Publications

2022 Identification of clinically relevant cohorts of people with heart failure from electronic health data in Aotearoa: potential, pitfalls and a plan

Journal Article

Authors: Vanessa Selak (Corresponding Author), Katrina Poppe (Co-author), Daniel Chan (Co-author), Corina Grey (Co-author), Matire Harwood (Co-author), Shanthi Ameratunga (Co-author), Sandra Hanchard (Co-author), Susan Wells (Co-author), Andrew J Kerr (Co-author), Mayanna Lund (Co-author), Robert Doughty (Co-author)

  • BibTex Key
  • Authors
  • Tags heart failure
  • Publisher New Zealand Medical Journal

    2022 Counties Manukau Research Week

    Proceeding

    Manawataki Fatu Fatu for CMH Research Week

    Dr Karen Brewer

    Whakatoohea/Ngaiterangi

    Research title: Manawataki: Fatu Fatu for ACCESS (Māori and Pacific hearts in unison for Achieving Cardiovascular Care in Equity StudieS)

    Karen is a speech-language therapist and kaupapa Māori researcher. She is leading the qualitative aspects of the Manawataki Fatu Fatu research programme. Karen’s main interest is in stroke and aphasia but she is quickly learning about the heart so she can keep up in team discussions and understand what the research participants are talking about.

    Name: Julie Winter-Smith

    Iwi or ethnic group: Tongan (`Alaki Fonua/Pelehake, Tongatapu)

    Role title: PhD candidate

    Short biography for introduction:  Julie Winter-Smith is a doctoral candidate based in the Section of Epidemiology and Biostatistics at the University of Auckland. She is part of the Manawataki Fatu Fatu for Achieving Cardiovascular Care for Equity StudieS (ACCESS) research programme, which is focused on achieving equity in cardiovascular disease for Māori and Pacific people. Her doctoral research is using Statistics New Zealand’s Integrated Data Infrastructure to investigate patterns of cardiovascular disease and its management among different Pacific ethnic groups, including how this differs for Pacific peoples born outside of New Zealand. Julie’s research is generously funded through the Health Research Council of New Zealand.

    Dr Sandra Hanchard

    Research Fellow

    Research Title: Equity-focused discharge planning for heart failure

    Sandra is a Pacific researcher of Tongan heritage who is researching what equity looks like for heart health services. Her current focus is discharge planning for heart failure from secondary care to long-term management in the community. She is passionate about redesigning health systems that empower Māori and Pacific patients with long-term conditions to live well and to be partners in their own care. Sandra has a research background in information and communication systems and has recently returned to Aotearoa after a decade living in South-East Asia.

    Pablo A. Callejas

    Clinical Support Officer with the Clinical Audit and Research Team, Hato Hone (St John)

    Iwi or ethnic group: Latin American

    Research Title: Ethnicity findings from the 2020/21 Out-of-Hospital ST-segment Elevation Myocardial Infarction Registry

    Pablo has over 10 years’ experience working as a Paramedic. Pablo started with the New York City EMS and has held a variety of Clinical positions. Currently, Pablo holds a Clinical Support position within Hato Hone (St John) as one of the team leading the focused audit portfolio. In his role as a focused auditor, he has authored the inaugural annual STEMI report.

    • BibTex Key
    • Authors J. Winter-Smith | K. Brewer | P. Callejas | S. Hanchard
    • Tags Equity

      2022 U21 Health Sciences

      Proceeding

      U21 Health Sciences Group

      Award to Manawataki Fatu Fatu, PhD candidate, Jess Hutchings

      • BibTex Key
      • Authors J. Hutchings
      • Tags Pharmacy

        2022 Understanding the barriers and facilitators that influence access to quality cardiovascular care for rural indigenous peoples: a scoping review

        Proceeding

        National Rural Healthcare Conference: Home | NRHC 2022 (nationalruralhealthconference.org.nz)

        Presentation by Taria Tane

        Background: Māori are disproportionately represented in cardiovascular disease (CVD) prevalence, morbidity, and mortality rates, and are less likely to receive evidence-based CVD healthcare. Rural Māori in Aotearoa New Zealand experience additional barriers to treatment access, poorer health outcomes, and a greater burden of CVD risk factors, compared to Non-Māori and Māori living in urban areas. Despite these inequities in access and outcomes, little is known about the barriers and facilitators that may influence rural Māori accessing quality CVD healthcare. Importantly, inequities in CVD outcomes and access to quality CVD healthcare in Aotearoa New Zealand are similar to those experienced by Indigenous Peoples, in other nations impacted by colonisation. 

