Key points:

Research published in the Medical Journal of Australia found Indigenous Australians develop atrial fibrillation nearly 16 years earlier on average than non-Indigenous Australians, contributing to significantly higher stroke rates at younger ages.

Researchers from UNSW Sydney recommend AF screening from age 55 for Indigenous Australians, with experts saying simple 30-second ECG checks and early treatment could reduce stroke risk by up to 70 per cent.

Health experts and Aboriginal community leaders say updated national guidelines, improved access to care and culturally safe follow-up services are essential to reducing preventable strokes and advancing Closing the Gap outcomes.

New research recommends earlier heart rhythm screening after findings shows atrial fibrillation develops much younger in Indigenous people

Research published in the Medical Journal of Australia has found Indigenous Australians develop atrial fibrillation (AF) nearly 16 years earlier on average than non-Indigenous Australians, contributing to substantially higher stroke rates at younger ages.

AF is a common heart rhythm condition characterised by an irregular heartbeat which can cause blood clots to form in the heart and travel to the brain. It often has no symptoms - until a clot triggers a stroke.

AF-related strokes are typically more severe than other types, however AF itself can be detected through a pulse check or a 30-second recording using a portable single-lead ECG device.

Current Australian guidelines recommend AF screening from age 65.

"That threshold is based on population-wide data," UNSW Co-design Health Research and Innovation (CHRI) group director, Associate Professor Kylie Gwynne, said.

"But Indigenous people in Australia experience stroke at around two to three times the rate of other Australians.

"These strokes occur younger, often result in long-term disability and are more likely to be fatal," she says.

The study recommends screening Indigenous Australians from at least age 55, and earlier for those at elevated stroke risk.

"We now have strong evidence showing Indigenous Australians develop AF much earlier," Associate Professor Gwynne said.

Associate Professor Gwynne said medication and lifestyle changes can reduce stroke risk by up to 70 per cent, "so, waiting until age 65 to screen misses a critical window for prevention".

Earlier screening needed

The study's lead author, UNSW's Dr Vita Christie, says the systematic review analysed 24 Australian studies on AF onset, stroke incidence, treatment patterns and outcomes.

"In some studies, almost half of AF cases for Indigenous people occurred before the age of 55," Dr Christie said.

The review also found Indigenous Australians with AF were less likely to receive guideline-recommended therapies, which compounded the risk of preventable stroke.

"Under-treatment adds to the problem of under-diagnosis," Dr Christie said.

"Our expert panel unanimously recommended AF screening from at least age 55 for Indigenous Australians."

A clear case for reform

The study authors include cardiologists, epidemiologists, Aboriginal health leaders and policy and practice experts.

Associate Professor Gwynne said the findings of the study reflect more than a decade of collaborative research with Aboriginal communities and primary care services.

"Stroke is not inevitable," she said. "Stroke prevention requires both earlier detection and timely access to treatment.

"If we can detect AF earlier and ensure appropriate treatment, we can prevent strokes and long-term disability."

Associate Professor Gwynn said the issue is aligning care with risk.

"A single screening age across all populations assumes equal risk," she says.

"Indigenous people with AF are also more likely to have additional cardiovascular risk factors such as diabetes, hypertension, kidney disease and rheumatic heart disease."

She compared AF management to another chronic condition familiar in primary care.

"The treatment for AF is similar to treatment for type 2 diabetes - improved diet, exercise and medication," she says.

"And, like diabetes, the risks increase if the condition goes untreated."

Impact on communities

Brewarrina Aboriginal Medical Service CEO and co-author, Katrina Ward, said earlier screening has direct implications for Aboriginal Community Controlled Health Organisations (ACCHOs).

"Stroke has devastating impacts on our families and communities," Ms Ward said.

"When strokes happen younger, the consequences ripple through generations — affecting work, caregiving and community leadership."

However the screening doesn't always happen, Ms Ward said, even though anyone can use it — even on smartwatches — and it can easily be implemented into routine care.

"We've seen first-hand that our health workers and community members value early detection," she said.

Ms Ward said national policy change would support community-controlled services to act earlier and prevent harm.

"If guidelines recognise earlier risk, it strengthens our ability to secure resources and implement prevention where it's needed most," she said.

A practical solution

Associate Professor Gwynne said detecting AF is only the first step and that national leadership is now needed.

"Technology alone does not prevent stroke," she said. "Systems of care do. Screening must be accompanied by timely follow-up, culturally responsive communication and access to care aligned to clinical guidelines."

The CHRI team have developed a free five-minute online training module to help primary care clinicians detect and manage AF earlier.

Associate Professor Gwynne said guideline bodies and cardiovascular organisations should formally review AF screening recommendations, considering the new evidence.

She said primary care clinicians working with Aboriginal and Torres Strait Islander patients should consider opportunistic AF screening from age 55 - and earlier for those at higher risk.

If AF is identified, clinicians should follow established guidelines for managing heart rhythm, reducing stroke risk and addressing co-existing conditions.

"Updating screening recommendations is a straightforward, low-cost and immediately actionable step to reduce preventable stroke and advance Closing the Gap," Associate Professor Gwynne said.

However, Professor Gwynne said, earlier screening alone is not enough.

"Care pathways must take account of rural and remote access barriers, cost, continuity of care and cultural safety," she said.

"When we identify AF earlier and treat it effectively, we prevent disability, preserve independence and save lives."