New National Stroke Strategy welcomed but more needs to be done to support survivors

(Caption: Launching the new National Stroke Strategy 2022-2027, are: Dr David Bradley, Consultant Neurologist, St James’s Hospital; Professor Clare Fallon, Consultant Geriatrician and GIM Physician, Regional Hospital Mullingar; Professor Mary Horgan, President of the Royal College of Physicians of Ireland; Professor Rónán Collins, Clinical Lead, National Clinical Programme for Stroke; Sinéad Coleman, Programme Manager, National Clinical Programme for Stroke; Professor Riona Mulcahy, Consultant Physician in General and Geriatric Medicine, University Hospital Waterford; Professor Dominick McCabe, Consultant Neurologist and Clinical Professor in Neurology, Tallaght University Hospital.)

The Irish Heart Foundation has welcomed Ireland’s long-awaited National Stroke Strategy 2022-2027 which was published recently by the HSE National Clinical Programme for Stroke.

Welcoming its publication Mr Chris Macey, Director of Advocacy at the Irish Heart Foundation said that the full implementation of the new strategy would “save many lives, reduce the long-term disabling impact of stroke on many more survivors and will cut the long-term cost of stroke to the State, particularly by reducing the number of people requiring long-term care.”

“We have campaigned long and hard for its main provisions, such as tackling huge deficits in medical, nursing and therapy expertise in our stroke units; investing more in lifesaving thrombectomy services, and greatly expanding early supported discharge programmes that improve outcomes and save money by providing therapy in people’s homes instead of hospital,” Mr Macey stated.

However, Mr Macey added that more than what was included in the strategy needed to be done to meet the needs of “ tens of thousands of stroke survivors who feel abandoned at the hospital gates because of the chronic enduring deficits in vital community services that promote recovery and maximise quality of life.”

According to Mr Macey, “Rapid improvements in acute stroke services over the last decade mean that more stroke survivors than ever are surviving and returning home after stroke. But there has been no corresponding State investment in community rehabilitation, along with life-after-stroke services and supports that help rebuild lives and are often the difference between independence and lifelong reliance on institutional care for some.

“In effect, our health system is putting major expertise and resources into saving lives only to squander the recoveries of many stroke survivors by failing to deliver vital community services that should be an integral part of the care pathway,” he said.

Stroke is the second leading cause of death in middle to higher income countries and the leading cause of acquired neurological disability in Ireland.

Approximately 5,800 adults were admitted to hospitals with a stroke in 2020. This figure does not include the estimated 1,500-2,000 people admitted or evaluated urgently for a suspected / threatened stroke or a transient ischaemic attack (TIA).

Professor Rónán Collins, Clinical Lead for the HSE National Clinical Programme for Stroke said, “Stroke is a major cause of mortality and morbidity in our population and a major cost to our health service when outcomes are poor. Much improvement in services and outcomes has occurred since the inception of the National Clinical Programme for Stroke, but the nature of our changing demography, development of new stroke treatments and technologies, and the need for healthcare staff and public engagement on the issue of stroke are a significant challenge over the next decade.

The programme has prioritised an ambitious but realistic strategy to improve resourcing of stroke services and seeks commitment from government for a structured implementation, review and a ‘next steps for stroke’ strategy, to commence in 2026 with the aim of full realisation of the Stroke Action Plan for Europe by 2031.”

To meet the challenge of a predicted 59 per cent increase in the total number of strokes in Ireland four pillars of the new National Stroke Strategy were identified which focus on:

• Stroke Prevention
• Acute Care and Cure
• Rehabilitation and Restoration to Living
• Education and Research

National Stroke Strategy Recommendations

Stroke Prevention includes:

• Many strokes are preventable – principal risk factors for stroke, such as high blood pressure and atrial fibrillation are increasing in prevalence.
• Develop a pathway for the case-finding, diagnosis and treatment of high blood pressure in over 45 year olds
• Develop a pathway for the prevention and case detection of atrial fibrillation
• Ensure all hospitals receiving acute stroke patients have a specialist-led rapid access stroke service or access to such a service within their hospital network.
• Ensure that all patients recovering from a stroke have access to a specialist secondary prevention stroke service and diagnostics.

Acute Care includes:

• Acute stroke services must have adequate staffing and diagnostic resources to provide 24/7 acute stroke care and treatment
• All hospitals receiving acute stroke patients must have an acute stroke unit.
• Appropriate staffing of specialist stroke units with a number of trained physicians, nurses, healthcare assistants, health and social care professionals
• All patients must have 24/7 access to emergency acute stroke assessment and treatment by a stroke specialist

Rehabilitation includes:

• Early Supported Discharge teams to be fully commissioned across 21 high activity sites over a three-year period to cover 92 per cent of the stroke inpatient population
• ‘Stroke Key Worker’ resource to be by appointed in each Community Health Organisation so that discharged stroke patients and their families have access to the specific support and advice
• All stroke patients to have a ‘stroke passport’

Education and Research includes:

• Funding for a sustained public awareness campaign on stroke
• Creation of Professorships in Neurovascular and Stroke Medicine in our six medical schools to improve Irish research and teaching in stroke
• Creation of three Stroke Research Fellowships to enhance research and career opportunities and help retain our excellent medical graduates in stroke medicine
• To view the National Stroke Strategy document please see here 

If you notice symptoms of a stroke it is important to get to an Emergency Department as soon as possible.