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The study showed that in-hospital mortality has been reduced from 19 per cent to 14 per cent, whilst eight per cent of patients are now being discharged to nursing homes, compared to 15 per cent in 2008 when the previous national audit was conducted. Around 7,000 are hospitalised due to stroke here each year. The death toll of just below 2,000 makes stroke Ireland’s third biggest killer disease after cancer and heart disease.
The improvement in outcomes has been driven by the HSE’s National Stroke Programme, which has led a reorganisation of acute stroke services in Ireland, increasing the number of hospitals with stroke units from one to 21 and raising the rate of potentially lifesaving thrombolysis (clot-busting) treatment tenfold to 11 per cent – one of the highest national rates in the world – in the wake of the Irish Heart Foundation’s FAST campaign.
Despite the Programme’s success in developing services, many stroke deaths remain preventable, whilst a high proportion of stroke survivors continue to suffer undue disability in terms of both severity and length of time due to inadequate rehabilitation services. For example, despite their crucial importance in improving outcomes, only 29 per cent of patients are admitted directly to a stroke unit and almost half do not receive treatment in a unit at any point during their hospital stay. Nearly a quarter of hospitals providing acute stroke care do not meet minimum requirements and three of these had none of the required infrastructure in place for a stroke unit.
In addition, there are staffing deficits of 50 per cent for physiotherapists, 61 per cent for occupational therapists and 31 per cent for speech and language therapists, whilst only 44 per cent of hospitals had any access to medical social workers and 19 per cent had access to a neuropsychologist.
“The audit shows encouraging improvement in many areas of stroke care that has been achieved in the midst of the worst economic crisis in the history of the State, a rapidly contracting health service and just a small amount of dedicated financial resource,” said National Stroke Programme co-lead Professor Joe Harbison, who led the audit along with, Dr Paul McElwaine and project manager Joan McCormack of the Irish Heart Foundation.
Prof Harbison continued: “But the progress made cannot take away from persistent substantial deficits in services. The study shows that only about half of patients are admitted to a stroke unit at any time during their hospital stay. Treatment in a stroke unit is the most basic standard in the care of stroke patients and substantially improves the chances of independent recovery after a stroke.”
Prof Harbison said there is also a large deficit in the availability of rehabilitation services to stroke patients with few receiving the level of any therapy recommended in national and international guidelines. And whilst half of stroke survivors suffer anxiety, depression, or severe psychological distress, access to services was limited to just two hospitals nationally.
He concluded that there had been little additional investment in stroke care since the National Stroke Programme was established: “To maintain the improvements and to progress care of our fellow citizens suffering stroke to a level commensurate with a modern Western country, further investment in stroke services is undoubtedly necessary.”
Prof Harbison added that Early Supported Discharge teams are currently operating from just four hospitals nationwide, despite strong evidence of their effectiveness in reducing length of hospital stay. This now stands at 22.4 days according to the audit, which although a week less than in 2008 is still around a week longer than in the UK. He also called for greater investment in the new clot retrieval therapy, thrombectomy, which Irish doctors have helped to pioneer and which trials show could reduce death and severe permanent disability from stroke by 50 per cent.