Stroke Patients In Wales More Likely To Die Than In England

Main Category: Stroke
Article Date: 15 May 2007 - 6:00 PST

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The results of the 2006 National Sentinel Audit for Stroke show that patients in Wales are more likely die from stroke, or if they survive will have higher levels of disability than in England or Northern Ireland.

The Audit, funded by the Healthcare Commission, was carried out on behalf of the Intercollegiate Stroke Group by the Royal College of Physicians' Clinical Effectiveness and Evaluation Unit (CEEu), and covers 100% of eligible hospitals in England and Wales. As in 2005, results for each participating site are published on the RCP website (PDF).

The late launch of a National Service Framework in Wales in 2006 appears to have handicapped the development of specialist stroke services in Wales, which need urgent attention. Only 45% of eligible hospitals in Wales (nine hospitals) have a stroke unit, compared with 97% of eligible hospitals in England. Only 3 sites (15%) have acute stroke unit provision. Given the evidence for the benefits of stroke units, the very low rate of stroke unit provision and admission is unacceptable.

-- Only 28% of patients in Wales were treated in a stroke unit during their stay compared to 64% in England and 73% in Northern Ireland

-- Only 22% of patients in Wales spent more than half their time on a stroke unit (56% England, 60% NI)

-- Patients managed on stroke units have much better results than patients looked after in other settings - they are much more likely to have had their ability to swallow checked, to have started aspirin within 48 hours, been assessed by therapists within the recommended times; had rehabilitation goals documented and have a home visit performed before discharge

-- Only 38% of patients had brain imaging to confirm their diagnosis within 24 hours of the onset of symptoms, a figure similar to England (43%) and NI (40%). This figure is unacceptably low and must be improved. Patients need a brain scan to determine if it is appropriate to prescribe aspirin - if given within 48 hours of the stroke this can save lives and reduce disability

-- The percentage of patients screened for swallowing disorders in Wales was 55% compared to 67% in England and 62% in Northern Ireland

-- Physiotherapy assessment within the first 72 hours of admission was carried out in 54% of patients in Wales, compared to 72% in England and 74% in Northern Ireland

For other measures of stroke care, the results were similar to England and Northern Ireland. The comparative table is attached.

The audit concludes that Wales needs to identify systems to raise the quality of stroke across the whole patient pathway, particularly through the development of stroke units.

Dr Tony Rudd, Chair of the Intercollegiate Stroke Network and Associate Director of the RCP Clinical Effectiveness and Evaluation Unit, said:

"While there have been some welcome improvements in the quality of stroke care over the last two years there are still too many patients who receive substandard care which is likely to result in higher death rates or greater disability than necessary. The failure of the majority of hospitals in Wales to offer stroke unit care is scandalous and needs urgent action"

Dr. Jonathan Boyce, Head of Clinical Audit at the Healthcare Commission, said:

"This study shows welcome improvements within the last two years in hospital care for people who have suffered a stroke, suggesting that what gets measured does indeed get managed. But there is still too much variation, too many places and regions that are not responding as well as they could to minimise the harm done by this serious and common condition. They now need to get their house in order."

Joe Korner, Director of Communications for The Stroke Association comments:

"While it's great to see a general improvement in stroke care, the latest audit shows that over a third of people who have a stroke never get treated on a stroke unit. Stroke units can halve your chance of dying from a stroke, so it is a scandal that getting treated on one is a matter of luck or your postcode.

"The Stroke Association is campaigning to ensure that the stroke care you get is not down to chance. Radical improvements in stroke care are within our reach. The Government, with a new stroke strategy in development, has the chance to do for stroke what has been achieved for heart disease in the last ten years. It is vital that stroke gets the priority and investment needed - without investment hundreds will die needlessly."

The executive summary and recommendations are attached. Individual hospital results are published on the RCP website here (PDF).

-- Individual hospital results

Royal College of Physicians of London

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