Women’s cardiovascular health in Aotearoa New Zealand: insights from a systematic literature review

Heart disease (HD) is a leading cause of morbidity and mortality globally, yet it remains understudied, underdiagnosed and undertreated in women. Although attention towards gender equity in heart health has increased, significant knowledge gaps persist in understanding the impact, incidence and experiences of women living with HD in Aotearoa New Zealand. This systematic review identified and synthesised evidence on the heart health of women in Aotearoa New Zealand, focussing on clinical outcomes, awareness of HD and lived experiences. The review followed a registered protocol (PROSPERO: CRD420246000029). Systematic searches of Ovid MEDLINE, PubMed, Embase, CINAHL, Cochrane Library, ProQuest Health & Medical and ProQuest Dissertations identified studies published between 2000 and 2024. Inclusion/exclusion criteria were defined in PROSPERO and refined in Covidence. Eligible studies were assessed for risk of bias using Joanna Briggs Institute appraisal tools, and data were synthesised using Braun and Clarke’s thematic framework. The search identified 61 papers. Key themes included: delayed diagnosis for women and lower likelihood of receiving guideline-recommended treatments; pronounced equity gaps for Māori and Pacific women, who face higher premature cardiovascular mortality and barriers to care; the psychological burden of HD and women’s experiences of reduced or delayed care; and the essential role of culturally responsive, patient-centred models of care in improving outcomes. The literature reveals ongoing gaps in diagnosis, treatment and care for women with HD in Aotearoa New Zealand. Addressing these inequities requires genderspecific and culturally grounded strategies to improve cardiovascular outcomes for diverse communities.