STROKE
Eduardo
C.Gerding
This article
is based on various Argentine statistics (National
Register of Stroke (Arenas 2018), British (State of the Nation, Stroke Statistics) and the Veterans
Administration of the USA among others.
The
Argentine war veterans´conscripts currently have an average age of 55 years. Argentine
female war veterans range between 60/62 years. Many British war veterans were 19
years old at the time of the conflict. (Lucy
Beck-Remembering the victims of the Falklands war-April 2007)
This is of an utmost importance because the
risk of suffering a stroke is doubled for each decade after age 55. 18
In the next 20 years (between now and 2035)
episodes of first-time stroke in people over 45 years old will increase by 59% .15
In addition, people in deprived areas are usually
more likely to suffer from severe stroke. 15
According to
a study by Dr. Marlene Grenon of the University of California, San Francisco
(USA) war veterans with PTSD have their blood vessels damaged which would predispose
them to heart attacks and stroke. These vessels dilate less than normal. It is
possible that stress damages the internal lining of the vessels through
hormonal changes or inflammation.17.
This was also corroborated in a longitudinal study conducted by Mu-Hong Chen et
al and published by The British Journal
of Psychiatry.7
Currently, every 4 minutes an Argentine suffers a
stroke. Out of
this number, 18 thousand deaths per year are released.4
The profile
of the Argentine who really has substantial
knowledge about stroke is: Adults over 50, university students, married
and residents in the City of Buenos Aires. 9
Types of Strokes
A
stroke occurs when a blood vessel that carries oxygen and nutrients to the
brain is either blocked by a clot or bursts. Brain cells in the immediate area
begin to die because they stop getting the oxygen and nutrients they need to
function.18
·
A blockage of a blood vessel in the brain or neck, called an ischemic
stroke, is the most frequent cause of stroke (85%) and is responsible for about 80 percent of strokes.
· When a weakened blood vessel ruptures and spills
into brain tissue, it’s called a hemorrhagic stroke (15%). The most common cause for the rupture is uncontrolled hypertension or
high blood pressure.
·
Around
1 in 10 patients who have a
haemorrhagic stroke die before reaching hospital. 15
·
Strokes
caused by a bleed (haemorrhagic) are more common in children than in adults.
TIA
·
A TIA is a
type of stroke where the stroke symptoms last only a few minutes and
generally stop. A TIA is a serious medical event that needs prompt medical
attention.
·
A transient ischemic attack is considered a “warning stroke.” Full
strokes often happen after a mini-stroke. About half of all strokes that occur
after a TIA, happen within 24 hours.15
·
1 in
12 people (8%) will have a full stroke within a week of having a TIA. 15
A study carried out in the Argentine Ramos Mejia hospital and published in the
prestigious medical journal Stroke reveals that, in the population that goes to
the Ramos Mejía hospital, 30% of patients with stroke present hemorrhages,
when in the world such percentage does not exceed 20 percent.
This study also indicates that the subtype of stroke caused by the so-called
penetrating vessel disease (the accident occurs in the smaller arteries that
supply the brain) accounts for 42% of the cases, when in Europe and the
United States is about 20% 8
Mortality worldwide 15
·
Stroke
is the second leading cause of death worldwide.
·
Every
two seconds, someone in the world will have a stroke.
·
In
2016, there were almost 14 million incidences of first-time
strokes worldwide.
·
Stroke
causes around 6.2 million deaths each year, taking a life
every five seconds.
·
Worldwide
stroke-related illness, disability and early death is set
to double in the next 15 years (by
2035).
·
Almost 1 in 8 (12%) deaths worldwide are caused by
stroke.
· 1 in 3 Argentines do not know that stroke is a pathology with
high mortality. 9
Statistics
USA:
·
According to the National Institutes of Health, each year nearly 800,000
Americans experience a new or recurrent stroke. Approximately 610,000 of these
are first attacks, and 185,000 are recurrent attacks. Stroke is the fifth
leading cause of death in the US, killing nearly 133,000 people a year and
accounting for one of every 19 deaths. Nearly three-quarters of all strokes
occur in people over the age of 65 and the risk of having stroke more than
doubles each decade after the age of 55. 18
UK 15
·
There
are more than 100,000 strokes in the UK each year.
