Deaths by stroke fall by over 25% in the last 7 years

Stroke deaths have been cut by more than a quarter and the rate of direct discharge to nursing homes has almost halved in the past seven years, it has emerged.

A national audit of acute stroke services carried out by the Irish Heart Foundation and the HSE shows the number of people dying from stroke in hospital has reduced from 19% to 14%.

Also, 8% of patients are now being discharged to nursing homes, compared to 15% in 2008, when a previous national audit was conducted.

About 7,000 people are hospitalised due to stroke every year and, with just under 2,000 deaths, stroke is Ireland’s third-biggest killer after cancer and heart disease.

The improvement in outcomes has been driven by the HSE’s national stroke programme that has managed the re-organisation of acute stroke services.

The number of hospitals with stroke units has increased from one to 21 and the rate of potentially life-saving thrombolysis (clot-busting) treatment has increased tenfold to 11% — one of the highest rates in the world.

However, despite the programme’s success in developing services, preventable stroke deaths continue and a high proportion of stroke survivors continue to suffer severe disability.

The audit shows only 29% 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.

Also, 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% for physiotherapists, 61% for occupational therapists, and 31% for speech and language therapists. Only 44% of hospitals had access to medical social workers and just 19% had access to a neuro-psychologist.

The national stroke programme co-lead, Prof Joe Harbison, conducted the audit together with Dr Paul McElwaine and Irish Heart Foundation project manager, Joan McCormack.

“The audit shows encouraging improvements in many areas of stroke care that have been achieved in the midst of the worst economic crisis in the history of the State, rapidly contracting health services, and just a small amount of dedicated financial resource,” said Prof Harbison.

While progress was made there were still persistent, substantial deficits in services and he referenced the fact that the study showed that only about half of patients were 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,” he said.

Prof Harbison said there was also a large deficit in the availability of rehabilitation services to stroke patients with few receiving the level of therapy recommended in national and international guidelines.

He added that early supported discharge teams were operating from just four hospitals, despite strong evidence that they shortened hospital stay.

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