New figures reveal that, for the first time, more than half of NHS patients who need vital stroke prevention surgery are accessing it within two weeks of experiencing symptoms of stroke or transient ischemic attack (TIA or mini stroke). However, more must be done to raise public and professional awareness about the need for quick treatment, and improve referral patterns from GPs and other clinicians. Hospital services should be organised to ensure there is rapid access to specialist imaging and care.
Figures from the fifth report of the Carotid Endarterectomy Audit show that 56% of patients who need surgery of the neck arteries in order to prevent stroke (carotid endarterectomy or CEA) are receiving it within the two week time-frame set by the National Institute for Health and Care Excellence (NICE). But the study also reveals considerable variation across the UK, with delays between patients experiencing symptoms, referral to stroke specialists and on to surgery. While some hospitals average five days from symptom to surgery, patients are waiting up to three months for their operations in others.
Mr David Mitchell, chairman of the Vascular Society’s Audit & Quality Improvement Committee and a consultant vascular surgeon, said: “Not all patients with symptoms of stroke or TIA require surgery, however for those that do, quick access is crucial in preventing needless strokes and their associated misery. Despite the good work by many clinicians, we still have a long way to go if we are to meet NICE guidance of getting 100% of patients into the operating theatre within 14 days of symptoms. However, patients undergoing this operation should be reassured, as the audit shows, that carotid surgery is being performed more effectively than ever before in the NHS, with complication rates consistently low.”
Surgeons say that most delays in meeting the two week timeframe set by NICE relate to late presentation and/or referral. Of those patients who did not meet the 14 day timeframe, 65% were found to have had a slow diagnosis – either because they didn’t call 999, go to A&E or visit a GP (27%), or they weren’t referred to specialist stroke centre quickly (38%).
In certain regions across the UK, stroke services and vascular surgery have been centralised into larger centres where experienced multidisciplinary teams of surgeons, stroke physicians and neurologists assess and treat patients presenting with symptoms of stroke. The authors of the report point to the reorganisation of stroke services in London (which saw 17 units go down to 11), where the average delay from symptom to surgery has fallen from 12 days in 2009 to 8 days in 2012.
Professor Ian Loftus, consultant vascular surgeon at St George’s Healthcare NHS Trust, said: “Stroke is the largest single cause of significant adult disability in the UK. More needs to be done to ensure the public are aware of the alarm symptoms which include sudden onset of blurred vision, slurred speech, and weakness in the face, arms or legs. We know that fast referral to specialist stroke services is absolutely vital to improving patient care and outcomes. Care should be focused in centres that are well-organised and experienced in performing stroke prevention surgery.”