·
That
is around one stroke every five minutes in the UK.
·
Between
1990 and 2010 the incidence of strokes fell by almost
a quarter.
·
Around
1 in 6 men will have a stroke in their life.
·
Around
1 in 5 women will have a stroke in their life.
·
The
rate of first time strokes in people aged 45 and over is
expected to increase by 59% in the
next 20 years (between now
and 2035).
·
In
the same period, it’s estimated that the number of stroke
survivors, aged 45 and over, living
in the UK is expected to rise
by 123%.
Mortality
·
Stroke
is the fourth biggest killer in the UK.
·
Stroke
is the fourth single leading cause of death in England
and Wales, and the third biggest cause of death in Scotland and
Northern Ireland.
·
In
2016, almost 38,000 people died of stroke in the UK. That’s a
life lost every 13 minutes.
·
1 in
14 deaths are caused by stroke in the UK. This is equivalent
to 6% of all deaths in men, and 7% of all deaths in women.
·
1 in
8 strokes are fatal within the first 30 days.
·
Stroke
death rates in the UK fell by almost half in the period from
1990 to 2010.
·
In
2016, stroke caused almost twice as many deaths in women
as breast cancer.
·
In men, stroke causes 5,000 more deaths a year than
prostate cancer
Social
deprivation
·
In
general, people from more deprived areas have an increased
risk of stroke.
·
A
study in Norfolk found that people living with the greatest
levels of social deprivation were
two and half times more likely
to have a stroke.
·
In
general, people from more deprived areas are likely to
experience more severe strokes.
·
A
study using data from England, Wales and Northern Ireland
found that people with the greatest
levels of social deprivation
experienced strokes approximately
five years earlier in their
lives, compared to the least deprived.
·
On
average, people from low and middle income countries
have strokes at a younger age than people from higher income
countries.
Modifiable risk factors
High
Blood Presure
·
Having
high blood pressure can triple your risk of stroke and
heart disease.
·
High
blood pressure is a contributing factor in around half of
strokes in England, Wales and
Northern Ireland.
·
There
are 9.5 million people in the UK diagnosed as having high
blood pressure, also known as
hypertension. That is 1 in 7
people in the UK.
·
The
number of people diagnosed as having high blood pressure
has consistently increased since
2005.
·
For
every 10 people diagnosed with high blood pressure, seven
remain undiagnosed and untreated.
·
In
England, 5.5 million people are living undiagnosed with high
blood pressure.
·
Treatment
for high blood pressure significantly reduces the
risk of stroke, heart attack and
heart failure. Every 10 mmHg
reduction in systolic blood pressure
reduces the risk of stroke
and heart attack
by 20%.
High
blood Cholesterol
·
As a general guide, ‘bad’ cholesterol (LDL) levels
should be:
3mmol/L or less for healthy adults
2mmol/L or less for those at high
risk.
·
Statins
are medicines which limit the production of ‘bad’
cholesterol in the liver. The use of
statins in people at high risk
of cardiovascular events reduces the
risk of stroke by 25%.
·
Reducing
cholesterol by 1mmol/L reduces stroke risk by 21%.
·
Daily
consumption of oats and barley can help maintain healthy
levels of cholesterol.
·
Consumption
of ‘good fats’ (monosaturated and polysaturated)
like the ones found in nuts,
avocados, and fish contributes to
healthy levels of cholesterol.
Consumption of saturated fats,
like the ones found in meat and
dairy, can increase cholesterol
levels in the blood. Foods containing
trans fats, such as crisps,
cookies, and fried foods, have the
most impact on cholesterol
levels.
Diabetes type 2
·
Type
2 diabetes almost doubles the risk of stroke within the first
five years of diagnosis, and is a
contributing factor in up to 1 in 5
strokes in England, Wales and
Northern Ireland.
