and incidence of AF among these populations.9 In a 2022 study, Sanchez et al. discussed that American Indians develop AF at a higher rate relative to other racial and ethnic groups, and there are also disparities in administering anticoagulation therapy, rhythm control strategies, and overall quality of healthcare in this population (Figure 3 ).34 Similar findings regarding the prevalence of AF were also demonstrated in a cross-sectional study of Indigenous Australians compared to non-Indigenous Australians.35 A 2021 study on implementing AF screening in a tribal primary care clinic using a mobile single-lead ECG device showed that among 1,019 screened patients, new AF was diagnosed in 1.5% compared to 0.3% in the control group that did not undergo screening. The mean difference was 1.2%, indicating that mobile ECG screening detected a significantly higher incidence of AF than usual care, displaying the efficacy of implementing a deliberate AF screening protocol in Native American healthcare.36