| Popis: |
Atrial fibrillation (AF) is the most common cardiac arrhythmia, yet there is paucity of studies in rural communities. The primary aim of this thesis was to demonstrate the utility of software algorithms for AF detection, and use them for association studies with AF risk factors and health-seeking in the Australian rural community of Ararat. Our systematic review (Chapter 1B) demonstrated that there have been 18 global AF screening studies conducted in rural populations, across 11 countries. Methods: 278 rural residents responded to the Big Ararat Health Study baseline survey and 133 (47.8%) attended health assessments for blood pressure (BP), 12-lead electrocardiogram (ECG), 24-hour Holter ECG, and blood collection. Results and Discussion: In Chapter 2, we found that the AF detection of each device were as follows: Microlife BP (4.5%), 12-lead ECG (2.3%), and 24-h ECG (42.9%). All the devices consistently identified AF from the three participants who had persistent AF. The highest yield was from the 24-hour ECG, which likely indicates the detection of paroxysmal AF. In Chapter 3, we found significant associations between software-detected intermittent AF and age, maximum heart rate (HR), average HR and frequent atrial ectopy. We also demonstrated a linear relationship between maximum HR and total atrial ectopy. However, inflammatory biomarkers were not related to intermittent AF episodes. In Chapter 4, we found that atrial ectopy or episodes of atrial arrhythmias do not result in historical health-seeking with general practitioner (GP) visits. Our finding supports the notion that like BP, atrial arrhythmia risk is silent and requires screening for diagnosis and management. In Chapter 5, we demonstrated that self-reported hypertension and poor perception of health were associated with frequent monthly visits to the GP. Given that hypertension is an important risk factor of AF and a driver of GP health-seeking, AF screening may be useful in hypertensive patients. |
