Dr Daniel Chan was born and raised in Auckland, got his degree from the Auckland Medical School, and did his five years of cardiology training in Auckland. He’s got a big-city background, and as he prepared to begin his cardiology career in Northland, his Auckland colleagues, sensing a disconnect, regularly asked – ‘Are you sure you’re comfortable up there Danny?’
But put it this way, Dr Chan and the north have history. He did much of his junior doctor training at Whangarei Hospital. He proposed to Dr Stephanie Valent, now his wife, on a Bream Head summit. The couple now have two children, and run sheep, cattle, and three horses on a 10-acre block beneath another Whangarei Heads summit, Mt Manaia. Then there’s the sea. In his teens, Dr Chan was an explosive 100-metres swimmer at regional level, with placings that took him into the Olympic trials. In his 30s now, Whangarei Heads offers him a silent rocky world away from the pressures of medicine; scuba diving and spear-fishing in productive waters.
Its primarily from that same Northland base also that, by way of Zoom calls and email exchanges with Ministry of Health biostatisticians, Dr Chan’s part-time research teased out a significant pattern for heart failure (HF) in New Zealand.
Coronary heart disease interventions are what Dr Chan calls the ‘golden child’ of cardiology. The treatments are well researched, well resourced, successful, and often quick. HF treatment, by contrast, is an underdog. The heart fails to pump enough blood for the demands of the body. There’s less glamour in that, but HF racks up a similar number of hospitalisations to coronary heart disease, and in Dr Chan’s mind, it carries with it also the “burden” not just of numbers, but high rates of morbidity – symptoms impacting quality of life, recurrent hospitalisations etc – and mortality. Yet there’s less research as to who, when and why. The overall figures suggested a decline in HF rates, but anecdotal experience at the practical level suggested a more worrying story, and Dr Chan won the Couch Trust’s first research scholarship to investigate. The subsequent paper by Chan DZL, Kerr A, Grey C et al, was published on 22 October, 2021.
The paper confirmed an overall decline in HF rates over most of the study period, 2006-2018 but for the first time it showed that the rate had increased for those aged 20-49. In short, the more elderly and numerous cohorts were masking a significant problem at the young end of the spectrum. The paper sourced the HF increase to diabetes, but also hypothesized a range of other ailments linked to obesity.
The British Medical Journal ‘Heart’ featured the Chan research in a February 2022 editorial noting comparable trends in Denmark, Sweden and Western Australia. The editorial called the increases of HF in younger people “alarming”. The renewed focus on HF also led to an article in the New Zealand Medical Journal of October 7, 2022 that called for a National Heart Failure working group and a Heart Failure Registry to secure more data and accurately profile HF patients. The article noted the 2022 Pae Ora (Healthy Futures) Act’s emphasis on equitable health outcomes for Maori and other population groups and stated: “The case for urgent action in Aotearoa is compounded by the stark inequities in the burden of HF . . . “
The regions with known pockets of deprivation, and with big Maori populations that typically have a younger average age than the regional average, will benefit the most from such research and data. Northland is one, and Dr Chan suggests also that the model of care should be more accommodating than a clinician simply setting a time and expecting patients to turn up.
“Most Pākeha can handle that, but it doesn’t work for other ethnicities or people with other priorities in their lives or people who’re socially deprived, regardless of ethnicity.”
Dr Chan’s championing of more equal treatment may have some faint link to the discrimination he encountered growing up as the son of a Chinese couple who’d emigrated from Malaysia – ‘You’d be lying if you say you weren’t affected by it,’ he acknowledges. But for showing him inequality in plain sight, he credits his wife, Dr Valent, now an emergency specialist at Whangarei Hospital, and a primary retrieval medic for the Westpac Rescue Helicopter.
“We’re different, but we’re the same,” says Dr Chan. “She grew up on a little block out on Whangarei Heads with no power and a long drop, so her view of living and growing up is quite a bit different to mine. She dragged me out to do medical school training in Whangarei and the Far North and Rotorua. She’s the one I can attribute that kind of eye-opening experience.”
“Doctors are scared to go to the outside centres,” he says. “I’m not trying to bag the academic hospitals, but that focus more on the patient rather than the disease was the difference I saw in the outlying hospitals. There’s a closer connection and you’re not worried only about their disease and how do I treat their disease, but you’re also worried about how does the disease impact them and their family.”
Returning to Whangarei Hospital at the beginning of 2023 as the newest member of the hospital’s five-person cardiology service, Dr Chan is comfortable with that.