Burden of heart disease considerable for American Indians, Alaska natives

American Indian and Alaska Native patients with Medicare insurance have a considerable burden of cardiovascular disease, according to a study published online Sept. 22 in JAMA Network Open.

Lauren A. Eberly, M.D., M.P.H., from the Gallup Indian Medical Center in New Mexico, and colleagues conducted a population-based cohort study from January 2015 to December 2019 to examine the incidence and prevalence of cardiovascular disease among American Indian and Alaska Native Medicare beneficiaries (220,598 beneficiaries; median age, 72.5 years).

Within the cohort, 44.8, 61.3, and 72.2 percent were diagnosed with diabetes, hyperlipidemia, and hypertension, respectively, during the study period. The researchers found that the prevalence of coronary artery disease was 38.6 and 36.7 percent in 2015 and 2019, respectively. There was an increase in the incidence of acute myocardial infarction, from 6.9 to 7.7 per 1,000 person-years in 2015 and 2019, respectively (percentage change, 4.79).

The prevalence of heart failure was 22.9 and 21.4 percent in 2015 and 2019, while the incidence increased from 26.1 to 27.1 per 1,000 person-years, respectively (percentage change, 4.08 percent). The prevalence of atrial fibrillation was stable at 9.4 and 9.3 percent in 2015 and 2019, respectively. At least one severe cardiovascular condition was reported for half the patients, and the overall mortality rate was 19.8 percent.

"The path forward requires engagement to support community-led initiatives and targeted investment in Indigenous communities to rectify historical harms and address sociopolitical determinants of cardiovascular health," the authors write.

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