New Zealand Cardiology Wards and Adventures

1. New Zealand Cardiology Wards and Adventures Taylor Myers Locke

2. 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 Objectives

3. 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 New Zealand Healthcare Model www.moh.govt.nz

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

5. Auckland City Hospital

6. Heart disease accounts for 30 percent of national mortality • Increasing admission rates for ACS and AMI • Multidisciplinary approach to heart failure treatment State of New Zealand Cardiovascular Disease Elliott J and Richards M.

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

8. 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 ACS NZ Audits and Improvements NZACS SNAPSHOT Audit Group

9. 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 Comparison to Kansans? Kansas Department of Health and Environment

10. 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 Kansas Heart and Stroke Collaborative Ranney, Dave.

11. 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 Key Contrasts

12. 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 Kiwi Healthcare Culture http://www.kiwibird.org/

13. 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? Clinical Experience

14. 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 Conclusions

15. Sometimes, you have to jump

16. … and enjoy the view

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