Equity Grants

Manawataki Fatu Fatu (Māori and Pacific hearts in unison) for Achieving Cardiovascular Care for Equity Studies is a research programme that aims to improve timely and equitable access to high quality heart healthcare for Māori and Pacific people. 

We believe that heart healthcare can better meet the needs, aspirations and outcomes for Māori and Pacific people when they are active participants in the co-design. National workshops will be hosted around Aotearoa followed by online hui. In addition to developing an Equity Roadmap for Māori and Pacific heart health, a major outcome of the workshops will be to establish sustainable relationships between Māori and Pacific communities and providers with a shared purpose of optimising heart healthcare for better outcomes.

Findings

Four hui were held across the country - in Kaitāia, South Auckland, Lower Hutt and the South Island - with a total of 105 participants. The findings from the regional workshops will be integrated into the Manawataki Fatu Fatu Quality Improvement Equity Roadmap report. The report will include thematic frameworks, participant quotes, photographs and artist illustrations from the workshops. The Roadmap will be published on the Manawataki Fatu Fatu website and disseminated back to participants, Whānau and Hapori Māori Advisory Group and Pacific Families Advisory Group, clinical networks, including the National Cardiac Clinical Network, Regional cardiac clinical networks, Cardiac Society for Australia and New Zealand, and Te Whare Tukutuku Indigenous Māori and Pacific cardiology rōpū. It is hoped that this study will provide the evidence to elicit change and improvement in access for Māori and Pacific for heart healthcare.

Taking people to specialist Cardiac Arrest Centres may improve their survival. However, taking people out of their local area may have significant cultural, psychosocial, and practical impacts. The researchers will undertake three wānanga and up to five individual interviews with out of hospital cardiac arrest (OCHA) patients and whānau members (20-25 people in total), to explore their perceptions of bypassing local hospitals to go to specialist centres. Participants will be people living in rural areas of New Zealand without a Cardiac Arrest Centre, who have been personally affected by OHCA. This research will inform future policy and practice changes to incorporate the needs and perspectives of those affected by any such changes to promote equity in experience and outcome for Māori after OHCA.

Findings

The qualitative study employed a Kaupapa Māori Research approach, conducting five interviews and two focus groups with Māori tūroro (patients) and their whānau (families). Three main themes emerged: navigating care in unfamiliar settings, the importance of family (whānau), and respectful communication (mana-enhancing). The findings were published in 2025: Accessing care in an unfamiliar environment: experiences of tūroro Māori and their whānau when transported outside their local area after a cardiac emergency. 

The associated quantitative study, published in Resuscitation Plus, suggested a 22% decrease in 30- day mortality for patients transported directly to cardiac arrest centres, aligning with international research. The research informed the Hato Hone St John Clinical Senior Leadership Team about the experiences of tūroro and whānau, influencing ambulance decision-making and highlighting the importance of effective communication to improve tūroro care.

We have developed a non-invasive imaging system to accurately measure neck skin movement caused by blood pressure pulses in major vessels, providing information about the heart's function. This system is currently being tested/validated in a clinical setting at Auckland City Hospital, and the initial results are promising. However, the patients recruited to date are mainly male and New Zealand European/Caucasian. 

Recruitment of additional female, Māori, and Pacific patients is needed to demonstrate that our system can cater to all New Zealanders, regardless of gender, ethnicity, and skin colour. 

The use of the system at Auckland City Hospital has highlighted potential device limitations. Improvements to portability, and application of co-design principles via engagement with Māori and Pasifika communities, will improve the device and acquisition protocols. This refined system will provide more equitable access to novel diagnostic information and open more channels for community outreach and education.

Our key outcome is to improve heart health among Māori. Establishing a meaningful long-term relationship between Ngāi Tahu Papatipu rūnanga, Ngā Mataawaka Māori, and the Christchurch Heart Institute is critical to achieving this. We will engage in hui with kaumātua and their whānau to determine the best ways to implement marae-based biomedical research in a co-designed study. 

