OPINION: Stroke  treatment rates can be improved

THE Australian Institute of Health and Welfare stroke report released this month provides a big-picture view of the burden of stroke and contemporary management of the disease, with predictions from two decades ago now being borne out in statistics.

The impact of stroke remains high, although death rates dropped by 70per cent between 1979 and 2010. In 2009, an estimated record 375,800 Australians had suffered a stroke at some time in their lives. In 2010 there were 8300 stroke-related deaths, representing 6per cent of all deaths and equating to 23 deaths a day.

The burden of stroke in Aboriginal and Torres Strait Islander people remains substantially higher than that seen in the non-indigenous community.

Prevalence rates are around 70per cent higher and the rate of hospitalisation for stroke is twice that of the non-indigenous population.

Death rates from stroke are 50per cent higher in the indigenous population overall and of great concern is the five-fold increase in fatalities among young indigenous sufferers.

No association was noted between living in a remote area and stroke prevalence or hospitalisation rates, however, the trend was evident in death rates comparing major cities and remote location.

There was also a link seen between socio-economic status and prevalence, hospitalisation rate and death rates.

On the positive side, statistics from both the AIHW and the National Stroke Foundation audits included in the report suggested that the care provided for stroke patients had improved over the past five to 10 years, as evidenced by a growing number of stroke care units in public hospitals, prompt and better access to diagnostic testing and the use of protocols and care pathways in acute and rehabilitative care.

The only proven effective acute drug therapy for stroke is intravenous thrombolysis, where prompt treatment can result in a complete cure for one in three people.

For every patient who responds to the drug, there’s a significant cost saving and economic benefit, not to mention lifestyle improvement.

Thrombolysis must be administered within 4½ hours of stroke onset. It is potentially an option for 30-40per cent of patients, yet it continues to be poorly implemented – only 7per cent of stroke victims are offered treatment across our major hospitals.

Where hospital emergency stroke-care systems are well organised, the thrombolysis treatment rate is as high as 25per cent, so major variation in care exists and there is considerable room for improvement.

Stroke is a complex illness to treat but I believe the limited access to thrombolysis is due in part to the lack of public awareness of the signs of acute stroke and the appropriate actions to take when symptoms are recognised.

The National Stroke Foundation has been promoting the FAST campaign since 2006, but survey data indicates that public awareness remains problematic. Most people are surprised by the speed with which stroke can hit, and everyone is shocked by the effect a stroke can have on someone’s physical and mental functioning.

FAST stands for Face, Arms, Speech and Time but we also want people to think and act fast. Has the person’s mouth dropped? Can they use their arms? Is their speech affected? Do they struggle to understand you?

If you see any of these, call 000.

According to the report, stroke mostly impacts people aged over 65, with males more prone than females. The report also confirms that around half of all stroke sufferers are left with a disability that interferes with everyday activities. Reportedly, one-third of these are under the age of 65.

There is evidence of the value of risk-factor screening and management of the modifiable factors of high blood pressure, smoking, high cholesterol, irregular heart rhythm atrial fibrillation, diabetes, obesity and excessive alcohol drinking.

Overall, the report suggests some major improvements – in particular a reducing stroke attack rate that is limiting, at least partially, the overall burden of stroke.

There remains much work to be done with prevention strategies in risk-factor management, improvements in hospital-based acute care and the provision of thrombolysis to all eligible acute stroke patients, particularly when it comes to treatment for Aboriginal and Torres Strait Islander people.

Professor Chris Levi is the head of Hunter Medical Research Institute’s brain and mental health research program

Stroke risk can be reduced by screening and management of blood pressure, smoking, high cholesterol, diabetes, obesity and excessive alcohol drinking.

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