        Aims/ objectives: To explore the barriers and facilitators in accessing quality CVD healthcare for rural Māori and international Indigenous Peoples in nations impacted by colonisation.  

        Methods: A scoping review will be performed in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews Checklist. A thematic analysis approach, underpinned by Kaupapa Māori Research principles, will be used to describe the literature. In addition, literature will be appraised according to the Consolidated Criteria for Strengthening Reporting of Health Research Involving Indigenous Peoples (CONSIDER) statement. 

        Findings and implications: We will describe the extent of research available and gaps in research, key barriers and facilitators, and recommendations for future research to benefit of healthcare access for rural Māori and other rural Indigenous Peoples.  

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        • Authors T.Tane | taria
        • Tags rural care

          2022 Paramedicine Research Day

          Proceeding

          Paramedicine Research Day 2022 Registration, Thu 20/10/2022 at 9:00 am | Eventbrite

          Hear from our Paramedicine Academic Staff, Postgraduate and Undergraduate students, who will present the latest research from their research projects. 

          Manawataki Fatu Fatu will be represented by Rochelle Newport, Sarah Penney and Aroha Ormsby-Brett

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          • Authors A. Ormsby-Brett | R. Newport | S. Penney
          • Tags Paramedicine

            2022 Pasifika Medical Association Conference

            Proceeding

            Pasifika Medical Association Conference

            4 – 6 September, 2022

            Te Papa Museum, Wellington

            Conference programme: PMA Conference 2022 – Programme Booklet ONLINE.pdf (pacifichealth.org.nz)

            Julie Winter-Smith

            Who Are Pacific People In Aotearoa New Zealand? Findings From A Pacific-Led Analysis Of National Health And Non-Health Datasets In The Idi

             Julie Winter-Smith

            Is It Appropriate To Homogenise Pacific People When Considering Their Need For Cvd Health

            Services? A Systematic Review Of The Epidemiology and Management Of CVD Among Pacific People

            • BibTex Key
            • Authors J. Winter-Smith
            • Tags Pacific health

              2022 Indigenous Health Council Symposium

              Proceeding

              Dr Karen Brewer presentation at Indigenous Health Symposium – CSANZ 2022 (csanzasm.com)

              Title of talk: Examples of good practice: Population Health / clinical perspective

               

              • BibTex Key
              • Authors K. Brewer
              • Tags Equity | Heart health services

                2022 What are the gaps in cardiovascular risk assessment and management in primary care for Māori and Pacific people in Aotearoa New Zealand: protocol for a systematic review.

                Journal Article

                What are the gaps in cardiovascular risk assessment and management in primary care for Māori and Pacific people in Aotearoa New Zealand? Protocol for a systematic review | BMJ Open

                Abstract

                Introduction In New Zealand, significant inequities exist between Māori and Pacific peoples compared with non-Māori, non-Pacific peoples in cardiovascular disease (CVD) risk factors, hospitalisations and management rates. This review will quantify and qualify already-reported gaps in CVD risk assessment and management in primary care for Māori and Pacific peoples compared with non-Māori/non-Pacific peoples in New Zealand.

                Methods and analysis We will conduct a systematic search of the following electronic databases and websites from 1 January 2000 to 31 December 2021: MEDLINE (OVID), EMBASE, Scopus, CINAHL Plus, NZresearch.org, National Library Catalogue (Te Puna), Index New Zealand (INNZ), Australia/New Zealand Reference Centre. In addition, we will search relevant websites such as the Ministry of Health and research organisations. Data sources will include published peer reviewed articles, reports and theses employing qualitative, quantitative and mixed methods.

