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UK stroke treatment is worst in Europe

August 27, 2007 By: Dr Search- Principal Consultant at the Search Clinic Category: Uncategorized

The UK has the worst outcome for strokes in western Europe despite spending the same amount or more on care as other countries, a leading article in the British Medical Journal warned.

Hugh Markus, professor of neurology at St George’s university and medical school, said three different studies had put the UK at the bottom among several other western European countries.

The problem appears to lie in the way services are organised, with strokes seen as a “Cinderella” subject that falls between neurology and geriatric medicine, Prof Markus said.

Instead it needs to be treated as “a condition that requires emergency action”.

Clot-busting drugs can now be given to patients whose stroke is due to a blocked blood vessel rather than a broken one.

To do that, however, rapid 24-hour access to specialised expertise and imaging equipment is needed to determine the type of stroke. The drugs have to be given within three hours to have most effect and can harm a patient whose stroke is due to bleeding.

“It is unlikely that every acute hospital will be able to provide such a service,” Prof Markus said, and alternative strategies that include regional centres and the use of telemedicine are needed, as in Germany and America.

“In many European countries,” Prof Markus added, brain imaging “is performed on admission to the accident and emergency department, while in the UK many units struggle to provide it within 24 hours.”

A National Audit Office report in 2005 calculated that 550 deaths could be avoided a year, and 1,700 patients would recover fully rather than being disabled, if ­services were better organised.

A stroke strategy is apparently due to be published by the health department in the next few months.

The limited data available, Prof Markus said, “show that European countries with better outcomes focus resources more heavily on the acute aspects of care”.

“The vast majority of the cost of in-hospital stroke care in the UK is for nursing and hospital overheads, with the cost of investigations and medical care being very low.”

At present less than 1 per cent of patients eligible for clot-busting drugs get them in the UK, against 20 to 30 per cent in many European countries and North ­America and Australia.

From:
http://www.ft.com/cms/s/0/d7bdb1d6-518f-11dc-8779-0000779fd2ac.html

It is nearly two years since MPs in the National Audit Office pointed out that hundreds of UK citizens are dying needlessly and over a year since Health Direct posted on July 12, 2006- Stroke patients dying needlessly from Labour’s health failures

Since then new Prime minster- same lack of compassion and urgency.

Stroke patients are needlessly dying or suffering more serious disablement because not enough priority is given to stroke services, according to a report by the Commons Public Accounts committee.

The report found that stroke is not treated as a medical emergency, brain scans for patients are often delayed and a significant proportion of stroke patients are not treated on specialist units.

The MPs found:
* Stroke is not treated as a medical emergency in the same way as a suspected heart attack, though the shorter the time between the stroke and the treatment, the greater the chance of reducing damage to brain tissue.
* Brain scans for many stroke patients are being delayed, though a scan is vital for determining appropriate treatment.
* A significant proportion of stroke patients are not being treated on a specialist stroke unit, despite evidence that this is the most clinically effective model for acute care.
* There is considerable variation between hospitals as to what a specialised stroke service entails.
* Public awareness of the symptoms and impact of stroke, and how strokes can be prevented, is very low.
* There are insufficient nursing, therapist and other specialist staff with expertise in stroke care across the primary and secondary healthcare sectors, and there is scope to improve training for the existing stroke workforce in the National Health Service (for example, by training stroke consultants to interpret brain scan results).
* The carers of stroke survivors, and stroke survivors living on their own, are often not accessing the social and care services they need.
* There is low awareness on the part of members of the public and general practitioners about the fact that a transient ischaemic attack (‘mini stroke’) is a strong indication of increased risk of major stroke, and requires immediate investigation and treatment.

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