Waiting lists are failing Maori patients

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(NZDOCTOR) Heart surgery waiting lists are failing Maori patients by ignoring their more serious disease states and worse outcomes, Auckland cardiologist Harvey White says.

Once they reach a wait list for coronary artery bypass grafting (CABG), #Maori should be given higher priority, says Professor White, director of coronary care and cardiovascular research at Auckland City Hospital.

He says he will seek to have the national priority tool redesigned, and cites other areas where the health sector needs to lift its game for Maori.

Fix the inequalities first

One of the pillars of the health system is equity, he says. Its all very well to say there are reasons, but we know there are inequalities, so fix the inequalities first

Maori are doing worse, we have to address that, and earlier access helps.

Professor White supervised research by cardiology registrar Tom Wang, who crunched the numbers on more than 800 Auckland City Hospital CABG patients and found Maori and Pacific patients were at a four-fold risk of death two years after CABG surgery.

Dr Wang says timing is the main problem in difference in outcomes.

Risk scores assume similar operative mortality across ethnicities when, in fact, Maori and Pacific peoples do worse, he says.

By 30 days after surgery, 4.9 per cent of the Maori patients had died, compared with 0.6 per cent of the New Zealand Europeans.

Too few ops done on Maori

Maori are a younger population than Europeans but are presenting at about the same rate for surgery. This is despite heart disease being well recognised as a disease of older age groups, Dr Wang says.

Professor White says Maori should be over-represented in the numbers having surgery, but they are under-represented.

The Maori patients in Dr Wangs study wereon average eight years younger than Europeans.

Years of ill health prior to op

They were also worse off at baseline, on characteristics such as heart failure, ejection fraction, shortness of breath, renal dialysis and renal failure. These differences were major drivers of worse outcomes, Dr Wang says.

He suggests factors may include late presentation to primary care, late referral for investigation and late attendance after having a heart attack.

Professor White says the extraordinary, poorer outcomes in the study remained even after adjusting for factors such as higher cholesterol, smoking and socioeconomic position.

Promotion to target Maori

He says later presentation to the GP is an issue, confirming the importance of, for example, marae-based heart health checks and prevention education.

There are some wonderful things being done, but obviously its not enough.

Noting Maori are targeted for cardiovascular risk assessments earlier in life than others, Professor White wants primary care to do more.

Vigilance should start at age 18

With any Maori patientwe need to check blood pressure and cholesterol and talk about ideal weight, diet, exercise and not smoking, from the age of 18, he says.

Suspicion of heart disease in a Maori patient should lead to a referral to a specialist for a prompt assessment.

All along the line, from the first specialist assessment to referral for surgery, Maori should have special access, in my view.

Dr Wang presented his analysis, across six ethnicities, to the World Congress of Cardiology in Melbourne last month.

Related link

Maori have worse outcomes after coronary artery bypass graftingthan Europeans in New Zealand New Zealand Medical Journal

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