Heart care variation in NZ 'unacceptable'

1.00pm

It is "unacceptable" that there are large inequities in cardiovascular health and access to care in New Zealand, the National Heart Foundation has said.

Norman Sharpe, medical director of the foundation, said there were "major disparities" in access to recommended treatments and while heart disease deaths had declined steadily since the 1970s it had been slower for poorer people and ethnic groups.

Guidelines are now being developed for cardiovascular disease, which is the leading cause of death in New Zealand accounting for more than four in every ten deaths.

Dr Sharpe said: "While there is agreement on the principles and priority objectives for healthcare including cardiovascular health in NZ, there is a need for cohesive national planning and action to ensure general achievement of agreed quality standards and remove inequities."

The death rate from the disease had declined more steeply in Australia and the United States than it had in New Zealand.

Maori have the highest rate of hospital admissions for heart failure -- nearly three times that of Europeans/others.

Pacific people have the highest mortality rate for cerebrovascular disease and the highest hospital discharge rate for stroke.

In a NZ Medical Journal Editorial to be published on Friday Dr Sharpe said that apart from ethnic and socio-economic disparities there were also "major" disparities in access to recommended treatments.

He said a comparison between the management of patients with acute coronary syndromes at Taranaki and Waikato hospitals showed significant differences.

In Waikato more cardiac angiography and revascularisation procedures were done.

He said centres which had facilities to do invasive procedures were quicker to perform operations than others.

Dr Sharpe also commented on an audit of 36 hospitals which found similar differences.

"Cardiac investigation levels, revascularisation rates and use of discharge medications of proven benefit were all generally low," he said.

"Comparison with contemporary practice in other western countries shows that rates in all New Zealand centres, with or without invasive facilities, are relatively low," Dr Sharpe noted.

He also raised concerns about the lack of people completing heart health programmes after discharge and noted that cholesterol-lowering statin drugs were not being used as much as they should.

Clinical services strategy manager Dr Andrew Holmes said: "New Zealand has high rates of heart disease compared with other similar countries, and its treatment costs hundreds of millions of taxpayer dollars each year, so it's important we take the time to get guidelines that deliver the best health outcomes."

The Cardiac Society, the Ministry of Health and the New Zealand Guidelines Group would work together to produce appropriate advice about the best management of acute coronary syndrome, Dr Holmes said.

The guidelines group is being funded $180,000 to evaluate the latest international research.

Dr Holmes said there was considerable debate internationally and within New Zealand amongst health professionals about the effectiveness of medical treatment compared with surgical treatments.

"It's very difficult for doctors to have sufficient time to keep up with and compare the many new studies and decide what they mean for their day-to-day practice," he said.

"Yet it's important doctors are able to systematically apply the results of the accumulated research evidence so our management of disease best takes advantage of improvements in knowledge, technique and skills gained both here and internationally.

He said the guidelines, expected to be produced next year, would help doctors apply the evidence.

"Without such guidelines it's a bit like trying to do your tax return in your head."

Ministry of Health Chief Medical Advisor David Geddis said the guidelines would help clinicians decide the best way to treat patients.

He said disparities were partly caused by a difference of opinion about how to treat patients and guidelines would reduce this.

Dr Geddis said research showed some hospitals did more operations than others but there could be reasons for that. These could include sufferers not even seeking medical help when they should.

"Whenever we look at the disparities mentioned it isn't all that simple," Dr Geddis told National Radio.

"We've got quite a difference for the intervention rate for say people that live in Te Tai Rawhiti (Poverty Bay) than for people who live in the West Coast of the South Island.

"Both those places are distant from a tertiary centre that offers intervention cardiology and yet in one instance it is happening and in the other it didn't."

Dr Geddis said there should be one standard of treatment for everyone in New Zealand but said it was important not just to focus on operation rates.

Diet, exercise and lifestyle were important as were drugs. He said sufferers also needed to take responsibility for their health.

Key points:

* During the past 20 years the risk for cardiovascular death for poorer people grew compared to wealthier people, the increase was worse for men than women.

* Coronary heart disease death rates during the same 20-year period show even greater ethnic disparity: rates for men aged 35-64 years of age were 3.5 times higher for Maori compared with non-Maori and non-Pacific, with Pacific men intermediate. Heart failure death rates for middle-aged Maori men and women were eight times greater than for non-Maori.

* Cardiac investigation levels, revascularisation (coronary artery surgery or angioplasty) and use of proven medications were all generally low.

* Coronary revascularisation rates generally (acute and elective) across all 21 District Health Boards in NZ showed variations. The rates for some DHBs approached only half the overall national rate while others were 1.5 times the national rate. The overall national rate was low in comparison with other western countries,

* Only 12 per cent of eligible patients completed cardiac rehabilitation after discharge.