Ireland’s mortality rate from stroke had fallen from 19% to 8% without an increase in nursing home discharge over the last decade, Prof. Ronán Collins, National Clinical Lead for Stroke and consultant in geriatric and stroke medicine at Tallaght University Hospital, told the Conference.
Speaking on “Stroke: our Joint Journey” he said that in the same period provision of thrombolysis in Ireland had increased from 1% to 12%, the number of stroke units increased from 1 to 21 sites across 27 acute hospital and, an early supported discharge service was piloted and rolled out in six sites.
It was also now possible to get stroke rehabilitation at home, telemedicine had been piloted and was active in two networks and Ireland had become an international leader in the provision of a stroke thrombectomy service.
He said “Nothing happens through clinicians alone. This happened by our working together. We have set about tackling stroke in the way we needed to by first understanding our deficits through audit and making stroke part of national health policy in the 2010 Cardiovascular Strategy. Then through a joint clinical and managerial leadership for stroke services with set KPIs requiring appropriate institutional investment and regular re-audit. The National Stroke Programme has not been without its’ hiccoughs but it is delivering tangible results,” he said.
There are about 7,500 strokes a year in Ireland at present, Dr Collins said. Explaining stroke in its’ most basic, he said put simply stroke was brain damage due to an occluded or ruptured blood vessel. It was the second leading cause of death in the western world and the leading cause of acquired adult neurological disability. It was also a major cause of depression and dementia in later life and a disease with major institutional, societal and personal costs.
The situation had not been good in Ireland in 2008. We had no pathways in primary care for rapid access stroke prevention , only 50% hospitals had a stroke prevention clinic, there was just one stroke unit in the country, less than 1% of acute stroke patients received thrombolysis, mortality was 19% and almost 30% of patients went to nursing homes. Thirty per cent of hospitals had no routine access to CT and there was no organised MDT system of assessment or rehabilitation for stroke patients, he said.
In 2010, The National Stroke Programme commenced. A joint consultant lead from neurology and geriatric medicine was appointed, and a Clinical Advisory Group of consultants was established to monitor and advise on strategy implementation. A Working Group of multidisciplinary team members was set up to review and devise new guidelines and policies on critical aspects of stroke care and advise on staffing, new service initiatives.
The goals were, “to reduce one death and disability from stroke each day and to prevent one stroke each day.”
The following were among the recommendations adopted as part of the National Cardiovascular Health Policy 2010 – 2019.