Ethnic differences in case fatality following an acute ischaemic heart disease event in New Zealand: ANZACS-QI 13

Grey, Corina; Jackson, Rod; Wells, Susan; Marshall, Roger; Mehta, Suneela; Kerr, Andrew

doi:10.1177/2047487316657671

Cited by 8 publications

(6 citation statements)

References 25 publications

(27 reference statements)

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“…When adjusted for age, sex and NT-proBNP levels, Māori ethnicity was associated with higher risk of adverse outcomes compared with European ethnicity, consistent with known health inequities 2 3. However, when including the clinical summary score, the association between Māori ethnicity and risk of death or CV readmission was attenuated and not statistically significant, indicating that the prior increased risk for Māori participants was at least partly explained by the 20 clinical factors in the score.…”

Section: Discussionmentioning

confidence: 69%

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Prognostic modelling of clinical outcomes after first-time acute coronary syndrome in New Zealand

Earle

Poppe

Rolleston

et al. 2023

Heart

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ObjectiveThe Multi-Ethnic New Zealand Study of Acute Coronary Syndromes (MENZACS) was established to investigate the drivers of secondary events after first-time acute coronary syndrome (ACS), including addressing inequitable outcomes by ethnicity. Herein, the first clinical outcomes and prognostic modelling approach are reported.MethodsFirst, in 28 176 New Zealanders with first-time ACS from a national registry, a clinical summary score for predicting 1-year death/cardiovascular readmission was created using Cox regression of 20 clinical variables. This score was then calculated in the 2015 participant MENZACS study to represent clinical risk. In MENZACS, Cox regression was used to assess N-terminal pro-B-type natriuretic peptide (NT-proBNP) as a prognostic marker for death/cardiovascular readmission in four models, adjusting for (1) age and sex; (2) age, sex, ethnicity; (3) clinical summary score; (4) clinical summary score and ethnicity.ResultsOf the 2015 MENZACS participants (mean age 61 years, 79% male, 73% European, 14% Māori, 5% Pacific people), 2003 were alive at discharge. Of the 2003, 416 (20.8%) experienced all-cause death/cardiovascular readmission over a median of 3.5 years. In a simple model, age, male sex, Māori ethnicity and NT-proBNP levels were significant predictors of outcome. After adjustment for the clinical summary score, which includes age and sex, NT-proBNP and ethnicity were no longer statistically significant: log2(NT-proBNP) hazard ratio (HR) 1.03, 95% confidence interval (95% CI) 0.98 to 1.08, p=0.305; Māori ethnicity HR 1.26, 95% CI 0.97 to 1.62, p=0.084.ConclusionsIn 2015 patients with first-time ACS, recurrent events were common (20.8%). Increasing NT-proBNP levels and Māori ethnicity were predictors of death/cardiovascular readmission, but not after adjustment for the 20 clinical risk factors represented by the clinical summary score.Trial registration numberACTRN12615000676516.

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Section: Discussionmentioning

confidence: 69%

“…In New Zealand (NZ), there are persistent inequitable outcomes by ethnicity, with worse outcomes for Māori (the Indigenous people of NZ) and Pacific people. The causes of these inequities are multifactorial, and they remain after accounting for known modifiable clinical risk factors 2 3…”

Section: Introductionmentioning

confidence: 99%

Prognostic modelling of clinical outcomes after first-time acute coronary syndrome in New Zealand

Earle

Poppe

Rolleston

et al. 2023

Heart

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“…It is of concern that Māori and Pacific peoples are overrepresented in patients with CKD in New Zealand In this study, only 20% of those with normal renal function were Maori or Pacific but over half of those with stage 5 CKD identified as Māori or Pacific. Previous analysis of the ANZACS‐QI investigators has shown a 50% increased risk of death in patients of Māori and Pacific ethnicity compared with those of European descent . This is despite Māori and Pacific peoples being, on average, younger at the time of ACS.…”

Section: Discussionmentioning

confidence: 99%

Impact of chronic kidney disease on mortality and cardiovascular outcomes after acute coronary syndrome: A nationwide data linkage study (ANZACS‐QI 44)

