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Stroke care is transformed, so what’s next?

In a guest blog for the MTG, Professor Tony Rudd explains how stroke care has seen significant improvements in a generation, and what more can be done to enhance prevention and patient outcomes.

When I started out as a consultant geriatrician and general physician at St Thomas’s in 1988, stroke was considered by most to be untreatable and patients had little hope for rehabilitation.

Nearly 30 years on though, prevention and treatment of stroke has improved significantly. Between 1990 and 2010 incidence fell 19 per cent, and mortality rates halved over the same period. Meanwhile disability outcomes for patients have become much better. Today, there are over 1.2 million stroke survivors in the UK with nine out of ten in England, Wales, and Northern Ireland living at home.

However, stroke can still remind us of our own mortality. Of the 100,000 new stroke victims each year, one in five will die within twelve months. When you learn that 60 per cent of strokes are preventable, the need to do more becomes abundantly clear.

The solution lies in a combination of low and high-tech solutions.

Identifying everyone with atrial fibrillation (AF) for example could prevent 12-15 per cent of cases alone. Government policies to tackle diabetes and obesity would contribute even further. And, with the need for treatment by specialists is now increasingly understood, making England’s 24 specialist centres operational will have a significant impact.

Technology remains one area where we are not always delivering the best treatment. Around 10 per cent of stroke admissions are suitable for mechanical thrombectomy for example, but only around 500 procedures were performed last year. The technology has demonstrated its potential to transform life chances and enable many patients to go on to live independent lives, so the recent decision to broaden provision, via annual funding of £100 million, is very welcome and will bring hope to many more patients and their families. I would now like to see this resource supported with specialist staff and units to deliver it widely.

More work is also needed to improve patient access to diagnostics, and the NHS could get better at providing the appropriate technology in post-care to enable independence. For instance, the areas of robotics and virtual reality to support patient rehabilitation are still relatively untapped opportunities.

While considerable progress has taken place over the past few decades, we have often been late to the party when it comes to technology, lagging behind our European neighbours. But when we do recognise the its value – such as intravenous thrombolysis, now provided to 12 per cent of stroke patients – we do so widely and relatively equitably.

The potential benefits of investing in technology to improve stroke care are irrefutable. One in six of us will have a stroke in our lifetime. Apart from the human factor, the financial impact to the UK from direct costs, productivity losses from mortality and morbidity, as well as informal care costs, amounts to around £9 billion.

So, let’s take that these lessons on board and keep up the progress.

July 2017

Professor Tony Rudd is NHS England’s National Clinical Director for Stroke and a consultant stroke physician at Guys & St Thomas’s Hospital, London.

Sources:
https://www.stroke.org.uk/sites/default/files/stroke_statistics_2015.pdf
https://www.stroke.org.uk/sites/default/files/state_of_the_nation_2017_final_1.pdf

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