Search

Background: Ischaemic Heart Disease (IHD) is a leading cause of death in New Zealand and the burden falls disproportionately on Māori, the indigenous population of Aotearoa New Zealand. Methods: Data for Māori:non-Māori disparities in risk factors, hospitalisation, procedure receipt and mortality for IHD are analysed. Age-adjusted rates of IHD mortality (2000–2004) and publicly funded hospitalisations and procedures (2003–2005) for Māori and non-Māori are reported and compared. Results: Significant inequalities between Māori and non-Māori in IHD risk factors, hospitalisations, mortality and the receipt of related procedures exist. IHD hospitalisation rates for Māori are 1.4 times that of non-Māori, however mortality rates are more than twice that of non-Māori. In recent years Māori revascularisation rates have increased (as have non-Māori rates) but are still considerably less than might be expected given the much higher mortality rates. Conclusion: Despite high need, Māori receive relatively low access to appropriate care for IHD. The role of society, policy, and the clinician are three key factors to be considered in reducing inequalities for IHD between Māori and non-Māori. [Copyright &y& Elsevier]

Background: Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) are rare in high-income countries; however, in Aotearoa New Zealand ARF and RHD disproportionately affect Indigenous Māori and Pacific Peoples. This narrative review explores the evidence regarding non-surgical management of patients with clinically significant valve disease or heart failure due to RHD.Methods: Medline, EMBASE and Scopus databases were searched, and additional publications were identified through cross-referencing. Included were 28 publications from 1980 onwards.Results: Of the available interventions, improved anticoagulation management and a national RHD register could improve RHD outcomes in New Zealand. Where community pharmacy anticoagulant management services (CPAMS) are available good anticoagulation control can be achieved with a time in the therapeutic range (TTR) of more than 70%, which is above the internationally recommended level of 60%. The use of pharmacists in anticoagulation control is cost-effective, acceptable to patients, pharmacists, and primary care practitioners. There is a lack of local data available to fully assess other interventions; including optimal therapy for heart failure, equitable access to specialist RHD care, prevention, and management of endocarditis.Conclusion: As RHD continues to disproportionately affect Indigenous and minority groups, pro-equity tertiary prevention interventions should be fully evaluated to ensure they are reducing disease burden and improving outcomes in patients with RHD. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to describe ethnic differences in angiography and revascularisation rates following an acute coronary syndrome (ACS) in New Zealand.Methods: National hospitalisation and mortality data were anonymously linked to determine receipt of angiography and revascularisation for 30-84 year-olds hospitalised with ACS between 2007 and 2012. Multilevel Cox regression, accounting for individual factors and admitting hospital, was used to estimate adjusted procedural rates within 30 days of admission.Results: Of the 50,324 ACS patients included, 10% were Māori, 4% Pacific, 3% Indian and 83% New Zealand European or Other ethnicities (NZEO). A larger proportion of Māori (48%) than NZEO (36%), Pacific (19%) and Indian (14%) patients were admitted to hospitals without catheterisation facilities. More Māori and Pacific (22-24%) than NZEO and Indian patients (12-13%) had severe comorbidities. Māori and Pacific were less likely than NZEO patients to receive angiography (adjusted HRs 0.94 [0.91-0.98] and 0.93 [0.87-0.98] respectively) and revascularisation (adjusted HRs 0.79 [0.75-0.83] and 0.77 [0.71-0.83]), even after adjusting for important demographic and clinical factors.Conclusions: A higher comorbidity burden in Māori and Pacific patients and reduced access to catheterisation facilities for non-urban Māori contributed to lower procedure rates after ACS admission. Ethnic differences remained after adjustment for these factors and require further investigation. [ABSTRACT FROM AUTHOR]