Irish stroke sufferers are less likely to survive than other Europeans, writes Theresa Judge
Up to 500 lives are lost each year because of a lack of dedicated stroke units in the Republic's hospitals, according to Prof Des O'Neill of Tallaght Hospital who is also chairman of the Irish Heart Foundation's council on stroke.
He said it had been known for over a decade and confirmed by a recent study in the UK that such specialist units reduce death and disability by 25 per cent.
O'Neill said the fact that outcomes for stroke sufferers in the Republic were much poorer than in other European countries was due to a shortage of services.
From international figures showing that dedicated stroke units reduce death rates, it could be calculated that between 350 and 500 lives are lost each year due to the lack of such units, he said.
"There is a handful of hospitals now that have started initiatives for stroke units, but there is still no hospital that could say hand on heart that 100 per cent of stroke patients are getting to stroke units," O'Neill said.
About 10,000 people suffer stroke each year in the Republic, resulting in some 2,500 deaths. Stroke kills more people than lung cancer, bowel cancer and breast cancer combined. It is believed that more than 30,000 people are living with a disability as a result of stroke.
The Irish Heart Foundation's biggest fundraising event of the year, Happy Heart Weekend, takes place from Thursday to Saturday and the aim this year is to raise money to improve stroke services. Money will be used to help employ nurses to work in the community with stroke patients and to help fund a major review of stroke services.
It is the first national audit of services and is being jointly funded by the heart foundation and the Department of Health. It follows concerns that services, both in hospitals and in the community, were not sufficiently well-resourced or focused.
The audit has three main components. One is aimed at getting accurate figures for the incidence of stroke and there will also be surveys of hospital services and community services. Another component will examine the experiences of 200 patients after they are discharged from hospital.
O'Neill said information gathered would lead to "authoritative recommendations" on the development of services.
There have been major advances in the care of stroke patients over recent years including the development of drugs that can break down clots.
An important development at Tallaght Hospital has been the opening three months ago of a specialist TIA (Transient Ischaemic Attack) clinic under the direction of Dr Rónán Collins.
TIA can be regarded as "brain angina", Collins said. As angina (heart pain due to inadequate blood supply to the heart) can be a warning sign of a heart attack, TIA is a warning sign for stroke that should not be ignored.
With TIA, the blood supply to the brain is interrupted for a period of less than 24 hours, but in the case of stroke the interruption does not resolve itself naturally and lasts for more than 24 hours causing a small part of the brain to die.
Symptoms of TIA, which can sometimes be misinterpreted or not taken seriously by a patient, include a loss of speech or slurred speech, weakness or numbness in the face, arm or leg, and loss of vision in an eye or in one side of the field of vision in both eyes. Collins said the hallmark to diagnosis was a very sudden onset of symptoms.
In most cases symptoms last for less than an hour.
The advantage of a specialist TIA clinic is that patients get the treatment they need very quickly. Those at very high risk of stroke are admitted immediately and cared for by the stroke service in the hospital while others are seen within a week at the clinic.
A scoring system is used to assess which patients are at high risk of early stroke - this can be as high as 12 per cent in the first week after TIA. GPs can also use the clinic's internet site to follow the scoring system to help them decide where to refer a patient. For up to about 10 per cent of patients, surgery is required, while others will need a combination of medication and a change in lifestyle.
In its first three months, the clinic has assessed 50 patients and 15 were admitted to hospital. In addition to providing a more co-ordinated service for patients, the clinic results in fewer people having to go through A&E. None of the 50 patients went on to suffer a stroke.
What was important about the clinic, Collins said, was the model of service it provided, which was in line with best practice guidelines. It represented the second stage in the development of specialist stroke services at Tallaght hospital, with the next phase involving thrombolysis therapy, using drugs that can break down clots.
Collins said it was important that people heeded the warning signs to prevent stroke and the damage it could cause. Anybody with a family history of stroke should get themselves checked when they reach their mid-30s, he said. The youngest patient he has seen was only 27.
People should also remember the importance of lifestyle factors. While the dangers of smoking, being overweight and not getting enough exercise are generally known, people should also be aware that cocaine use is a risk factor.Collins also stressed the importance of eating fresh fruit and vegetables.