·
There
are 3.6 million adults diagnosed as diabetic in the UK,
which is about 5% of the population.
·
9
out of 10 (90%) diabetes cases are type 2.
·
It
is estimated there are another one million people with
undiagnosed diabetes in the UK. This
includes both types of
diabetes.
·
Obese
people are 80 times more likely to develop diabetes than
a healthy person
with a BMI under .
· In Argentina, 22% of patients with stroke are diabetic and the
disease extends to 12% of the population.4
Overweight
· Obese people are 80 times more likely to develop diabetes than healthy people with a low BMI.
· 35.4% of Argentines are overweight and 18% suffer from obesity. 4
Smoking
·
Smoking
doubles the risk of dying from a stroke.
·
Tobacco
smoke contains over 7,000 toxic chemicals, including
carbon monoxide, formaldehyde,
arsenic and cyanide. These
chemicals are transferred from your lungs into
your blood
stream, changing and damaging cells all around
your body, and
increasing your risk of stroke.
·
Cigarette
smoke can affect cholesterol levels, reducing the
amount of ‘good’ cholesterol (HDL) in
your blood stream and
increasing the amount of ‘bad’
cholesterol (LDL).
·
When
you inhale cigarette smoke, carbon monoxide and
nicotine enter your bloodstream. The
carbon monoxide
reduces the amount of oxygen in your
blood. Nicotine
makes your heart beat faster and
raises your blood pressure,
increasing your risk of a stroke. Smoking can
also trigger an
episode of atrial fibrillation.
·
The
chemicals in cigarette smoke also make platelets in your
blood more likely to stick together.
This increases the chance of
a clot forming.
·
1 in
6 (16%) people in the UK are active smokers104 105 106 107,
however the number of smokers is
rapidly declining.
·
There
are about 1.9 million visits to UK hospitals a year for
conditions related to smoking.99 100
101 102
·
Shisha
smoking carries the same risks as cigarette smoking.
·
A
study conducted in Sweden on healthy non-smokers showed
that 30 minutes of e-cigarette smoking
increased heart rate,
arterial stiffness, and blood pressure. All
of these are factors
that can contribute to an increased
risk of stroke.
Despite this, Public Health England has
been encouraging
switching from tobacco to e-cigarettes if
people find it
difficult to quit because other studies have
found them to be
less
toxic.
· 27% of Argentines are smokers and 40% are exposed to cigarette smoke. 4
Alcohol
·
Regular
consumption of large amounts of alcohol greatly
increases the risk of having a
stroke, as it can lead to high
blood pressure, diabetes, obesity,
and trigger atrial fibrillation.
·
Drinking
too much alcohol can also damage the liver and
stop it from making substances that
help your blood to clot,
increasing your risk of having a
stroke caused by bleed.
·
When
asked, 1 in 3 adults in the UK reported drinking more
than recommended at least once a
week. Drinking over the
recommended weekly amount of alcohol
was most common
among adults aged 55 to 64
·
One
study found that heavy drinking (considered as more than
two drinks per day) was found to
shorten the time to stroke by
five years.
·
Another
study found that drinking more than five drinks a day
increases your risk of stroke by 1.6 times.
Drug use
·
Each
type of illicit drug has a different effect on the brain and
circulatory system, but all can have
severe health repercussions
which can cause both ischaemic and haemorrhagic
strokes in
young healthy people.
·
A
recent study found that 6 out of 10 young adults were actively
engaged in smoking, alcohol abuse or
illegal drug use at the
time of their stroke.
·
Marijuana
use increases your risk of stroke. Some studies
estimated it can increase your risk
of heart disease by 30%.
·
Cocaine
increases the risk of stroke in the 24 hours following
use, as it can cause your blood to
thicken and can drastically
increase your blood pressure.
·
A
study from 2012 found that 1 in 5 (20%) of those under 45
who had a stroke
had used illegal drugs.
The sedentary lifestyle
The sedentary lifestyle has increased notably in recent years.
