Background: Maori have the poorest cardiovascular health outcomes of all population groups in Aotearoa New Zealand. Although these inequities have been documented for many years progress toward addressing, rather than tolerating, them has been alarmingly slow.

Methods: Over the past 10 years we have developed a clinical decision support system, PREDICT, that provides primary and secondary care clinicians with patient-specific cardiovascular risk assessment and guideline-based management advice. At the same time it collects risk profile data that we link to service utilisation, laboratory results, pharmaceutical prescribing, hospital admissions and deaths via encrypted patient identifiers.

A new phase of research to study patterns in cardiovascular disease outcomes, clinical activity and expenditure at the population level is described. It aims to identify, track and improve unwarranted variations in cardiovascular risk and risk management. Key elements will be to provide (1) interactive web-based national and local atlases of vascular burden and health service provision, (2) feedback to policy-makers and clinicians regarding disparities in clinical outcomes and care, (3) evidence of interventions focussed on improving the quality of cardiac services for Maori, and (4) accurate Maori and non-Maori risk prediction algorithms to inform appropriate targeting of resources.

Results and Conclusion: Multi-level approaches to improving cardiovascular health for Maori, in which evidence-based population strategies are complemented by evidence-based clinical strategies, are needed. These approaches must be guided by science and focussed on quality.