A Handle on Stroke

The hard-hitting FAST stroke public health campaign ads are commendable. But are Irish stroke services adequate to back-up fast action? For the proper provision of stroke services in Ireland, their first needs to be good data. The North Dublin Population Stroke study is the first study to provide population data.

The adoption of the actions of the FAST acronym by the general public to look for early warning signs of a stroke will undoubtedly help save lives. The FAST acronym stands for:
• Face: has their face fallen on one side? Can they smile?
• Arms: Can they raise both arms and keep them there?
• Speech: Is their speech slurred?
• Time: call 999 immediately.

Stroke is the third commonest cause of death in the country, as it is in most developed countries. Stroke alone accounts for the same number of deaths annually in Ireland (2000 deaths) as the two commonest cancers combined, cancer of the lung and the breast.

Acting fast is proven to improve survival from a stroke and reduced disability after a stroke. But getting people to hospital faster will only work if it is backed up by adequate stroke services and a more proactive stroke policy.

Good stroke policy is determined on evidence base. The lack of data on stroke hampers good planning for services. This is the case in Ireland with stroke services lagging well behind other countries.

From clinical trials it is known that many acute strokes can be effectively prevented and effectively treated. Real world data, however, indicates that we are not implementing the findings of clinical trials in practice.

Many people with atrial fibrillation (AF) don’t get warfarin despite the evidence from AF clinical trials. Similarly despite it being fifteen years since NINDS trial there are many cases where emergency thrombolysis is not implemented for those with acute stroke.

Clinical trials are very well organised and well funded. The money and organisation does not currently translate to stroke services. Currently the shortfall in Irish stroke services includes:

• Limited stroke units. Only one in three hospitals in Ireland has a stroke units.
• Few stroke specialists.
• Very scant services in the community for post-stroke rehab for the estimated 30,000 stroke survivors.
• Only about half of acute hospitals have thrombolysis services with a miserable only less than 10% of stroke patients getting it.
• Restricted occupational therapy and physiotherapy services for stroke patients.

The North Dublin Population Stroke Study compared data for stroke with the Oxvasc Study in Oxford in the UK. The rates of stroke were found to be higher in Dublin by one third and Dubliners were more likely to have a severe stroke. The number of deaths was similar so there seems to be more survivors in Dublin of more severe stroke.

The number of people discharged from hospital with either a stroke or mini-stroke using hospital data was lower than in the Stroke Study in Dublin, so the current figures used for strokes may be an underestimation of the problem.

Those who have a mini-stroke or TIA or who have previously had a stroke are much more likely to have a more severe stroke and there is not enough provision for monitoring and follow up of these patients as a preventative measure.

Getting people into hospital quicker is an admirable step in the stroke prevention strategy but it needs to be backed up by an improvement in the provision of in hospital and community stroke services to really make an impact.

For further information go to http://www.stroke.ie


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