Audit calls for increased public awareness of stroke

There has been a significant reduction in the number of deaths from ischaemic stroke and heart attack in Irish hospitals, but little improvement in deaths from heart failure and haemorrhagic stroke , a new report has found.

The National Office of Clinical Audit (NOCA) has published its fourth report from the National Audit of Hospital Mortality (NAHM) which looks at the patterns and trends of patients who die in hospital.

The 2018 report found that that there has been a significant reduction over ten years (38%) in ischaemic stroke in-hospital deaths per 1,000 admissions, from 123 in 2009 to 76 in 2018 and heart attack (35%), from 74 in 2009 to 48 in 2018.

An ischaemic stroke is caused by the death of brain cells in a particular area of the brain due to inadequate blood flow caused by a blood clot. Ischaemic strokes account for approximately 85 per cent of all strokes which result in hospitalisation in Ireland every year. A haemorrhagic stroke is caused by a bleed on the brain.

The report presents information across six medical conditions: heart attack, heart failure, ischaemic stroke, haemorrhagic stroke, chronic obstructive pulmonary disease (COPD) and pneumonia and uses data from 44 publicly funded hospitals in Ireland. However, data from all 44 hospitals were not included for all six medical conditions as small sample sizes may provide erratic results; for this reason, only hospitals with 100 or more admissions of these conditions were included for analysis in order to ensure statistical reliability.

According to the report, the significant reduction in in-hospital mortality from ischaemic stroke in Ireland and in the predicted increase of stroke admissions was due to a number of reasons including, increased public awareness of cardiovascular risk factors and general healthier living practices.

It also stated that early detection and management of key risk factors for stroke, such as high blood pressure and atrial fibrillation were “key drivers of this trend.”

Furthermore, the report noted that time-dependent acute treatments for ischaemic stroke, such as thrombolysis and thrombectomy, have improved greatly in recent years.

The report also stated, “there is an ongoing need to increase public awareness of stroke, and the National Clinical Programme for Stroke is working with the Department of Health and the Irish Heart Foundation to reinstate the F.A.S.T. campaign.”

Commenting Dr Angie Brown, Medical Director of the Irish Heart Foundation said, “We are very pleased to see the decrease in mortality for ischaemic stroke and heart attack. We know that 80 per cent of cardiovascular disease is preventable, this data suggests the awareness and treatment of risk factors such as hypertension and atrial fibrillation is improving. However, there is still much more that needs to be done, so we will be advocating for increased awareness with campaigns such as F.A.S.T.”

Unfortunately the audit found that there has been no significant reduction over 10 years in haemorrhagic stroke in-hospital deaths per 1,000 admissions, from 302 in 2009 to 252 in 2018 and no significant reduction over 10 years in heart failure in-hospital deaths per 1000 admissions, from 82 in 2009 to 77 in 2018.

The report also found that while there has been a significant reduction over ten years (28%) in pneumonia in-hospital deaths per 1,000 admissions, from 145 in 2009 to 104 in 2018, the same cannot be said for COPD in-hospital deaths which has seen no reduction with 37 deaths per 1,000 admissions in both 2009 and 2018.

It is important to note that this report cannot be used to compare hospitals as no two hospitals will have the same patient profile. Some will have larger numbers of patients with severe conditions; for example, hospitals such as specialist referral centres may only admit patients with more complicated conditions.

Dr Colm Henry, Chief Clinical Officer of the HSE commented, “I welcome the continued use of the National Audit of Hospital Mortality tool by hospitals who use it as one key part of their picture of quality of care and to support improvements. The results demonstrate the improvements in outcomes for some of the most significant illnesses in our hospitals. The work by NOCA demonstrates our commitment to learning and improvement and I would like to acknowledge their work and all who contributed from our hospitals to this report”.