He Aronga Hou: Reimagining Early Detection of Heart Risk for Maori Adults

What is the intervention The intervention is a community-based cardiovascular screening programme designed to support the early detection of subclinical cardiovascular disease in Maori adults at intermediate predicted cardiovascular risk. Participants undergo computed tomography coronary angiography (CTCA) with coronary artery calcium scoring and plaque assessment, blood biomarker testing including N-terminal pro B-type natriuretic peptide (NT-proBNP), and cardiovascular risk assessment. Participants identified as higher risk are referred back to their primary care provider with cardiology-supported recommendations for further investigation and management. How participants will gain access to the intervention Participants will primarily be identified and referred through partnering Maori health providers and affiliated primary care/general practice services (e.g., Ngati Whatua Orakei, Ngati Porou Oranga, Turanga Health). Recruitment pathways may include: • Referral from primary healthcare providers or nurse-led clinics • Identification through existing cardiovascular risk assessment programmes • Community outreach and provider-led engagement • Self-expression of interest following community promotion approved by partner organisations Once referred, participants will be contacted by the research/provider team to confirm eligibility and arrange screening appointments. Who delivers it and their relevant expertise The study is delivered collaboratively by Maori health providers, the research team, radiology services, and cardiology specialists. Maori health provider research staff and coordinators support recruitment, consent, participant engagement, and study logistics within their communities. CTCA imaging is performed by trained radiographers and overseen by radiologists and cardiologists experienced in cardiovascular imaging. The study team includes researchers and clinicians with expertise in cardiovascular medicine, Maori health, and community-based health research. Training and support for radiographers and clinical staff Radiographers and relevant clinical staff involved in CTCA and echocardiography procedures are already appropriately qualified and experienced in delivering these clinical assessments as part of standard practice. Prior to commencement of participant enrolment, the study team will provide: • Study-specific orientation regarding referral pathways, participant flow, and research processes • Guidance on study documentation and communication procedures • Clarification of escalation pathways for incidental or clinically significant findings • Cultural safety expectations and kaupapa Maori principles underpinning the project This orientation/training will occur prior to the first participant enrolment and will include 1-2 online briefings Timing of training relative to assessment period All study orientation and relevant staff training will occur before participant recruitment and commencement of assessments. Ongoing communication and support will be available throughout the study period as needed. How it is delivered The study is delivered primarily through face-to-face interactions within Maori health provider settings and clinical imaging services. Participant recruitment and consent occur kanohi ki te kanohi (face-to-face) with support from Maori health provider staff and research personnel. Screening procedures are delivered individually. Follow-up communication may occur by phone or email where appropriate. How often and for how long Participants complete a single screening pathway over approximately 1–3 months, depending on scheduling and follow-up requirements. This includes one baseline assessment and blood test appointment, one CTCA imaging appointment, and additional follow-up investigations (e.g., echocardiography) if clinically indicated based on screening findings. Approximate duration of appointments and follow-up visits Estimated participant time commitments are: Initial screening/consent visit: 30–60 minutes Blood test appointment: 15–20 minutes CT Coronary Angiography (CTCA): 45–90 minutes Echocardiography (if indicated): 30–60 minutes Follow-up discussion/results review: 20–40 minutes Some participants may require additional clinical follow-up depending on screening findings and referral Where it is delivered The intervention is delivered through Maori health provider clinics and associated clinical services in Auckland and Tairawhiti/Gisborne. CTCA scans are undertaken at participating radiology services, including The Heart Group in Auckland and Gisborne Hospital. Adherence Participant engagement and adherence are supported through ongoing communication from Maori health provider coordinators and research staff. Appointment scheduling assistance, reminder phone calls, text messages, and follow-up contact are used to support attendance and completion of study procedures. The community-led nature of the project and involvement of trusted local providers are intended to support participant retention and engagement throughout the screening pathway.