The usual aerobic exercise in the third age can diminish until 25%
the risk of suffering an attack. 4
Non modifiable risk factors
Age
·
In
England, Wales and Northern Ireland the average age for
someone to have a stroke is 72 for
men and 78 for women.
·
In
Scotland the average age to have a stroke is 71 for men and
75 for women
·
Around
one in four strokes happen to people of working age.
·
People
are having strokes earlier in their lives.
·
In
1990 only a quarter of all strokes occurred in people aged
20-64. In 2010, a third of all
strokes happened to people in that
age group.
·
People are most likely to have a stroke after the
age of 55.
Ethnicity
·
White
people in the UK are more likely to have atrial fibrillation
(a type of irregular heart beat), smoke
and drink alcohol than
other ethnicities.These are all factors that
increase the risk
of stroke.
·
Black
people are almost twice as likely to have a stroke than
white people.
·
On
average, people of black African, black Caribbean and South
Asian descent in the UK have strokes
earlier on in their lives.36
·
Studies
suggest that black and South Asian people tend to have
strokes 10 years earlier than white
people.
·
Research
suggests this is because black people are more likely
to have high blood pressure and
diabetes than white people,
both of which are stroke risk
factors.
·
In
the last 20 years, stroke incidence in London has decreased
by 40% for white people, but has not
decreased for black
people.
·
Black
people are also more likely to have sickle cell disease,
which increases the risk of a stroke.
·
South
Asian people are almost twice as likely to develop
diabetes (a risk factor for stroke)
as the rest of the UK
population, and
are likely to develop it at an earlier age.
Gender
·
Men
are at a higher risk of having a stroke at a younger age than
women. This is generally due to a
combination of behavioural
and medical factors.
·
Diabetes
and heart disease, both risk factors for stroke, are
more common amongst men.
·
In
addition, on average, men consume more alcohol and are
more likely to smoke.
·
More
women than men die of stroke. This is because
women tend to live longer than men,
and the risk of stroke
increases with age.
·
Women
can experience increased stroke risk due to hormone
changes, contraception, pregnancy and
childbirth.
·
Hormonal
contraception with oestrogen can increase the
chance of blood clots.
Studies have reported that taking the pill
can increase your risk of heart
attack and stroke by 1.6 times.28
Although for healthy women who don’t
have other risk factors,
the risk is still extremely low.
·
Hormone
replacement therapy (HRT) can slightly increase your
risk of stroke. For every 1,000 women
taking HRT, an extra six
will have a stroke and an extra eight
will develop a blood clot.29
·
Although
the overall risk of younger women having a stroke is
very low, pregnancy can increase your risk of
stroke. In 100,000
pregnancies, 30 soon-to-be mothers will have
a pregnancyrelated
stroke.
·
Women
tend to experience worse psychological and physical
repercussions from stroke. This may
be because women tend
to have strokes
when they’re older and often living alone.
Atrial
fibrillation
·
Atrial
fibrillation (AF) is a heart condition that causes an
irregular and often abnormally fast
heartbeat.
·
There
are about 1.2 million people with AF in the UK.
It is estimated there could be
another half a million people in
the UK with undiagnosed AF.
·
People
with AF are five times more likely to have a stroke.
·
AF is a contributing factor in up to 1 in 5 strokes
in the UK.
·
Anticoagulant
drugs, such as warfarin, can be given to people
with AF to reduce the risk of blood
clots forming.
·
Anticoagulants
continue to be under-prescribed. In the UK,
around a quarter of eligible
patients with AF do not receive
anticoagulant drugs. But, this is improving year on year. 81
·
Some
studies suggest the reason for this is that people tend to
be prescribed antiplatelet medicines
such as aspirin, even though
they have been found to be less effective in stroke prevention.
·
It
is estimated that if AF were adequately treated, around 7,000
strokes would be prevented and over
2,000 lives saved every
year in England alone.
·
Anticoagulants
have also been found to lower the risk of
dementia by 26% in patients with AF.
