Wheeler Annaliese, Rahiri Jamie-Lee, Ellison-Lupena Rochelle, Hanchard Sandra, Brewer Karen Marie, Paynter Janine, Winter-Smith Julie, Selak Vanessa, Ameratunga Shanthi, Grey Corina, Harwood Matire
Department of General Practice and Primary Health Care, School of Population Health, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand.
School of Health, Victoria University of Wellington, Wellington, New Zealand.
Lancet Reg Health West Pac. 2025 Mar 17;56:101511. doi: 10.1016/j.lanwpc.2025.101511. eCollection 2025 Mar.
Māori and Pacific peoples carry the highest burden of cardiovascular disease in New Zealand (NZ). This systematic review aimed to determine access to evidence-based cardiovascular disease risk assessment (CVDRA) and management in primary care for Māori and Pacific peoples compared with other ethnicities in NZ, as well as factors contributing to reduced access.
In this systematic review with a narrative synthesis, keywords related to Māori and Pacific peoples, cardiovascular disease, and primary care were used to search MEDLINE (OVID), EMBASE, Scopus, CINAHL, NZresearch.org, National Library Catalogue (Te Puna), Index New Zealand (INNZ), and Australia/New Zealand Reference Centre, grey literature and hand search sources from 1 January 2000 to 31 December 2024. Two reviewers screened texts and three reviewers extracted data and assessed quality. High quality was defined using Western (Mixed Methods Appraisal Tool, MMAT, ≥80% compliance) and Indigenous (CONSolIDated critERtia for strengthening the reporting of health research involving Indigenous Peoples, CONSIDER) research tools. The protocol for this systematic review was registered at: https://doi.org/10.17605/OSF.IO/VUDE9.
A total of 2765 texts were identified of which 69 were included. This review identified inadequate levels of CVDRA in Māori and Pacific peoples when measured against the 90% national target. While the provision of primary prevention medications was higher (antihypertensives) or similar (lipid-lowering) compared to that for other ethnic groups, adherence was lower for Māori and Pacific peoples compared to other groups. Māori and Pacific peoples were less likely than others to receive antiplatelets and lipid-lowering therapy for secondary prevention. Evidence for antihypertensives in secondary prevention and combination therapy (in primary or secondary prevention) was mixed. Māori and Pacific peoples experienced reduced access to revascularisation compared with other ethnic groups, an inequity that persisted over time. Factors contributing to CVDRA and management were provision of adequate health literacy, relationships with providers and whānau, access to care, and cultural safety. While 64% of studies were ≥80% compliant with the MMAT, suggesting high quality from a Western research perspective, 71% of studies had an adapted CONSIDER score ≤2, suggesting low quality from an Indigenous perspective. The CONSIDER domains with the highest levels of reporting were Prioritisation, and Analysis and interpretation, while Capacity and Dissemination were the least reported domains. Qualitative studies had generally higher levels of CONSIDER reporting than mixed methods and quantitative studies. Kaupapa Māori Research was of the highest quality, followed by studies focused on Māori and/or Pacific peoples, while studies not focused on Māori and/or Pacific peoples had the lowest levels of CONSIDER reporting.
Extensive and inequitable gaps in CVDRA and management for Māori and Pacific peoples were identified. Opportunities for reducing these gaps include providing adequate CVD literacy, involvement of whanāu, patient-provider relationships, access to care, and enhancing cultural safety. Our findings will contribute to the development of a cardiovascular care equity roadmap in NZ. There are opportunities to improve reporting against the adapted CONSIDER criteria, which involves critical inquiry and a strength-based approach inclusive of Māori and Pacific values, particularly in quantitative research and research including but not focusing on Māori and Pacific peoples.
The Heart Foundation of New Zealand and Healthier Lives National Science Challenge, grant number 1819.
在新西兰（NZ），毛利人和太平洋岛民承受着最高的心血管疾病负担。本系统评价旨在确定与新西兰其他种族相比，毛利人和太平洋岛民在初级保健中获得循证心血管疾病风险评估（CVDRA）和管理的情况，以及导致获得机会减少的因素。
在这项采用叙述性综合的系统评价中，使用与毛利人和太平洋岛民、心血管疾病和初级保健相关的关键词，检索MEDLINE（OVID）、EMBASE、Scopus、CINAHL、NZresearch.org、国家图书馆目录（Te Puna）、新西兰索引（INNZ）以及澳大利亚/新西兰参考中心，检索2000年1月1日至2024年12月31日的灰色文献和手工检索来源。两名评审员筛选文本，三名评审员提取数据并评估质量。使用西方（混合方法评估工具，MMAT，合规率≥80%）和本土（加强涉及原住民健康研究报告的综合标准，CONSIDER）研究工具定义高质量。本系统评价的方案已在以下网址注册：https://doi.org/10.17605/OSF.IO/VUDE9。
共识别出2765篇文本，其中69篇被纳入。本评价发现，与90%的国家目标相比，毛利人和太平洋岛民的CVDRA水平不足。虽然与其他种族群体相比，初级预防药物（抗高血压药）的提供率较高，或（降脂药）相似，但毛利人和太平洋岛民的依从性低于其他群体。与其他群体相比，毛利人和太平洋岛民接受二级预防抗血小板和降脂治疗的可能性较小。二级预防中抗高血压药和联合治疗（一级或二级预防）的证据参差不齐。与其他种族群体相比，毛利人和太平洋岛民接受血运重建的机会减少，这种不公平现象长期存在。影响CVDRA和管理的因素包括提供足够的健康素养、与医疗服务提供者和家庭的关系、获得医疗服务的机会以及文化安全。虽然64%的研究符合MMAT标准的程度≥80%，从西方研究角度来看质量较高，但71%的研究经调整后的CONSIDER评分≤2，从本土角度来看质量较低。报告水平最高的CONSIDER领域是优先排序、分析和解释，而能力和传播是报告最少的领域。定性研究的CONSIDER报告水平总体高于混合方法和定量研究。毛利 kaupapa 研究质量最高，其次是关注毛利人和/或太平洋岛民的研究，而不关注毛利人和/或太平洋岛民的研究CONSIDER报告水平最低。
确定了毛利人和太平洋岛民在CVDRA和管理方面存在广泛且不公平的差距。缩小这些差距的机会包括提供足够的心血管疾病素养、家庭参与、医患关系、获得医疗服务的机会以及增强文化安全。我们的研究结果将有助于制定新西兰的心血管护理公平路线图。有机会根据调整后的CONSIDER标准改进报告，这涉及批判性探究和基于优势的方法，包括毛利人和太平洋岛民的价值观，特别是在定量研究以及包括但不限于关注毛利人和太平洋岛民的研究中。
新西兰心脏基金会和健康生活国家科学挑战，资助编号1819。
