New Zealand Cardiology Wards and

Adventures

Taylor Myers Locke

Objectives

• New Zealand Healthcare System

• Cardiovascular care in New Zealand

• Identifying cardiovascular at-risk populations

• Improvements in the Cardiovascular Healthcare delivery

• Comparison to Kansan’s health

• Kansas Heart and Stroke Collaborative: understanding, identifying, and comparison

• New Zealand adventures

New Zealand Healthcare Model

www.moh.govt.nz

• Funded by public, private and nongovernmental sectors

• Tax resources provided 83 percent of healthcare

• Improvement needed• Rural

• Asian, Pacific Islander,

• Maori adult population

• Systematic care

District Health Boards

• Non-profit boards made of a combination of elected, appointed and Maori representatives

• responsibility of healthcare planning, funding and implementation is broken up geographically

• High degree of autonomy

• Not all created equal

http://www.whyora.co.nz/Understanding-health/Health-Systems/

Auckland City Hospital

State of New Zealand Cardiovascular Disease

• Heart disease accounts for 30 percent of national mortality

• Increasing admission rates for ACS and AMI

• Multidisciplinary approach to heart failure treatment

Elliott J and Richards M.

Maori Population

• Comprise 15% of New Zealand’s population

• CV disease (CVD) is highest

• Coronary Artery Disease Death occurs on average a decade earlier • < 65 in 45 % of Maori population vs 11% in non-Maori

• Increased CVD risk factors• Smoking, hypertension, diabetes mellitus

Whalley GA, et al.http://www.businessinsider.com.au/jimmy-nelsons-tribal-photos-before-they-pass-away-2014-2

ACS NZ Audits and Improvements

• Started in 2002, aimed to improve ACS outcomes

• Identified weaknesses with rural and Maori populations, 50% less investigations and revascularization procedures in certain DHBs

• The 2012 audit recognized gaps in access to echocardiography, cardiac angiography, and delays in care at non-intervention centers

NZACS SNAPSHOT Audit Group

Comparison to Kansans?

• Large rural population resulting in lack of access

• Coronary heart disease mortality rates have decreased at national and state level

• Highest mortality rates in rural Kansas

• CAD risk factor rates have increased• Diabetes mellitus, obesity, hypertension

Kansas Department of Health and Environment

Kansas Heart and Stroke Collaborative

• Transforming model of care for heart and stroke disease, in areas traditionally with limited access

• Preventative and post event care managed by care managers and health coaches within the community

• Developing shared clinical guidelines, and EMRs

Ranney, Dave.

Key Contrasts

• Combining preventative to quaternary care (like the DHBs in New Zealand)

• Shared Clinical Guidelines

• Community healthcare providers to help manage patient with diagnosis and discharge• Heart failure nurse managers in New Zealand

• No national EMR and poor information exchange

Kiwi Healthcare Culture

• Young Pacific Islander immigrants or Maori population hospitalized for CV disease

• Reasonable expectations for disease state and end-of-life

• Conscious of ordering unnecessary tests and procedures

• Long wait time for specialist care and work up

• Heavily dependent on general practitioner

http://www.kiwibird.org/

Clinical Experience

• Mr. S had right sided heart failure with subsequent end stage liver disease requiring Lasix drip, followed by pressor support

• Family highly involved in care

• Stayed on cardiology ward throughout stay, never in CCU or MICU

• My work up and management differed• Maybe less is more?

Conclusions

• New Zealand health infrastructure is evolving, but well managed and providing quality care throughout the nation

• New Zealander’s struggle with cardiovascular risk factors and disease, especially the Maori population

• Community support and standardization throughout New Zealand is a model that is loosely reflected in the Kansas Heart and Stroke Collaborative

• Clinicians should be open to change and challenged to provide the best care possible

Sometimes, you have to jump

… and enjoy the view

References

• New Zealand Health System Review. Health Systems in Transition, World Health Organization, Vol.4 No. 2. 2014.

• Whalley GA, et al. Higher prevalence of left ventricular hypertrophy in two Māori cohorts: findings from the Hauora

Manawa/Community Heart Study. Australian and New Zealand journal of public health. 2015-01-05;n-a-n/a.

• Elliott J, Richards M. Heart attacks and unstable angina (acute coronary syndromes) have doubled in New Zealand since

1989: how do we best manage the epidemic? N Z Med J. 2005;118 (1223).

• New Zealand Acute Coronary Syndromes (NZACS) SNAPSHOT Audit Group. The management of acute coronary

syndrome patients across New Zealand in 2012: results of a third comprehensive nationwide audit and observations of

current interventional care. N Z Med J. 2013 Dec 13;126(1387):36-68.

• Ranney, Dave. "Moser to Lead Heart Disease, Stroke Collaborative at KU Hospital - See More At:

Http://www.khi.org/news/article/moser-lead-heart-disease-stroke-collaborative/#sthash.Zik3k6bG.v6EtJs8Y.dpuf." Kansas

Health Institute. 5 Dec. 2014. Web. 24 Mar. 2015.

• "Working Together for a Healthy Kansas: Kansas Action Plan for Heart Disease and Stroke Prevention, 2012-2017." Kansas

Department of Health and Environment. Heart and Stroke Alliance of Kansas, 1 Apr. 2013. Web. 24 Mar. 2015.

<http://www.kdheks.gov/cardio/download/CVH.pdf>.