Urgent action needed on stroke services

[Posted: Thu 19/11/2009]

The health authorities are not doing enough to combat a condition that is killing at least one person every day in Ireland, according to the Irish Heart Foundation (IHF)

The health authorities have been urged to take action to improve Ireland's stroke services and in doing so save around 500 lives a year, or more than one avoidable death every day.

The IHF has slammed the lack of action on improving stroke services 18 months after "appalling" deficiencies in these services were revealed in the first national stroke audit.

Around 10,000 people in Ireland get a stroke every year and 2,000 people die from stroke. Thousands more are forced to live with disabilities that are unnecessarily severe or prolonged as a result of the lack of proper treatment, after-care and education.

One-in-five people in Ireland will suffer a stroke at some time in their lives.

The IHF has launched a stroke manifesto, a 16-point plan to eliminate avoidable death and disability from stroke.

At the launch of the manifesto, the IHF pointed out that less than one-third of acute hospitals in Ireland have a stroke unit, at least 15% of strokes are misdiagnosed and less than 3% of acute stroke patients receive lifesaving "clotbuster" drugs.

Dr Brian Maurer, medical director of the IHF, said the lack of stroke units, clotbusting drug therapy, experienced stroke physicians and other back-up staff and rehabilitation services across large parts of the country continues to put patients "in unnecessary and intolerable danger."

He told the manifesto launch that many deaths and unnecessary disability from stroke are due to the fact that patients do not get priority treatment in the acute phase of the stroke.

"We still do not have stroke units in many of our hospitals and we do not have a concentration of expertise in many of the existing units that would ensure early rehabilitation," Dr Maurer said.

The IHF says despite the fact that the number of stroke units has increased over the past 18 months, a number of the units do not meet international standards.

Dr Maurer pointed out that as a result of major advances in medical care in recent decades, stroke should now be preventable, treatable and those who suffer from it should be able to get rehabilitation and return to normal life in many cases.

He said while some initial investment would be required to improve stroke services, he reckoned that the State could save up to €100 million per annum on what it currently spends on managing premature disability from stroke.

Dr Maurer said proper multidisciplinary teams, including consultants, therapists and psychologists, were needed for optimal stroke care.

He said in many areas of the country, proper after-care for stroke patients was non-existent. Some patients, he said have to spend months or even years in hospital because they cannot access rehabilitation and after-care.

The IHF says there is a major deficit in community stroke services in Ireland.

Dr Joe Harbison, consultant stroke physician at Dublin's St James's Hospital, said if you are admitted to a properly-resourced stroke unit, your chances of ending up dead or disabled are reduced by one quarter.

He said another problem was that strokes were often misdiagnosed by health professionals, as the symptoms can be mistaken for other conditions and it is sometimes difficult to recognise the symptoms.

In some cases, symptoms be erroneously diagnosed as stroke when it could be another condition such as epilepsy.

The IHF is promoting a FAST diagnosis system, calling on people to recognise the symptoms of stroke - Facial weakness; Arm weakness and Speech problems; and awareness that it is Time to dial 999.

Dr Harbison said a major problem was the lack of specialists in the area of stroke care, and one in seven strokes will be misdiagnosed if specialist services are not available.

The IHF says at least 15% of strokes are misdiagnosed and up to 50% of transient ischaemic attacks (TIAs) which can be a precursor of a later stroke, are missed.

It is also stressing that stroke is not a condition confined to older people, and younger people can get strokes too.

Dr Harbison pointed out that if someone has a major stroke in their 40s, the cost to the economy in terms of lost income and of looking after that person were more than €1 million, so improving services to prevent stroke would be very cost-effective.

The IHF's Stroke Manifesto covers areas such as the need to educate the public on stroke; to provide every hospital with a proper stroke unit including adequate staffing; to provide 24/7 availability of anti-thrombolytic (clotbusting) drugs to treat stroke; to provide appropriate rehab and community facilities and to address the needs of carers in supporting stroke survivors.

The IHF expects the recommendations of its manifesto to be reflected in the forthcoming Department of Health/HSE Cardiovascular Policy Group report, which is set to outline the future development of services for heart disease and stroke in Ireland.

Read an account of what it's like to have a stroke here

For more information visit www.irishheart.ie

View also irishhealth.com's Heart Disease Clinic here

Lolene  Posted: 21/11/2009 17:40

2 years ago I had a stroke resulting in Left H emiparesis.My blood pressure had been raised 150/90 previous 2 years,but gp did not prescribe anti hypertensives or diuretics.At 6pm I had TIA while driving , no LOC,and was taken to A&E by ambulance within 30 mins.ECG, chest x-ray and bloods done .Same results viewed by reg on duty,told I was lucky as had recovered movement in arm and leg, tho'left face still dragged.Was discharged home with Centyl tabs 2 after 3 hours. Collected my car, drove home and took one Centyl,went to bed . Woke up 3 hours later,tried to walk to toilet,collapsed on floor ,full blown stroke.Lay on floor for several hours,unable to reach phone.Back to A&E at 8.30am per same ambulance crew. No clotbusting drugs given. 2 days later given Aspirin 300mg for 7 days. It was New Years Eve ,beds probably reqd for incidents resulting from over indulgence of alcohol.I am/was a health proffessional, now invalided.

Anonymous  Posted: 25/11/2009 15:27

A good report. Sad, shocking but true.

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