                Two reviewers will independently screen the titles and abstracts of the citations and grade each as eligible, not eligible or might be eligible. Two reviewers will read each full report, with one medically qualified reviewer reading all reports and two other reviewers reading half each. The final list of included citations will be compiled from the results of the full report reading and agreed on by three reviewers. Data abstracted will include authors, title, year, study characteristics and participant characteristics. Data analysis and interpretation will involve critical inquiry and a strength-based approach that is inclusive of Māori and Pacific values. This means that critical appraisal includes an assessment of quality from an Indigenous perspective.

                Ethics and dissemination Ethical approval is not required. The findings will be published in a peer-reviewed journal and shared with stakeholders. This review contributes to a larger project which creates a Quality-Improvement Equity Roadmap to reduce barriers to Māori and Pacific peoples accessing evidence-based CVD care.

                 

                • BibTex Key
                • Authors C. Grey | J. Paynter | J. Winter-Smith | K. Brewer | M. Harwood | S. Amertunga | S. Hanchard | V. Selak
                • Tags CVD risk assessment | Māori health | Pacific health
                • DOI Number http://dx.doi.org/10.1136/bmjopen-2021-060145
                • Publisher BMJ Open
                • Edition 12(6), p.e060145

                  2022 The epidemiology of cardiovascular disease among Pacific people in New Zealand

                  Presentation

                  Julie Winter-Smith, a Tongan PhD candidate in Manawataki Fatu Fatu, will be presenting her research at the School of Population Health, University of Auckland Doctoral Showcase on Wednesday 22 June, 2-4:30pm.

                  • BibTex Key
                  • Authors J. Winter-Smith
                  • Tags Pacific health

                    2022 The impact of ethnicity on stroke care access and patient outcomes: a New Zealand nationwide observational study

                    Journal Article

                    Citation:

                    Thompson, S.G., Barber, P.A., Gommans, J.H., Cadilhac, D.A., Davis, A., Fink, J.N., Harwood, M., Levack, W., McNaughton, H., Feigin, V.L. and Abernethy, V., 2022. The impact of ethnicity on stroke care access and patient outcomes: a New Zealand nationwide observational study. The Lancet Regional Health-Western Pacific20, p.100358.

                    Summary

                    Background

                    Ethnic inequities in stroke care access have been reported internationally but the impact on outcomes remains unclear. In New Zealand, data on ethnic stroke inequities and resultant effects on outcomes are generally limited and conflicting.

                    Methods

                    In a prospective, nationwide, multi-centre observational study, we recruited consecutive adult patients with confirmed stroke from 28 hospitals between 1 May and 31 October 2018. Patient outcomes: favourable functional outcomes (modified Rankin Scale 0-2); quality of life (EQ-5D-3L); stroke/vascular events; and death at three, six and 12 months. Process measures: access to reperfusion therapies, stroke-units, investigations, secondary prevention, rehabilitation. Multivariate regression analyses assessed associations between ethnicity and outcomes and process measures.

                    Findings

                    The cohort comprised 2,379 patients (median age 78 (IQR 66-85); 51·2% male; 76·7% European, 11·5% Māori, 4·8% Pacific peoples, 4·8% Asian). Non-Europeans were younger, had more risk factors, had reduced access to acute stroke units (aOR=0·78, 95%CI, 0·60-0·97), and were less likely to receive a swallow screen within 24 hours of arrival (aOR=0·72, 0·53-0·99) or MRI imaging (OR=0·66, 0·52-0·85). Māori were less frequently prescribed anticoagulants (OR=0·68, 0·47-0·98). Pacific peoples received greater risk factor counselling. Fewer non-Europeans had a favourable mRS score at three (aOR=0·67, 0·47-0·96), six (aOR=0·63, 0·40-0·98) and 12 months (aOR=0·56, 0·36-0·88), and more Māori had died by 12 months (aOR=1·76, 1·07-2·89).

                    Interpretation

                    Non-Europeans, especially Māori, had poorer access to key stroke interventions and experience poorer outcomes. Further optimisation of stroke care targeting high-priority populations are needed to achieve equity.

                    Funding

                    New Zealand Health Research Council (HRC17/037).

