Chronic under-resourcing of cardiac care is costing lives, say doctors. File photo. Photo: 123 RF
Heart patients, their families and doctors are calling for an end to "postcode health care" when it comes to cardic services.
Chronic under-resourcing of cardiac care is costing lives and the economy, with the total impact - including early deaths - estimated at nearly $14b a year, according to Otago University research.
Taranaki electrician Darren started feeling a bit tired a couple of years ago.
"I was getting out of breath just walking across the car park."
He went a few times to the GP who ordered some tests, but did not diagnosed Darren's major congestive heart disease until he had a heart attack at work.
He was 48 - the same age as his mother when she had suffered a heart attack.
"I ended up having to stay in ICU for a few days while they figured out how they were going to try and treat me.
"But they said the wait list at Waikato [for surgery] was so long they said I would have to wait two to three months, and probably stay in ICU the whole time while they were waiting to ship me. So we ended up having to go private."
The bypass surgery in September last year cost $85,000 - but Darren does not know whether he would have survived the wait for surgery in the public system.
"I was lucky that my family was able to cover it. But there are lots of other people who aren't so fortunate, obviously."
The report - commissioned by Kia Manawanui Trust - found deaths from heart disease were highest in regions with the fewest cardiac staff: Tairāwhiti, Lakes, Whanganui, and Taranaki.
But Kia Manawanui Trust chief executive Letitia Harding said even in the main centres, services were patchy.
"We just haven't invested in this, the cardiac health services haven't been a focus for decades.
"It's hard to attract people when the infrastructure and services aren't there. Equipment isn't there.
"Some of the cathlab equipment in Wellington is 17 years old."
Such equipment in Australia could not be older than 10 years, she said.
Hawke's Bay resident Kevin was referred to Wellington Hospital after his first heart attack in February 2023, diagnosed with a 50 percent blockage to his main artery and given a stent.
However, a private cardiologist he saw subsequently found he had a 90 percent blockage and needed further stents.
When he asked that specialist why it had not been picked up in the public system, he got an indirect reply.
"He said he would only work with the best equipment that was available to him in Australia, and he demanded the same equipment here in New Zealand.
"So the inference I guess was that they missed it because the equipment they used was out of date. They don't even use it in Australia."
He had his second heart attack in November 2023 while on the table having further surgery in the private hospital.
"In December, I was still unwell and presented to the hospital in Hastings to be told there was nothing wrong with me.
"But they knew I had a procedure planned for January, and quite frankly I felt I was just being brushed off."
In total, he had six stents inserted privately in three procedures over 10 months.
That was after being discharged from Hastings Hospital on three occasions and told that nothing was wrong with his heart.
The Otago research has found half of all heart attack patients were not treated in an acceptable timeframe.
In an interview with Checkpoint, Health NZ Chief Clinical Officer Richard Sullivan said the agency was focused on "solving the problem of inequitable access".
"There are not cardiologists growing on trees, nor are there sonographers," Sullivan said.
"So, our approach is to find those areas of greatest need and really try to use the sites that have the resources to support those that are struggling."
For instance, while Tairāwhiti was currently without an onsite cardiologist and other key staff, images were being sent to other sites so that patients could be more quickly diagnosed, he said.
There was also the possibility of a "joint appointment" with Waikato, where the cardiothoracic list had improved dramatically this year, Sullivan said.
New Zealand homegrown training programme for sonographers was also paying off, with 10 due to graduate this year and another 16 next year.
While the report showed places with the fewest cardiac staff had the highest rate of deaths from heart disease, the picture was "complicated", as some of these regions also had higher rates of risk factors, including diabetes, smoking and high blood pressure, Sullivan said.
"It's important to recognise challenges for patients but also in the report we see there has been a substantial reduction heart disease, and hospitalisations across New Zealand," Sullivan said.
"We've got to focus on areas of greatest need - in some centres we're not short, we have appropriate staff, but the big challenge is that variation - so getting that regional cooperation, looking at models of care and helping those hotspots, to make sure they get rapid access to care."
Health Minister Simeon Brown said the National Clinical Cardiac Network - set up by Health NZ - was developing national standards and models of care.
However, Waikato cardiologist Professor Martin Stiles, a member of the clinical network, said without more funding, progress was stymied.
"Who is listening? Who is listening to the recommendations we are making? We have no resources of our own at the network. We can only recommend to other people where we feel that resource is best placed."
The minister's office today issued a media release saying the number of people in Northland waiting for their first heart specialist assessment has dropped by 36 percent since November 2023.
However, Northland cardiologist Marcus Lee said while first appointments were important, patients with known heart disease were waiting too long for follow up care.
"It's hard when you're telling a patient, 'We've missed the opportunity, we've missed the boat for you to get better care'. That's tough when they are in your system and you were going to see them in six months. But then a year comes around, and you haven't seen them."
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