The 2020 report from the Irish National Audit of Stroke revealed that just 5 per cent of stroke patients had access to psychological support

Just 50 per cent or one in two stroke patients arrived at hospital within three hours of the onset of stroke symptoms, and 21 per cent waited more than 12 hours, the latest data shows.

These figures were contained in the Irish National Audit of Stroke (INAS) National Report 2020  which was launched today (Wednesday 2 February 2022) by the National Office of Clinical Audit (NOCA).

According to NOCA,” Stroke is a medical emergency which requires urgent treatment.  The sooner a  person arrives at hospital,  is  assessed by  a  doctor  and receives  a  brain scan,  the less damage is likely to happen.  This results in better outcomes and less disability.”

The fact that stroke patients are not attending hospital in a timely manner has led NOCA to recommend once again that a national stroke awareness campaign be developed in Ireland.

There are approximately 6,000 strokes admitted to Irish hospitals per year – the 2020 Stroke audit analysed data on 5,153 stroke patients which represented 93 per cent of all stroke cases in 23 hospitals.  Of the 5,153 stroke cases analysed by NOCA, 85 per cent were ischaemic strokes, 57 per cent were male and 43 per cent were female.

While stroke is looked upon as a disease of the older person, over a quarter of the cases in 2020  were in people aged under 65 years of age.

The 2020 audit also revealed that just 71 per cent of stroke patients were admitted to a stroke unit and of those, 75 per cent spend their entire hospital stay in the Unit. The national target is that 90 per cent of stroke patients should be admitted to a stroke Unit.

Speaking at the launch of the audit Ms Joan McCormack, Cardiovascular Programme Audit Manager at  NOCA said that accessing stroke unit care was “a really important part”  of the provision of stroke care.

“ It’s known the patients who receive stroke unit care are more likely to be alive, living at home and independent, looking after themselves one year after their stroke and this is across all age ranges, sex, strokes severity,” she said.

Depression and anxiety are common post stroke however, the 2020 INAS report found that just 5 per cent of the stroke patients analysed in the audit had access to psychological support post-stroke which Ms McCormack said, “highlighted the lack of access to psychology in hospitals in Ireland.”

Launching this year’s report, Professor Joe Harbison, Clinical Lead on the Irish National Audit of Stroke (INAS) said “This years’ report is the largest and most complete we have produced in the last 10 years despite the challenges of compiling it during the COVID-19 pandemic. It shows continued improvement in some areas, especially in getting patients to urgent treatment faster. In other areas, such as admission to stroke units and provision of therapies, substantial room for improvements remain.”

Commenting Mr Chris Macey,  Director of Advocacy and Patient Support at the Irish Heart Foundation said, “The audit results demonstrate the extraordinary skill and professionalism of stroke care teams around the country in the face of huge challenges in the first year of the pandemic. But positive results in some areas do not mask major service deficits caused by chronic long-term underfunding of stroke services in Ireland that are being needlessly exacerbated by the HSE’s failure to publish and fund a National Stroke Strategy that was requested by the then Minister for Health over four years ago.

“International research predicts that the stroke rate in Ireland will increase by almost 60 per cent by 2030. Already there is a significant level of preventable death and disability from what is Ireland’s third biggest killer disease. A failure to invest now to futureproof stroke units and rehabilitation services will not just have serious repercussions for already overstretched stroke units, but will also result in a major spill over into other vital acute services.”

“This audit provides valuable information that is absolutely crucial to the development of stroke services nationally. But the health authorities must now extend this work beyond the acute setting to get some sort of picture of post-discharge services for stroke survivors. The Department of Health and HSE have never even tried to count the number of stroke survivors in Ireland, let alone properly establish their service and support needs in the community. This represents a gaping hole in stroke services that can no longer go unaddressed,” Mr Macey said.

Dr Angie Brown, Medical Director of the Irish Heart Foundation said,  “This important Irish National Audit of Stroke highlights the improvements in stroke care but also the inadequacies and in particular the need to improve awareness of the signs and symptoms of stroke so that more patients will present to hospital in time for life-saving treatment.”

Key Findings Irish National Audit of Stroke 2020

• The median time to contact with a doctor after arrival at hospital was 11 minutes, 6 minutes faster than in 2019.
• The median time from arrival at hospital to brain scan was 1 hour and 3 minutes, 17 minutes faster than in 2019.
• Thrombolysis is the breakdown  of blood clots formed in blood vessels using medication. The thrombolysis rate was 10.6%, similar to 2019 but could be increased if people attended hospital as soon as possible.
• 8.6% of all ischaemic stroke patients had a thrombectomy. This is a procedure where large clots can be removed from arteries in the brain. The current thrombectomy rate in Europe is 1.9%.
• 71% of patients with a stroke were admitted to a  stroke unit (below the  target of 90%).
• 88% of all patients with a stroke were assessed by at least one type of health and social care professional (HSCP).
• 71% of ischaemic stroke cases had disabilities on discharge.
• 59% of patients were discharged home with a further 7% provided with Early Supported Discharge (stroke specific rehabilitation in the home rather than in hospital).
• Mortality reduced from 12% in 2019 to 11% in 2020.
• There was no substantial change in stroke activity between the pre-COVID-19 and COVID-19 periods.

Copies of the report are available to download here