Fellowships

Cardiac magnetic resonance imaging (MRI) is widely used to assess cardiovascular function in health and disease. It is regarded as the gold standard for non-invasive measurement of heart size, morphology, and function. Essential to assessment with MRI is knowledge of the “normal” ranges for cardiac size, mass, and volumes, which vary naturally with age and body mass composition, which in turn are influenced by sex and ethnicity. These ranges provide important threshold values for diagnosis, prognosis, and ultimately clinical decision-making. 

Although these have been defined for European populations, MRI reference ranges specific to Māori and Pacific populations do not yet exist. The use of the current non-representative guidelines results in missed or incorrect diagnosis of heart disease for Māori and Pacific Peoples. This delays treatment and adversely affects patient health. There is a critical and urgent need to establish appropriate normative reference values for cardiac assessment.

Gestational diabetes is the most common complication associated with pregnancy and it has a direct impact on the future cardio-metabolic health of the mother and the child. Cardio-metabolic diseases are responsible for most of the gap in life expectancy and are associated with higher hospitalisation and mortality rates for Māori and Pasifika in Aotearoa New Zealand. The age of onset of cardio-metabolic conditions is also significantly younger in Māori than in non‐Māori New Zealanders and the incidence of these conditions continues to increase. 

This research will develop a targeted framework for better screening, management and follow-up of Māori and Pasifika women with gestational diabetes by utilising community partnership and co-design principles and understand crosstalk between placenta and sympathetic nervous system in the development of gestational diabetes. It has the potential to identify ways to prevent and/or treat gestational diabetes. Reduced incidence of gestational diabetes will break the vicious circle that perpetuates the transmission of cardio-metabolic diseases to future generations.

Disparities in outcomes for Māori and Pacific people with heart failure are stark, with significantly higher hospitalisation, readmission and mortality rates compared to non-Māori, non-Pacific people. Heart failure is a chronic syndrome where successful management involves effective communication between patients/whānau and their healthcare providers and coordinated care across providers and systems. While discharge planning is a crucial phase in the overall care of heart failure, there are opportunities to improve current practices. 

This investigation focuses on optimising discharge planning and interface between hospital-level and community care for heart failure, particularly for Māori and Pacific patients/whānau. The aims of this research are to gain a comprehensive picture of discharge planning for heart failure across public hospitals in Aotearoa New Zealand and determine approaches to discharge planning that work best for Māori and Pacific heart failure patients.