1. New Zealand Cardiology Wards and Adventures Taylor Myers Locke

2. Objectives 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

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

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

5. Auckland City Hospital

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

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

8. ACS NZ Audits and Improvements 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 NZACS SNAPSHOT Audit Group

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

10. Kansas Heart and Stroke Collaborative 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 Ranney, Dave.

11. Key Contrasts 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

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

13. Clinical Experience 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?

14. Conclusions 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

15. Sometimes, you have to jump

16. … and enjoy the view

17. References New Zealand Health System Review. Health Systems in Transition, World Health Organization, Vol.4 No. 2. 2014. Whalley GA, 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..