Government acts on stroke services

The strategy aims to accelerate the emergency response to stroke, by setting out a framework for care for those affected by stroke and raising awareness about symptoms and risk factors. The Department of Health believes the strategy could help avoid up to 6,800 deaths and cases of disability every year. A further 1,600 strokes could be averted through preventative work.

Key measures include MRI scans for higher-risk individuals with Transient Ischaemic Attack (TIA), or “mini-stroke”, within 24hrs of experiencing symptoms or within seven days for low-risk individuals. This could lead to an 80% reduction in the number of people who go on to have a full stroke. Currently, less than 35% of providers manage to treat TIA within seven days.

Those with suspected stroke should be immediately transferred to a specialist centre offering immediate clinical assessment, scans and clot-busting drugs. All local areas will have 24/7 coverage by at least one specialist centre. In addition, patients requiring urgent brain imaging will be scanned within the next scan slot during normal working hours, and within 60 minutes out of hours. People affected by stroke should also have immediate access to high quality rehabilitation and support from stroke-skilled services in hospital, allowing people to get home faster.

The Vascular Society commented that many more lives could be saved if patients gained quick access to treatment following TIA. The society commented that Carotid endarerectomy (CEA) has proven effective but currently only ten per cent of patients are getting this treatment within seven days. Many develop a full stroke before the surgery can be carried out – leading to severe paralysis, brain damage or death.
 
“Patients in the United States can expect to be treated within one to two days of a TIA. This report’s recommendation for surgery within seven days is a step in the right direction but shows that, even if achieved, the NHS would still someway off the ideal treatment for stroke,” said Jonothan Earnshaw, honorary secretary of the Vascular Society. “Vascular surgeons know that preventative stroke surgery saves lives if it is carried out early. At present the ultrasound services that are vital for diagnosis are a logjam as they are closed at weekends. In addition, patients often do not seek treatment if the symptoms go away and GPs often don’t refer these cases - so surgeons are not seeing patients early enough to make the difference.”