                    Keywords

                    Stroke

                    Disparities

                    Ethnicity

                    Indigenous

                    Health services research

                    Epidemiology

                    Outcome resarch

                     

                     

                     

                    • BibTex Key
                    • Authors M. Harwood
                    • Tags ethnicity | stroke
                    • DOI Number https://doi.org/10.1016/j.lanwpc.2021.100358
                    • Publisher The Lancet Regional Health Western Pacific

                      2021 Bula Sautu – A window on quality 2021: Pacific health in the year of COVID-19

                      Technical Report

                      ‘Bula Sautu’ is a Fijian saying expressing an aspirational goal for ‘good health that is lived to its full potential; a life of abundance’.

                      However, Pacific peoples living in Aotearoa New Zealand are suffering from some of the worst inequities in health in the country. Many are even worse than those of our wider Pacific whānau who are tangata whenua.

                      Pacific peoples live six fewer years of life than non-Māori, non-Pacific, and the gap is widening.

                      See the full report here: Bula Sautu – A window on quality 2021: Pacific health in the year of COVID-19 | He mata kounga 2021: Hauora Pasifika i te tau COVID-19 (hqsc.govt.nz)

                      • BibTex Key
                      • Authors A. Talemaitoa | C. Grey | D. Ryan
                      • Tags Pacific health
                      • Publisher Health Quality & Safety Commission. 2021 Wellington. 2021

                        2022 Contrasting trends in heart failure incidence in younger and older New Zealanders, 2006–2018

                        Journal Article

                        Abstract

                        Objective Studies indicate that age-standardised heart failure (HF) incidence has been decreasing internationally; however, contrasting trends in different age groups have been reported, with rates increasing in younger people and decreasing in the elderly. We aimed to describe age-specific trends in HF incidence in New Zealand (NZ).

                        Methods In this nationwide data linkage study, we used routinely collected hospitalisation data to identify incident HF hospitalisations in NZ residents aged ≥20 years between 2006 and 2018. Age-specific and age-standardised incidence rates were calculated for each calendar year. Joinpoint regression was used to compare incidence trends.

                        Results 116 113 incident HF hospitalisations were identified over the 13-year study period. Between 2006 and 2013, age-standardised incidence decreased from 403 to 323 per 100 000 (annual percentage change (APC) −2.6%, 95% CI −3.6 to −1.6%). This reduction then plateaued between 2013 and 2018 (APC 0.8%, 95% CI −0.8 to 2.5%). Between 2006 and 2018, rates in individuals aged 20–49 years old increased by 1.5% per year (95% CI 0.3 to 2.7%) and decreased in those aged ≥80 years old by 1.2% per year (95% CI −1.7 to −0.7%). Rates in individuals aged 50–79 years old initially declined from 2006 to 2013, and then remained stable or increased from 2013 to 2018. The proportion of HF hospitalisations associated with ischaemic heart disease decreased from 35.1% in 2006 to 28.0% in 2018.

                        Conclusion HF remains an important problem in NZ. The decline in overall incidence has plateaued since 2013 due to increasing rates of HF in younger age groups despite an ongoing decline in the elderly.

                        Paper: Contrasting trends in heart failure incidence in younger and older New Zealanders, 2006–2018 | Heart (bmj.com)

                        • BibTex Key 2022
                        • Authors A. Kerr | C. Grey | D. Chan | K. Poppe | M. Ai Wei Lee | M. Lund | R. Doughty | V. Selak
                        • Tags heart failure
                        • Publisher BMJ Heart
                        • Edition Volume 108, Issue 4

                          2021 Dr Tua Taueetia-Su’a

                          Presentation

                          Dr Tua Taueetia-Su’a givens an interview for Samoa Capital Radio on 21 December 2021. The interview (in the Samoan language) can be viewed here (at 3:12:00 to 3.55.10) Facebook Live | Facebook

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                          • Authors Dr Tua Taueetia-Su’a
                          • Tags Pacific health

                            2021 Prevalence and Predictors of Post-Traumatic Stress Disorder in a Cohort of 2200 Injured New Zealanders

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                            • Authors S. Amertunga
                            • Tags trauma

