Inadequate stroke services causing an avoidable death a day
Stroke death rate could be cut by 25% at no cost to the State
The Irish Heart Foundation today (Wednesday, November 18th) demanded urgent action to overhaul stroke services, insisting that the lives of up to a quarter of the 2,000 people who will die from stroke this year, would be saved by service improvements that could even save the taxpayer money.
More than 18 months after exposing “appalling” deficiencies in Irish stroke services in the first national audit on stroke care (April 2008), the Irish Heart Foundation (IHF) said there is still more than one avoidable death from stroke in Ireland every day, while thousands more are forced to live with disabilities that are unnecessarily severe or prolonged.
Launching its Irish Heart Foundation Stroke Manifesto – a 16 point plan to eliminate avoidable death and disability from stroke – the national charity fighting stroke and heart disease emphasised that:
- Less than one third of acute hospitals have a stroke unit – despite the fact that a national network of these units could save up to 500 lives a year.
- At least 15% of strokes in Ireland are misdiagnosed – over 1,500 cases every year.
- Less than 3% of acute stroke patients received the lifesaving clot buster treatment in the year to April 2009 – just 178 people. HSE statistics indicate that up to seven times more patients could receive thrombolysis with improved services.
Irish Heart Foundation Medical Director Dr Brian Maurer said: “Every day that passes without adequate stroke services results in unnecessary death and disability in our population, causing untold misery for the families of many stroke sufferers. We know that the Government and the HSE are working to prioritise action in this area but the lack of stroke units, thrombolysis, experienced stroke physicians, TIA clinics and rehabilitation services across large parts of the country continues to put patients in unnecessary and intolerable danger.
“One in five people will have a stroke in Ireland at some stage in their lives, so the quality of our stroke services will directly or indirectly affect just about everyone living here. There are currently huge differences in service standards around the country – in some hospitals having a stroke out of office hours could cost you your life. It is not acceptable that the place, time and day of a stroke largely determines whether you recover, die, or live the rest of your life with a disability.
“Furthermore at least 15% of strokes misdiagnosed and up to 50% of TIAs are missed. This means that over 1,500 cases are misdiagnosed each year with devastating consequences for many stroke patients and their families.”
According to the Foundation, just one stroke unit was identified in the country at the time of their national stroke audit. Now the HSE says that 11 of the country’s 36 acute hospitals have stroke units. However the IHF pointed out that a number of these do not meet minimum international standards. In addition, whilst more than half of acute hospitals can provide thrombolysis to stroke patients, many only operate a 9am-5pm Monday-Friday service.
Dr Maurer continued: “Medical advances have made stroke one of the most preventable and treatable of all diseases, but services in Ireland have not kept pace with these developments. This is despite a huge spend by the HSE on stroke services at around €422 million a year. We believe that implementing the measures contained in our Manifesto would eliminate avoidable death and disability from stroke. These measures would also be at least cost neutral and could even save the HSE money following a relatively small initial investment.”
The IHF expects the cost effectiveness of their Manifesto recommendations to be borne out by the conclusions of joint ESRI and RCSI research due for completion before the end of the year.
The Irish Heart Foundation also pointed out that each stroke patient should be entitled to a minimum of 45 minutes of required rehabilitation 5-7 days a week for as long as required. But the reality is that no service is available to the vast majority of these patients. Rehabilitation should include physiotherapy, occupational therapy, clinical psychology, speech and language therapy and nutrition and dietetic input provided by both hospital and community based stroke teams.
Dr Maurer added: “The recommendations of the Cardiovascular Policy Group – which provides a roadmap to the elimination of avoidable death and disability from stroke – was due to have been published last February. It has to be acted upon urgently. We fully support the efforts of the HSE and the Department of Health to develop stroke services, but call on them to implement this Manifesto in full now.”
The Stroke Manifesto is being published at the beginning of a 4-year advocacy campaign by the Irish Heart Foundation for better services and information for stroke patients, as well as improved public understanding of stroke in Ireland. The national charity’s plans include a FAST campaign to raise awareness of the warning signs of stroke and the need for emergency treatment in hospital for anyone who suspects they have had a stroke. (The FAST acronym refers to the main symptoms of stroke – Facial weakness, Arm weakness and Speech problems, along with the warning that it’s Time to call 999.)
As part of their stroke campaign, the Irish Heart Foundation is facilitating the development of a nationwide network of stroke support groups; comprehensive information provision for stroke patients and their families; and the scoping of a national stroke register.
Media queries to Caroline Cullen, Communications Manager, Irish Heart Foundation, Direct line: 01-6346908, Mobile: 086-6049282
• 10,000 people will suffer a stroke in Ireland this year.
• One in five people will have a stroke at some time in their life.
• Stroke is the third biggest killer disease in Ireland – causing more deaths than breast cancer, prostate cancer and bowel cancer combined.
Summary of Stroke Manifesto Recommendations
1. Up to 50% of strokes are preventable. That’s 5,000 strokes a year. A major public education programme is needed to help people reduce their risk.
2. Immediate treatment after stroke can be the difference between a complete recovery and a lifetime of dependency. Yet research shows that less than half the population would ring an ambulance if they thought they were having a stroke. A national campaign is needed to ensure that stroke is recognised as a medical emergency.
3. Every hospital admitting acute stroke patients should have a fully resourced stroke unit. This alone could save up to 500 lives a year.
4. Stroke units must comply with international standards. Any failure to do so in terms of capacity, staffing and equipment could cost lives.
5. Clot-busting thrombolysis prevents death and disability from stroke. Yet less than 3% of stroke patients receive the thrombolysis treatment which is available in just over half the country’s acute hospitals, often on a 9am-5pm Monday to Friday basis. 24/7 availability of thrombolysis countrywide must be urgently delivered.
6. The average stroke destroys 2 million brain cells a minute. Emergency services must be fully equipped and empowered to deal with acute strokes.
7. At least 15% of strokes and half of Transient Ischaemic Attacks (TIAs or mini strokes) are currently misdiagnosed. More consultant stroke physicians must be appointed to provide greater expertise in the diagnosis and treatment of stroke.
8. TIA services can reduce repeat mini strokes or full strokes by 80%. Yet they are provided in just a sixth of acute hospitals. Rapid access TIA clinics that are open seven days a week must be provided on a regional basis.
9. Every patient should be entitled to appropriate levels of hospital and community rehabilitation to relieve the unnecessary suffering experienced by thousands of stroke patients who cannot access services.
10. Every patient should have a planned and timely transition from hospital to their home or residential care.
11. Regional stroke co-ordinators should be appointed to ensure that services meet patient needs in every community.
12. Age-related inequities are common across Irish stroke services and must be eliminated.
13. Most patients are unaware that high quality stroke services can save lives and reduce disability. A Charter should be adopted to inform patients of their medical entitlements.
14. A national stroke register must be developed to ensure stroke services operate to maximum effect.
15. Comprehensive social and vocational supports must be available to enable stroke patients to achieve the best possible quality of life.
16. The social, emotional and practical needs of the carers of stroke survivors must be met.
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