·
Only
half of all of the patients with known AF in England, Wales
and Northern Ireland are on
anticoagulant medication when
they go to hospital with a stroke. In
Scotland, less than one
third of patients with AF are on
anticoagulation when they are
admitted with a stroke.
·
Almost
all (97%) of the stroke survivors in England, Wales
and Northern Ireland with AF are
prescribed anticoagulant
medication when they’re
discharged from hospital. In Scotland,
only
68% of stroke survivors
A
hole in the heart (PFO)
·
A patent foramen ovale (PFO or hole in the
heart) is an opening
between the left and right upper
chambers of the heart. This
hole normally closes at birth, but in
as many as one in four
people it remains open.
·
A
PFO is thought to increase stroke risk because it will allow a
clot to travel through the heart and
to the brain.
However, it’s unclear whether a
PFO increases the risk of
stroke, as some studies have shown that
someone with a PFO
is at no higher risk of stroke than someone
who does not have a
PFO.
Sickle cell disease
·
Sickle
cell disease is a disorder which affects the red blood cells.
These are usually round and flexible
to enable them to carry
oxygen around the body.
·
In
people with sickle cell disease, red blood cells become
crescent (or sickle) shaped. This
can lead them to clog up
blood vessels, causing health
problems and increasing the risk
of stroke.
·
Sickle
cell disease mainly affects people of African,
African-Caribbean, South Asian and
Mediterranean heritage.
·
A
quarter of people with sickle cell disease will have a stroke
before the age of 45.
·
Children
with sickle cell disease are over 300 times more likely
to have a stroke
than children without it.
Recurrence
·
Stroke
survivors are at greatest risk of having another stroke in
the first 30 days following a stroke.
·
Around
1 in 4 stroke survivors will experience another stroke
within five years.
·
In
England, Wales and Northern Ireland, over a quarter of people
who have a stroke have had a previous
stroke or TIA.
·
In
England, Wales and Northern Ireland 1 in 17 (6%) stroke
patients have another stroke while
still in hospital.
·
In
Scotland the number of people having TIAs has increased by
17% in the last
decade (since 2006).
Survival
Across
the globe, more people are surviving stroke than ever
before.
There
are over 1.2 million stroke survivors in the UK.
Scotland
has the largest percentage of the population who
are stroke survivors, and the highest
mortality rate of the UK
nations.
·
The
percentage of people in Scotland surviving for more than
30 days after their stroke has
slightly improved in the last
decade, from 81% in
2007, to 85% in 2016.
·
More
than 8 out of 10 stroke patients in England, Wales and
Northern Ireland survive their stay
in hospital, and two thirds of
stroke survivors are able to return home and
live independently
or with support in their own
homes.
·
9
out of 10 stroke survivors in England, Wales and Northern
Ireland have returned to living at home six
months after their
stroke.
·
A
quarter of all stroke survivors in England, Wales and Northern
Ireland live alone after their
stroke.
·
Almost
half (45%) of stroke survivors feel abandoned after they
leave hospital.
Symptoms of a stroke 18
Some of the effects of
stroke are:
·
Weakness
in arms and legs
·
Problems
with speaking, understanding, reading and writing
·
Swallowing
problems
·
Vision
problems
·
Losing
bowel and bladder control
·
Pain
and headaches
·
Fatigue
, tiredness that does not go away with rest
·
Problems
with memory and thinking
·
Eyesight
problems
·
Numb
skin, pins and needles.
Living with the physical impact of stroke 15
·
In a
survey of over 1,000 stroke survivors conducted in 2015,
4 in 10 people told us the physical
impact of stroke was the
hardest to deal with.
·
It
is estimated that 60% of stroke survivors have vision
problems immediately after their
stroke. This reduces to about
20% by three months after stroke.
·
Limb
weakness is common after stroke
·
More
than three quarters of stroke survivors report arm
weakness, which can make it
difficult for people to carry out
daily living activities, such as
washing and dressing.
·
Almost
three quarters of stroke survivors report leg
weakness, which can make walking and
balancing more
difficult.
·
Today,
around one million stroke survivors across England,
Wales and Northern Ireland require
further care after being
discharged from hospital.