                              2021 Kōkiri Te Oranga

                              Online

                              Panui:
                              In association with Te Kura Kaupapa Māori o Hoani Waititi Marae, Auckland District Health Board, Hāpai Te Hauora, Procare we present ‘Kōkiri Te Oranga’ a series of live streams, kōrero from Māori Health Experts about Māori issues around health and wellbeing.
                              E te whānau we are fortunate to have Dr Jin Russell who is a Development Pediatrician of 12-13years experience who works in starship. Accompanied by Dr Matire Harwood a General Practitioner and researcher into healthy outcomes for Māori and communities.
                              Te Wā:
                              Stream Live 6:00-6:30pm
                              Wednesday 8 December 2021
                              Ko Wai: Dr Jin Russell & Dr Matire Harwood
                              Ngā Take Kōrero:
                              1. Vaccination of 5yr-11yr in 2022.
                              2. Traffic Light System and how we should treat it
                              3. Isolation packs and planning for Covid while isolating at home.
                              Mā wai tēnei pāpahotanga? Who is this broadcast for?
                              For everyone but through a māori lens for Kura Kaupapa, Kura ā-Iwi, Kōhanga reo, Rūmaki, Reo-Rua, and hapori Māori of Tāmaki Makaurau.
                              Its purpose to ensure our hapori Māori are kept up to date with kōrero around Covid vaccination, the next steps, and living in a covid world. It changes all the time so staying ahead of the wave can only better prepare you and give info as to where to get support.
                              To further promote Māori solutions for Māori people and reaching out to those seeking kōrero from our own mātanga/tākuta.
                              Recording here: Facebook
                              • BibTex Key
                              • Authors M. Harwood | matire
                              • Tags Māori health

                                2021 Māori and Pacific peoples’ experiences of a Māori-led diabetes programme

                                Journal Article

                                AIM: Type 2 diabetes mellitus (T2DM) disproportionately affects Māori and Pacific peoples in Aotearoa (New Zealand). Despite this, the lived experiences of T2DM and its management by Māori and Pacific peoples are scarcely acknowledged in health literature. The present study examines the lived experiences of T2DM by Māori and Pacific participants in the Mana Tū diabetes programme. Mana Tū is a Māori-led diabetes support programme co-designed by the National Hauora Coalition (NHC) alongside patients with diabetes, clinicians, health service planners and whānau ora providers.

                                METHOD: The study used qualitative methods underpinned by Kaupapa Māori (Māori approaches) approaches. Twenty-two semi-structured interviews were conducted with participants of the Mana Tū diabetes programme and their whānau (thirteen Māori, 9 Pacific) from Tāmaki Makaurau (Auckland) and Te Tai Tokerau (Northland).

                                RESULTS: The study identified barriers, facilitators and motivators for participants to live well with T2DM. Four key themes were constituted: (1) whānau experience of T2DM, (2) cultural safety in healthcare interactions, (3) whānau ora (collective family wellbeing) and (4) Kaupapa Māori approaches to health interventions. Themes were consistent across Māori and Pacific participants.

                                CONCLUSION: Findings suggest that Māori-led health interventions can better support Māori and Pacific people living with T2DM and are needed to ensure these communities receive appropriate, responsive and equitable healthcare.

                                • BibTex Key
                                • Authors A.Peihopa | D.Nicholls | J.Murray | K.Hawkins | M. Harwood | N.Rice | T.Tane | V. Selak | V.Lata
                                • Tags Diabetes | Māori health | Pacific health
                                • Publisher The New Zealand Medical Journal (Online)
                                • Edition 134(1543), pp.79-6.

                                  2020 The importance of considering both primary and secondary diagnostic codes when using administrative health data to study acute coronary syndrome epidemiology (ANZACS-QI 47)

                                  Journal Article

                                  Abstract

                                  Aims

                                  Routinely collected health administrative data have become an important data source for investigators assessing disease epidemiology. Our aim was to investigate the implications of identifying acute coronary syndrome (ACS) events in New Zealand (NZ) national hospitalization data using either the first (primary) or subsequent (secondary) codes.

