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|City||Adelaide, South Australia|
|University||University of Adelaide|
|Thesis type||Master of Public Health|
In 1992, a 26 year old Aboriginal footballer from a community outside Darwin died suddenly, shortly after a game of football. Autopsy revealed that the cause of death was ischaemic heart disease and as a result many players from the same league presented to the local community health centre in the weeks following, requesting a 'check-up'. A review of 30 players at the time found no cases of ischaemic heart disease (IHD) but did find several players with rheumatic heart disease (RHD) and a high prevalence of risk factors for ischaemic heart disease. A screen of the entire league was planned and in mid-1994 the league was contacted to see if the players and coaches were keen to cooperate. The screen was performed from November 1994 to January 1995.
Screening was conducted in each of three communities covered by the football league, and consisted of four parts. Firstly, a clinical assessment was made which included history and examination with particular attention to the symptoms and signs of IHD and RDH, and also assessing risk factors. The risk factor questions followed those of the National Heart Foundation's Risk Factor Prevalence Study (NHFRFPS) but had to be amended to suit the cross-cultural setting in which they were used. Risk factors assessed by questionnaire were physical activity, smoking, alcohol intake and family history and those by clinical examination were body mass index (BMI), blood pressure and waist-to-hip ratio. Symptom inquiry included the presence of exercise-induced chest, arm or neck pain, palpitations, and syncope. The examination dwelt on signs of left ventricular hypertrophy, valvular lesions or cardiac compromise.
Secondly, a resting 12 lead ECG was performed. Thirdly, a fasting venous blood sample was taken and assayed for cholesterol, triglycerides, high density lipoprotein cholesterol, serum glucose, gamma glutaryl transferase. Finally, an assessment of aerobic fitness was made using the 20 metre shuttle run test. A group of non-Aboriginal footballers from a different football league was screened for comparison. This screen was conducted at the weekly football training in Darwin. Later in the season fasting venous blood was collected before a team breakfast.
One hundred and seventy three Aboriginal and six non-Aboriginal players underwent screening. Risk factors with increased prevalence in the Aboriginal group included smoking, raised triglycerides, abnormal blood glucose, and a higher alcohol intake. Aboriginal players had a significantly lower age-adjusted BMI than their non-Aboriginal colleagues and lower diastolic blood pressure. Family history was found to be unreliable and not used in any calculations nor counted as a risk factor. Fifty three percent of non-Aboriginal footballers had no risk factors compared with fifteen percent of players in the Aboriginal sides. The average number of risk factors per player was 1.4 for Aboriginal players and 0.7 for non-Aboriginal.
Of the fifteen players with suspicious or classical chest pain, ten were referred into Royal Darwin Hospital and seven had stress ECGs. Two of these were positive leading to a diagnosis of ischaemic heart disease. Of seven players with abnormal ECGs, six underwent further investigation and one of these was diagnosed with supraventricular tachycardia. The others proved normal. There were three players with known rheumatic heart disease and a further six were referred for investigation of heart murmurs found on examination. Three of these were found to have rheumatic heart disease and one congenital valvular disease. There was one player in the non-Aboriginal group who had a likely tachyarrythmia but who was not followed up.
This project illustrated how community response to a critical event such as an unexpected death can be directed into a health screening and awareness campaign. It revealed a greater prevalence of heart disease risk factors in Aboriginal footballers compared with their non-Aboriginal counterparts. The prevalence of ischaemic heart disease in the Aboriginal group was 1.2% and of all heart disease was 5.8%.
The initial outcome of the project was a raising of awareness of the symptoms and risk factors of heart disease. This was reflected in several players presenting and requesting follow-up for chest pain and others wanting to stop smoking. Aboriginal health workers were involved at every stage and they followed up players and arranged further talks with the players on a team basis. The tragic death of a player who had screened negative but subsequently developed chest pain further concentrated the community's awareness on the importance of heart disease.
As a whole, the screen was very popular and about 75% of the league participated. There were requests for it to be repeated the following season (1995-96) but this would hardly be of any additional benefit. Indeed, with the low yield of this study further resources may be better directed at improving symptom awareness and reducing risk factors than detailed screening. The project demonstrated how health promotion messages might be directed through sporting networks if health agencies are responsive enough to community needs. It allows health promotion messages to be delivered to groups that may not otherwise be reached, and raises the possibility of further health promotion through cultural and sporting events.
Australian Indigenous HealthInfoNet abstract