DoctorClaris Chung

Time is critical in the treatment of cardiovascular diseases. However, women, people of older age, of an ethnic minority, living in socioeconomically deprived conditions or of lower educational level are less likely to get timely and effective medical attention. Delays occur when individuals or bystanders cannot identify and/or evaluate the symptoms of cardiovascular diseases, delaying contact with emergency services and potentially increasing the time taken to convey the status of the patient. This research will bridge this gap by developing information systems that: 1) help patients and witnesses to evaluate the signs of cardiovascular diseases as quickly as possible and 2) help a first response service to accurately assess a patient’s situation so it can be dealt with in an efficient and timely manner. By doing so, this project will improve the accessibility of medical treatment for people suffering from acute cardiovascular diseases in Aotearoa New Zealand.

Cardiovascular and associated metabolic conditions are major preventable causes of health-expectancy gaps, particularly for Māori and Pacific people. Combined population-level and individualised interventions can halve cardiovascular-metabolic risk. We have already developed and implemented cardiovascular risk prediction algorithms so New Zealand clinicians and policymakers can target at-risk patients and populations. We will now establish the VAREANZ Register, which will include up-to-date anonymised cardiovascular-metabolic risk information on every adult New Zealander, and establish sub-registers for cardiovascular-metabolic conditions responsible for significant equity gaps (diabetes, gout, obesity, heart failure and atrial fibrillation). We will risk assess each person to identify individual-level and population-level cardiovascular-metabolic risk management equity gaps nationwide. We will facilitate improvements in risk management equity by developing direct pathways to share actionable evidence with patients, providers and policymakers. A data science expert group will provide advanced statistical and artificial intelligence methodological support. The programme will be governed by a Māori-led, equity-focused data sovereignty group, overseeing all research.

Multimorbidity (MM), having two or more long-term conditions, is significantly more common among Māori, Pacific, deprived populations and older people. It typically co-occurs with high cardiovascular disease (CVD) risk, yet MM is largely ignored in CVD risk assessment and management guidelines due to a lack of evidence of its impact on CVD risk and life expectancy. Current disease-oriented approaches in healthcare fragment the management of MM and CVD risk, leading to potential harms from over- or under-treatment. In collaboration with NZ’s largest Primary Health Organisation, we will link anonymised electronic health records to national health datasets on 600,000+ patients. We will integrate University of Auckland research expertise on CVD risk prediction and University of Otago expertise on MM to understand MM in the context of CVD risk and life expectancy and derive new integrated CVD risk equations. The equity-focussed outputs will directly inform care in routine general practice.