·
In
Scotland, more than half of stroke survivors need the
assistance of another person to be
able to walk.
·
Loss
of bladder and bowel control (incontinence) is a common
problem for stroke survivors. Around
half of stroke survivors
experience problems with bladder
control.
Communicating
·
Around
a third of stroke survivors experience some level of
aphasia, which affects their ability
to speak, write, read or
understand what others say.
Aphasia is a language and
communication disorder caused by
damage to the language centres of the
brain.
·
Stroke
can also cause dysarthria, a weakness in the facial
muscles which makes it difficult to
speak clearly; and apraxia,
a condition which makes it difficult to move
or coordinate the
face, mouth and throat muscles
needed for speech.
·
Communication
problems tend to improve quite quickly, usually
within the first three to six months.
However, between 30-40% of those
affected will remain
severely affected in the long term.
·
Around
half of all stroke survivors in England, Wales and
Northern Ireland require speech and
language therapy after a
stroke. However, only half of the
people who need this therapy
to aid their recovery actually
receive it. This means that more than half of the stroke survivors who need help to communicate have to go
without the support they need.
·
A
recent study found that 44% of stroke survivors experiences severe anxiety as a
result of their aphasia.
Swallowing and breathing
·
Swallowing
is a complicated task, which needs your brain to
coordinate lots of different muscles.
If a stroke damages the parts
of your brain needed to do this, it
can affect your ability to
swallow.
Doctors use the term dysphagia to
describe problems with
swallowing.
·
If
you can’t swallow safely then food and drink may be getting
into your airways and lungs. This is
called aspiration. It can lead
to infections and pneumonia, so it’s
extremely important that
swallowing problems are identified early.
·
Everyone
who has a stroke should be checked to see whether they
can swallow safely. This should
happen within the first few hours
after arriving at the hospital.
·
Around
half of all stroke survivors have problems swallowing.
This can make eating and drinking
difficult. Delays in hospital
assessments for swallowing are
associated with a higher risk of
pneumonia.
·
In
England, Wales and Northern Ireland, 1 in 3 patients are
not assessed to see if they can
swallow properly within the
recommended time window of four
hours. 1 in 5 patients is not
assessed at all.
·
In
Scotland, 1 in 3 patients is not assessed to see if they can
swallow properly, however this is
improving every year.
·
In
England, Wales and Northern Ireland, 8% of stroke survivors
contract pneumonia within seven days
of being discharged from
hospital.
Emotional impact
·
Emotionalism,
or difficulty controlling emotional responses
such as crying or laughing, is
common after stroke.
·
Emotionalism
affects about 1 in 5 stroke survivors in the first six
months after stroke.
·
In a
2015 Stroke Association survey of over 1000 stroke
survivors, 1 in 5 told us the
emotional impact of stroke was hard
to deal with.
·
42%
of people report a negative change in their relationship
with their partner after a stroke.
·
A
quarter of people report that stroke had a negative impact ontheir family.
Cognitive impairment and psychological impact of
stroke
·
Fatigue
is common after a stroke: half of stroke survivors
report fatigue. It can affect many
aspects of daily life. It can be a
serious problem for people returning
to work and is associated
with depression after stroke.
·
Stroke
can affect your mood, and cause changes in the way you
feel. Around a third of stroke
survivors experience depression
after their stroke.
·
Over
half of stroke survivors experience symptoms of anxiety
at some point within the ten
years of their stroke.
·
Cognitive
impairments include problems with thinking,
memory, concentration and practice
such as basic arithmetic,
and can make simple tasks very
difficult.
·
Some
stroke survivors experience apraxia (sometimes called
dyspraxia), which affects their
ability to plan tasks and order
the steps they need to take in their
heads, making it difficult to
complete daily tasks such as making a
cup of tea.
·
Neglect
is another cognitive impairment which can occur after
stroke. Neglect occurs when your
brain has difficulty processing
information from your body. If your
stroke has caused loss of
movement in one arm or leg it might
feel like this is not part of
your body.
