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The need to review knowledge gaps on sudden cardiac death in Canadian Indigenous populations

Published online by Cambridge University Press:  10 February 2020

Matthew Sem*
Affiliation:
Faculty of Medicine, University of Toronto, Toronto, ON
Steve Lin
Affiliation:
Emergency Physician, Trauma Team Leader, Department of Emergency Medicine, St. Michael's Hospital, Toronto, ON Scientist, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON Assistant Professor, Faculty of Medicine, University of Toronto, Toronto, ON
Jeff Reading
Affiliation:
British Columbia First Nations Health Authority Chair in Heart Health & Wellness, St. Paul's Hospital Director, I-HEART Centre, Division of Cardiology, St. Paul's Hospital, Providence Health Care, Vancouver, BC Professor, Faculty of Health Sciences, Simon Fraser University, Burnaby, BC Professor, Emeritus, Faculty of Health Sciences, University of Victoria, Victoria, BC Adjunct Professor, Dalla Lana Faculty of Public Health, University of Toronto, Toronto, ON
Rohit Mohindra
Affiliation:
Emergency Physician and Research Scientist, Department of Emergency Medicine, North York General Hospital, Toronto, ON Visiting Scientist, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON
*
Correspondence to: Matthew Sem, Faculty of Medicine, University of Toronto, 1 King's College Cir, Toronto, ONM5S 1A8; Email: [email protected]

Abstract

Type
Letter
Copyright
Copyright © Canadian Association of Emergency Physicians 2020

LETTER TO THE EDITOR

Sir,

It is known that the prevalence and mortality of cardiovascular disease are disproportionately higher in Indigenous peoples of Canada (First Nations, Métis, and Inuit).Reference Smylie, O'Brien and Xavier1 Sudden cardiac death is responsible for approximately one-half of all deaths from cardiovascular disease globally. However, the incidence of sudden cardiac death has not been specifically described for Canadian Indigenous populations,Reference Wong, Brown and Lau2 and it is unclear what modifiable factors should be addressed to improve the prevention, recognition, and treatment. Therefore, there is need for a national strategy to address the knowledge gaps regarding sudden cardiac death in Indigenous peoples.

The disparities in determinants of cardiovascular health between Indigenous and non-Indigenous persons are well documented. An unequal burden of poverty, inequities in medical treatment, along with socioeconomic factors stemming from historic governmental policies that disrupted Indigenous societies, all contribute toward the increased prevalence of cardiovascular disease.Reference Smylie, O'Brien and Xavier1 Bresee and colleagues found that across urban and remote geographies, First Nations people were less likely to receive coronary angiography within 24 hours of myocardial infarction and more likely to die from sudden cardiac death.Reference Bresee, Knudtson and Zhang3 Remote Indigenous communities experience higher mortality rates from poorer emergency medical service (EMS) response time, a lack of permanent road access, and hazardous conditions.Reference Curran, Ritchie and Beardy4 Early defibrillation remains the key to survival in arrhythmias leading to sudden cardiac death, hence acknowledging challenges of providing timely resuscitation is important. Furthermore, genetic differences between Indigenous and non-Indigenous populations should be considered. Arbour and colleagues found at least three different Canadian Indigenous communities have a disproportionately higher rate of congenital long QT syndrome.Reference Arbour, Asuri, Whittome, Polanco and Hegele5 The culmination of these socioeconomic, epidemiological, and genetic risk factors place Indigenous populations at higher risk of sudden cardiac death and require a unique approach to optimize survival outcomes.Reference Arbour, Asuri, Whittome, Polanco and Hegele5

We propose the development of a national strategy to address this. First, it will be important to gather input from key stakeholders including EMS, Indigenous leaders, medical/public health representatives, and various governmental healthcare experts. Second, developing an efficient method of tracking cardiac arrests will be necessary. Involving the Canadian Sudden Cardiac Arrest Network Registry, which is working to build Canada's first database of sudden cardiac death cases, will be valuable. Lastly, Indigenous communities face barriers to many basic services, which have a significant impact on general health including cardiovascular disease. This project will serve as a window into one of many serious public health deficiencies that affect overall Indigenous health. It is hoped that by highlighting gaps in care with sudden cardiac death in Indigenous communities, attention to other public health needs will be addressed.

Competing interests

The authors do not have any conflicts of interests to disclose.

References

REFERENCES

1.Smylie, J, O'Brien, K, Xavier, CG, et al. Primary care intervention to address cardiovascular disease medication health literacy among Indigenous peoples: Canadian results of a pre-post-design study. Can J Public Health 2018;109(1):117–27.10.17269/s41997-018-0034-9CrossRefGoogle ScholarPubMed
2.Wong, CX, Brown, A, Lau, DH, et al. Epidemiology of sudden cardiac death: global and regional perspectives. Heart Lung Circ 2019;28:614.10.1016/j.hlc.2018.08.026CrossRefGoogle ScholarPubMed
3.Bresee, LC, Knudtson, ML, Zhang, J, et al. Likelihood of coronary angiography among First Nations patients with acute myocardial infarction. CMAJ 2014;186(10):E37280.10.1503/cmaj.131667CrossRefGoogle ScholarPubMed
4.Curran, J, Ritchie, SD, Beardy, J, et al. Conceptualizing and managing medical emergencies where no formal paramedical system exists: perspectives from a remote Indigenous community in Canada. Int J Environ Res Public Health 2018;15(2): pii: E267.10.3390/ijerph15020267CrossRefGoogle ScholarPubMed
5.Arbour, L, Asuri, S, Whittome, B, Polanco, F, Hegele, RA.The genetics of cardiovascular disease in Canadian and international aboriginal populations. Can J Cardiol 2015;31(9):1094–115.10.1016/j.cjca.2015.07.005CrossRefGoogle ScholarPubMed