870 stroke patients in England, Wales and Northern Ireland received thrombolysis – the use of drugs to break up a blood clot – during the last year, and while this is still a very low number, it is a four-fold increase since 2006, according to the 2008 National Sentinel Organisational Audit of Stroke.
The audit, which is carried out every two years, also finds that there have been particular improvements since 2006 in acute stroke care and the management of transient ischaemic attack (ITA or “ministroke”). However, it adds: “all hospitals need to understand that stroke is a treatable disease that needs to be recognised as a medical emergency.”
About 30% of hospitals in England, Wales and Northern Ireland are now “actively thrombolysing” but, given that many units have just set up their services, the numbers are likely to have increased considerably when the audit is conducted again in April 2009, says the report, which was funded by the Healthcare Commission and carried out on behalf of the Intercollegiate Stroke Group by the Royal College of Physicians’ (RCP) Clinical Effectiveness and Evaluation Unit (CEEu).
In order to ensure that patients receive appropriate treatment at the right time, there needs to be better public and professional awareness of the symptoms of stroke and how to respond when it does occur, plus an educated and responsive paramedic service and well-organised care for the patient when they arrive at the hospital, it says.
“We should be aiming for at least 10% of stroke admissions being thrombolysed nationally – this is the level that many centres in America, Australia and mainland Europe achieve, as well as some centres in the UK,” says the audit, but it also stresses that thrombolysis is only highly effective if given to the right patients in the right way.
There are major risks of introducing it if the service is not organised to deliver high-quality acute care by physicians and nurses who are trained and experienced in identifying which patients are appropriate and then carefully monitoring its delivery, it warns.
“We would plead that hospitals do not rush into providing thrombolysis before the other components of the service are functioning well. There are greater benefits to the stroke population as a whole by having an effective acute stroke unit delivering ‘basic’ stroke care than by having a thrombolysis service without the other components. This audit unfortunately suggests that in some cases thrombolysis may have been introduced too early,” the authors caution.
Overall, however, the authors say that while there is no room for complacency, there is now, for the first time since the audit began 10 years ago, “reason for optimism.” Stroke is high on the political agendas of England, Wales and Northern Ireland, with well-supported national strategies which should, if implemented, “result in services that are the envy of the world,” they conclude.
