This has prompted calls for significant new investment in prevention programmes, along with health and community care services to cater for younger stroke survivors. Working age people are now accounting for 1 in 4 of all strokes, and men account for over two-thirds of these younger stroke cases.
Statistics from the National Stroke Audit, published jointly by the Irish Heart Foundation and the HSE’s National Stroke Programme, revealed a 26% increase in the proportion of strokes among people under 65 – this is the equivalent of over 300 extra strokes among people of working age in Ireland every year.
Although more women die from stroke across all age groups, the figures show that men account for almost three-quarters of strokes across the younger age categories. The increase is in stark contrast to audit results showing a reduction in overall stroke mortality of over a quarter and of almost 50% in the rate of severe disability.
The research shows that 40% of the younger stroke sufferers are smokers – more than twice our national smoking rate – whilst the rate of people already diagnosed with high blood pressure was also worryingly high. Similar results in the UK have largely been ascribed to increasing inactive and unhealthy lifestyles.
Whilst the reasons behind this increase have not yet been fully established and may be complex, it is clear that preventable risk factors such as smoking and high blood pressure are significant contributors.
Dr Paul McElwaine, Stroke Research Fellow with the HSE National Stroke programme which led the audit research said, “this raises the distinct possibility that whilst people in older age groups are acting on advice and information campaigns to minimise their risk of stroke and cardiovascular disease generally, middle aged men are not, perhaps because they do not understand their level of risk.”
Irish Heart Foundation head of advocacy, Chris Macey said the statistics show that stroke can no longer be seen as only a disease of older people. “People of working age are now accounting for one in four of all strokes and the rate is growing rapidly in spite of Ireland’s ageing population.
It appears that middle aged men in particular are not heeding the health messages around prevention of stroke and we must remedy this starting with prevention awareness campaigns specifically targeted at them.”
With more people than ever surviving stroke and returning home, there was also a need to develop community health and social care services for younger stroke sufferers who may have to cope for decades with the disabilities caused by stroke.
This includes an overhaul of programmes to help working age stroke survivors return to work in response to separate research carried out by the RCSI and the Irish Heart Foundation showing that only 32% of those who returned to employment were working full-time one year after their stroke.
“Having a stroke is a devastating experience, the impact of which could be significantly reduced by the development of better community health, social care and vocational services that can provide enormous help on the road to recovery, whilst also benefiting society as a whole both socially and economically,” added Mr Macey.
Dr McElwaine said the national stroke audit showed major reductions in death and permanent severe disability from stroke and a sharp increase in the proportion of milder strokes hitting younger people.
One specific and cost effective service improvement benefiting this group would be to extend Early Supported Discharge (ESD) programmes that enable stroke survivors to be discharged quicker after stroke and receive intensive therapy services in their own homes.
Only 10% of Irish stroke survivors were able to avail of ESD, compared to 30% in the UK despite conclusive international and Irish evidence on their effectiveness in improving outcomes and reducing overall health service costs. The ESRI has estimated that over half of all stroke survivors could avail of ESD – more than 3,000 people annually – delivering a saving of 24,000 bed days a year in Irish hospitals, along with significant quality of life improvements for patients.
In January 2016 the Irish Heart Foundation announced the findings from a national audit of acute stroke services with the HSE and headline figures are below:
The 2015 National Stroke Audit is the second audit of stroke services by the Irish Heart Foundation, following the Irish National Audit of Stroke Care 2008.
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