Our original aim was to focus on kaumātua, who have not received the attention they deserve regarding cardiovascular disease research; however, after consultation with the community, we wish to widen the study to include whānau and other members of the local Māori community. This study will lay the foundation for a multi-centre New Zealand-wide study that will be able to establish with appropriate power, contributors to cardiovascular disease and levels of biomarkers that are relevant for Māori.

This award will fund the enrolment of 400 more women into the FAIR-ACS (Females in Aotearoa with Ischemic heaRt disease and Acute Coronary Syndromes) study. This will enable investigation of sex-specific differences in outcome after a heart attack with increased explanatory power and will enable us to explore female-specific aspects of coronary disease and prognosis. This focus on women aims to remedy the under-representation of women in many previous clinical research studies, leading to more equitable development and application of precision medicine in the prediction, management, and treatment of heart disease in NZ.

Findings

A Māori Governance Group established at the start of this study helped to ensure Māori were well represented in the study. Genotyping (analysis of DNA) for all participants will be completed by early 2025. Additional funding from the Heart Foundation will pay for a bioinformatician to analyse this data. In addition, Pūtahi Manawa IRM project, Restoring the balance: Heart health of wāhine, Fafine, Va’ine, Fifine and Women in Aotearoa, has been able to use the plasma collected via this study to analyse five sex hormones that may impact heart health in women post-heart attack. During the study, the researchers also established a new collaboration to investigate further the role of steroid hormones and their impact on cardiovascular disease in women, using the plasma samples collected. 

Further work on the calculation of polygenic risk scores (a tool that estimates an individual’s genetic predisposition to a disease or trait by aggregating the effects of many common genetic variants) is now being done by these Pūtahi Manawa researchers.

This project aims to increase recruitment of Māori participants in a study to see if modern computerized tomography (CT) scanners provide an alternative, safer, non-invasive approach to quickly image the heart arteries. Currently, most patients admitted to hospital with a presumed heart attack remain in hospital until an invasive test involving a tube and dye being inserted into the heart’s arteries (a coronary angiogram) can be completed. 

The project will create an animated video with two lead characters speaking te reo Māori, along with Te Ao Māori motifs to normalise the involvement of Māori in the study and promote the cultural safety of the study. Recruitment of Māori participants is a priority for the study so it can make meaningful recommendations to health service providers on how to ensure health equity in current and future cardiac care.

“We are really excited to be part of the Pūtahi Manawa CoRE. The funding of this project will allow us to strive for equitable representation of Māori within our wider project through innovation in; the training of recruiters, the recruitment design tools, and with the inclusion of Māori research nurses involved in the oversight of recruitment of participants into the study.”

Critical congenital heart disease (CCHD) is the most severe manifestation of the spectrum of congenital heart disease that leads to death in the absence of prompt intervention. Some types of CCHD are readily correctable with access to appropriate specialist multidisciplinary teams; in other types, treatment is more complex and outcomes more uncertain. Infant survival in Aotearoa New Zealand from this more complex type of CCHD differs by ethnicity, with more Māori and Pacific babies suffering stillbirth or dying in infancy. Research has found that this outcome is not due to more severe disease in these babies. This project provides a comprehensive picture of the factors that contribute to particular outcomes for Māori and Pacific babies and how these differ from those for babies of European and other ethnicities. We aim to determine system factors that underlie the inequitable outcomes, including the potential for unconscious bias /systemic racism.

Osita Isichei - Medical Student, University of Auckland 

“I am very grateful for the scholarship given by Pūtahi Manawa for the opportunity to learn more about cardiovascular disease alongside my medical studies. Through this internship I have become increasingly passionate about congenital heart defects in particular and the unequitable outcomes faced by Māori and Pasifika. I hope to contribute to the great work done in cardiovascular disease research by Pūtahi Manawa which makes a difference to the lives of many New Zealanders.”