NOCA Irish National Audit of Stroke Report 2019 calls for stroke awareness campaign

One in two stroke patients arrived at hospital more than three hours from the time they first experienced stroke symptoms meaning that they were less likely to receive vital treatment, a new report has revealed.

According to the Irish National Audit of Stroke report 2019 which was launched yesterday (Wednesday 16^th December) at a virtual meeting hosted by the National Office of Clinical Audit (NOCA), 51 per cent of patients arrived at hospital more than three hours after the onset of stroke symptoms, with 20 per cent arriving between four and a half and 12 hours, with 21 per cent arriving at hospital more than 12 hours post stroke.

Treatment of acute stroke is time dependent, but the audit found that less than half of cases (49 per cent) arrived at hospital within three hours of onset of stroke symptom. This is a decrease from 53 per cent in 2017 and means that patients are less likely to receive acute treatments such as thrombolysis, the audit found.

Thrombolysis is the breakdown of blood clots formed in blood vessels using medication. It can only be given within 4.5-hours of onset of stroke symptoms.

One of the main recommendations of the report was for the development of a F.A.S.T. stroke awareness campaign. According to the report “All citizens will benefit from increased stroke awareness for themselves and for their families, friends and colleagues. In addition, individuals who suffer a stroke will benefit through reduction in disability after stroke if treated early.”

Just last month the Irish Heart Foundation launched a new F.A.S.T. campaign with the support of the Government of Ireland. The new campaign aims to raise awareness of the signs of stroke, and the importance of getting to hospital as soon as possible.

During the coronavirus pandemic, people have been slow to attend hospital for non-COVID-19 issues such as stroke. This F.A.S.T. campaign by the Irish Heart Foundation with the support of the Government of Ireland aims to counter this trend and save lives.

The report also found that nine per cent of patients who had a stroke last year received thrombectomy treatment. This puts Ireland ahead of most other European countries in the use of this life saving stroke treatment as the rate of thrombectomy in Europe is currently just two per cent.

The 2019 stroke audit also found that the median time from hospital arrival to contact with the medical team was 17 minutes and the national median ‘door to imaging’ (DTI) time  (time from when the patient arrived at the hospital to when they received their first scans) for all patients with a stroke was 1 hour and 20 minutes.

The audit also found that 71 per cent of patients were admitted to a stroke unit in 2019 and the median length of stay was eight days. Furthermore, 72 per cent of patients with ischaemic stroke and 62 per cent of patients with haemorrhagic stroke had disabilities on discharge. Only five per cent of patients were referred to Early Supported Discharge.

The mortality or death rate for ischaemic stroke in the 2019 audit was 9 per cent while the rate for haemorrhagic stroke was 31 per cent.

The report highlighted the sustained improvements that have been made in caring for patients with a stroke, but it also identified continued challenges and limitations in specific areas of care, as well as some worrying signs of regression in some areas, such as delays in presentation to hospital after the onset of stroke symptoms.

Commenting on one of the recommendations of the audit for the development of a stroke awareness campaign, Kathryn Reilly, Policy Manager with the Irish Heart Foundation said, “The Irish Heart Foundation has been calling for a F.A.S.T. campaign with multi-annual funding to embed stroke awareness in the population, and to offset the disastrous personal, social and economic costs of delayed stroke diagnosis and treatment.

“The Government of Ireland supported our F.A.S.T. campaign this winter, but one seasonal campaign is not sufficient.  There needs to be a broader recognition that funding an ongoing F.A.S.T. campaign will save lives and reduce the severity of disability caused by stroke, while also reducing overall costs to the health service.”

“The findings of the report, undertaken prior to the current F.A.S.T. campaign, highlight the effects of diminished recognition of stroke symptoms in the population. The audit’s recommendations complement the ongoing work of the Irish Heart Foundation in highlighting the need for an ongoing stroke awareness campaign and we hope that this recommendation will be carried forward, not only in 2021, but every year,” she said.

The Irish National Audit of Stroke (INAS) is a clinically led quality audit, which measures the quality of stroke care, as well as the structure of stroke services, provided to patients in hospitals that admit acute stroke patients. There are 25 hospitals in Ireland participating in this audit. Activity within the participating hospitals is measured against evidence-based standards to help improve the standard of acute stroke care.

Data on 20 hospitals and 4,275 stroke patients was included in the 2019 report, which is available to download from the National Office for Clinical Audit (NOCA).