Specialist Chris Ellis, who led audits of care for heart patients at hospitals around the country in 2002 and 2007, said the most recent study showed that heart attack patients were waiting too long for tests which would determine their level of risk and what treatment they needed.
In particular there were major issues for patients outside the main centres.
Access to coronary artery bypass grafting surgery remained very limited, despite a "small but encouraging" improvement since 2002, he said.
The availability of non-invasive tests, especially echocardiograms and exercise treadmill tests, showed no improvement.
The study also found that New Zealand lagged behind European countries in access to discharge medications which would improve the outcome for patients.
A drug called clopidogrel had been shown in overseas studies to greatly reduce the chance of stroke, heart attack, or vascular death in coronary care patients, compared with the standard prescription of aspirin.
Australians had been able to access clopidogrel since 1999, but in New Zealand not even those strongly allergic to aspirin could get funding for the drug, the study found.
"Aspects of care remain of significant concern and have not substantially changed in five years," Dr Ellis said.
"There remains an urgent need to develop a comprehensive national strategy to improve all aspects of acute coronary syndrome patient management."
Health Minister Tony Ryall today admitted services for heart patients in the regions were still not up to scratch, and that there were problems getting them to the main centres for care.