et al. 2020

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Aims Chronic kidney disease (CKD) is associated with an increased risk of cardiovascular disease (CVD). We examined the characteristics, management and outcomes of patients with CKD in the All New Zealand Acute Coronary Syndrome Quality Improvement (ANZACS‐QI) national registry. Methods The cohort comprised New Zealand (NZ) patients with an acute coronary syndrome undergoing coronary angiography between January 2013 and December 2016. Patients were categorized according to their stage of CKD. Outcomes included all‐cause and cause‐specific mortality and hospitalization with myocardial infarction (MI), stroke and major bleeding. Results Of the 20 604 patients, 20.3% had normal renal function, with 53.3%, 23.3%, 1.7% and 1.4% having CKD stages 2, 3, 4 and 5 CKD, respectively. Patients with severe CKD were more likely to be Māori or Pacific and live in an area with greater socioeconomic deprivation. Death, recurrent MI or stroke, and major bleeding all increased incrementally with each worsening stage of CKD severity. Compared with those with normal renal function, patients with stage 5 CKD had a much higher all‐cause (hazard ratio [HR] 16.41, 95% CI 13.06‐20.61), cardiovascular (HR 16.38, 95% CI 12.17‐22.04) and non‐cardiovascular mortality (HR 13.66 9, 95% CI.56‐19.51). In addition, patients with stage 5 CKD were at a higher risk of recurrent MI or stroke (HR 4.73, 95% CI 3.86‐5.80) and bleeding (HR 5.84, 95% CI 4.39‐7.76). Conclusion CKD was associated with increased mortality and a high incidence of morbidity in patients undergoing coronary angiography in New Zealand. Initiatives to understand and improve outcomes in this group of patients are urgently needed.

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“…In addition, Māori and Pacific people are significantly more likely than Europeans to die from CHD before reaching hospital (Grey et al, 2016a), are less likely to call an ambulance when experiencing an acute coronary syndrome (ACS) (Garofalo et al, 2012), and are more likely to experience delays to defibrillation (Kerr et al, 2019). Such delays to care are crucially important; definitive medical treatment for ACS should be started as soon as possible to prevent life-threatening complications, and ideally within 1 hour of symptom onset (Chew et al, 2016; Moser et al, 2006; Norris, 2005).…”

Section: Introductionmentioning

confidence: 99%

Manawataki Fatu Fatu for ACCESS (Māori and Pacific Hearts in Unison for Achieving Cardiovascular Care in Equity StudieS). Protocol for a Mixed Methods Programme of Research

Grey

Brewer

Ameratunga

et al. 2023

International Journal of Qualitative Methods

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Māori and Pacific peoples in Aotearoa New Zealand (NZ) face significant inequities in cardiovascular disease (CVD) risk factors, hospitalisations and management rates, compared with non-Māori, non-Pacific peoples. These inequities are intimately linked to factors such as colonisation and the intergenerational impacts of systemic racism. This is the protocol for Manawataki Fatu Fatu for ACCESS (Māori and Pacific hearts in unison for Achieving Cardiovascular Care in Equity StudieS), a mixed-methods programme of research, combining kaupapa Māori and Pacific research methodologies (i.e. incorporating the knowledges, skills and values of Māori and Pacific peoples). In this Māori and Pacific led research programme, we will use qualitative and quantitative methodologies to identify evidence-practice gaps along the healthcare continuum that can be addressed to improve heart health outcomes for Māori and Pacific people in NZ. The programme is built on three foundation projects: (i) the assessment and management of CVD risk in primary care; (ii) pre-hospital delays in accessing care following an acute cardiac event in the community; and (iii) post-discharge and long-term management of heart failure. There are three phases. Phase 1 aims to systematically document research, completed or underway, about equitable access to evidence-based heart health care. We will establish a national collaboration of equity-focused heart health researchers and providers, and undertake systematic reviews relating to the three foundation projects. In Phase 2, we will undertake qualitative and quantitative research in the three foundational projects, to identify interventions to increase access to heart health care that have most potential to improve Māori and Pacific health outcomes and achieve equity. The quantitative and qualitative studies will be undertaken in parallel and will inform each other. Phase 3 will use findings from Phases 1 and 2 to create a Quality-Improvement-Equity Roadmap to inform interventions to improve Māori and Pacific people’s access to evidence-based CVD care.

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Ethnic differences in case fatality following an acute ischaemic heart disease event in New Zealand: ANZACS-QI 13

Abstract: Major ethnic inequalities in IHD case fatality occur with and without associated hospitalisations. Improvements in both primary prevention and hospital care will be required to reduce inequalities.

Cited by 8 publications

References 25 publications

Prognostic modelling of clinical outcomes after first-time acute coronary syndrome in New Zealand

Prognostic modelling of clinical outcomes after first-time acute coronary syndrome in New Zealand

Impact of chronic kidney disease on mortality and cardiovascular outcomes after acute coronary syndrome: A nationwide data linkage study (ANZACS‐QI 44)

Manawataki Fatu Fatu for ACCESS (Māori and Pacific Hearts in Unison for Achieving Cardiovascular Care in Equity StudieS). Protocol for a Mixed Methods Programme of Research

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