                                  Methods and results

                                  Using national health datasets, we identified all NZ hospitalizations (2014–16) for patients ≥20 years with a primary or secondary International Classification of Diseases 10th Revision, Australian Modification (ICD10-AM) ACS code. Outcomes included 1-year all-cause and cause-specific mortality, hospitalized non-fatal myocardial infarction, heart failure, stroke, or major bleeding, and a composite comprising these outcomes. Of 35 646 ACS hospitalizations, 78.5% were primary and 21.5% secondary diagnoses. Compared to primary coding, patients with a secondary diagnosis were older (mean 77 vs. 69 years), more likely to be females (48% vs. 36%), had more comorbidity, and were less likely to receive coronary angiography or revascularization. Higher adverse event rates were observed for the secondary diagnosis group including a three-fold higher 1-year mortality (40% vs. 13%) and two-fold higher composite adverse outcome (54% vs. 26%). The use of primary codes alone, rather than combined primary and secondary codes, resulted in overestimation of coronary angiography and revascularization rates, and underestimation of the 1-year case fatality (13.1% vs. 19.0%) and composite adverse event rate (26% vs. 32%).

                                  Conclusion

                                  Patient characteristics and outcomes of ACS events recorded as primary vs. secondary codes are very different. These findings have important implications for designing studies utilizing ICD10-AM codes.

                                  • BibTex Key
                                  • Authors A. Kerr | C. Grey | K. Poppe | S. Wells | T. Wang | Y.Jiang
                                  • Tags Acute coronary syndrome | ANZACS
                                  • DOI Number 10.1093/ehjqcco/qcaa056
                                  • Publisher European Heart Journal-Quality of Care and Clinical Outcomes
                                  • Edition Volume 7, Issue 6

                                    2021 mRNA and Māori Health

                                    Presentation

                                    Webinar hosted by Healthier Lives on 17 November 2021: Pathways between research, policy and practice for equitable evidence-informed health and wellbeing in Aotearoa’s new health system

                                    • BibTex Key
                                    • Authors M. Harwood
                                    • Tags implementation science | Māori health

                                      2021 Cardiovascular disease and its management among Pacific people: a systematic review by ethnicity and place of birth

                                      Journal Article

                                      Abstract

                                      Background:

                                      Pacific people experience a disproportionate burden of cardiovascular disease (CVD), whether they remain in their country of origin or migrate to higher‑income countries, such as Australia, Aotearoa New Zealand or the United States of America. We sought to determine whether the CVD health needs of Pacific people vary according to their ethnicity or place of birth.

                                      Methods:

                                      We conducted a systematic review of medical research databases and grey literature to identify relevant data published up to 2020. Texts were included if they contained original data stratified by Pacific‑specific ethnicity or place of birth on the burden or management of CVD, and were assessed as having good quality using a National Heart, Lung, and Blood Institute quality assessment tool. The protocol for this review was registered with the Open Science Forum (https:// doi. org/ 10. 17605/ OSF. IO/ X7NR6).

                                      Results:

                                      Of 3679 texts identified, 310 full texts were reviewed and the quality of 23 of these assessed, using the pre‑defined search strategy. Six items (four reports, one article, one webpage) of good quality met the review eligibility criteria. All included texts provided data on epidemiology but only one reported on the management of CVD. Four texts were of Pacific populations in Pacific Island countries and two were of Pacific diaspora in other countries. Data from the Global Burden of Disease study, which provided estimates for the greatest number of Pacific countries, showed substantial differences in mortality rates between Pacific countries for every CVD type. For example, the mortality rate per 100,000 for ischemic heart disease (IHD) ranged from 103.41 in the Cook Islands to 430.35 in the Solomon Islands. A New Zealand‑based report showed differences in CVD rates by Pacific ethnicity (e.g. the age‑standardised prevalence of IHD per 1,000 population in Auckland ranged from 107.8 (Niuean) to 138 among Cook Islands Māori (p < 0.001)).

                                      Conclusions:

                                      This review of published studies reveals that the epidemiology of CVD among Pacific people varies by specific ethnic groups, place of birth, and country of residence. There is a critical need for high‑quality contemporary ethnic‑specific Pacific data to respond to the diverse CVD health needs in these underrepresented groups.

                                      Open access: https://rdcu.be/cz2T5

                                       

                                      • BibTex Key
                                      • Authors C. Grey | J. Winter-Smith | M. Harwood | S. Amertunga | V. Selak
                                      • Tags Atherosclerosis | Cardiovascular disease | Epidemiology | Equity | Management | Migrant | Pacific
                                      • DOI Number https://doi.org/10.1186/s12872‑021‑02313‑x
                                      • Publisher BMC Cardiovascular disorders