Vascular dementia
·
Cognitive
impairments after a stroke may improve in some
patients, but in others it may
worsen and develop into dementia.
·
Vascular
dementia has similar symptoms to other types of
dementia, including difficulties with
understanding and
responding to things quickly;
struggling to remember things; and
problems concentrating. The main difference is that
vascular
dementia is caused by a loss of
blood supply to the brain, which
often happens over a long period
of time.
·
Vascular
dementia can happen through a single stroke or a series
of strokes, and is linked to small
vessel disease. Small vessel
disease is caused by the
narrowing of small blood vessels deep
inside the brain. At the moment
relatively little is known about
how to diagnose, treat or prevent
vascular dementia.
·
20%
of all people with dementia in the UK have vascular
dementia. Another 10% of people are
diagnosed with mixed
dementia, which could consist of a
combination of dementia
types like Alzheimer’s disease and
vascular dementia.
·
It
is estimated that around 7 out of 10 65-year-olds and almost
all 90-year-olds show signs of small
vessel disease in the
brain. This is thought to be a
contributing factor in 4 out of
10 dementias.
·
Stroke
and vascular dementia are both consequences of small
vessel disease of the brain.
·
A
recent study has found that up to 1 in 3 stroke survivors are at
risk of developing [vascular]
dementia within five years.
·
Three
quarters (75%) of dementia cases in stroke survivors are
thought to be caused by vascular
dementia.
·
Vascular
dementia is a condition strongly linked to stroke, and
there is currently no proven
treatment.
·
People
live an average of five years after being diagnosed with
vascular dementia.
·
People
with vascular dementia are most likely to die from a stroke or a heart attack.
Important elements of diagnosis
·
Almost
a third of people who went to hospital with a stroke in
England, Wales and Northern Ireland
in 2016–17 did not know
what time their symptoms started.
·
An
estimated 1.9 million neurons are lost every minute a stroke
is untreated.
·
80% of people having a stroke in England, Wales and
Northern
Ireland arrived at hospital by
ambulance.
·
In
England, Wales and Northern Ireland, about half of patients
who go to hospital while having a
stroke receive a brain scan
within an hour of arriving, and
almost 9 out of 10 of stroke
patients receive a brain scan within
12 hours.
·
In
Scotland, 9 in 10 patients receive a brain scan within 24 hours
of admission.
·
It
takes an average of seven and half hours from the onset
of symptoms to be admitted to a
stroke unit across England,
Wales, and Northern Ireland.
·
In
Scotland, 8 out of 10 people are admitted to a stroke unit
within 24 hours.
·
In
Scotland, less than 70% of stroke patients receive the
complete stroke care bundle (a group
of intervention
processes, which together can
significantly improve the
patient’s
outcomes).
Transfer of the stroke patient
• The Brain Rescue Mobile Units represent an opportunity for patients
suffering from this event. These are ambulances specially equipped with
technology and professionals for the diagnosis and immediate treatment of
stroke. Two recent studies of the Society of NeuroInterventional Surgery (SNS)
of the United States show how these mobile devices significantly reduce the
time that elapses from the time the LCA is unleashed until the treatment is
implemented and that would improve the survival rates and the probability
of recovery of the patient. 2
• The "downtimes" that occur throughout care were also reduced compared to
control groups, accelerating the entrance to the health center from 31 to 19
minutes; from admission to computed tomography, from 32 to 12 minutes,
and from tomography to intra-arterial intervention, from 165 to 82 minutes. 2
• If the diagnosis of ischemic stroke is confirmed, treatment begins in the same
ambulance, by administering a thrombolytic drug.
Stroke
Unit
·
A
stroke unit is a specialist hospital ward where stroke patients
are cared for by a team of
professionals who specialise in stroke
care.
·
Stroke
patients who are cared for on stroke units are more
likely to be alive and living
independently one year after having a
stroke than those cared for on other
wards.110
·
In
England, Wales and Northern Ireland, 9 out of 10 (96%) stroke
patients are cared for on a stroke
unit.
In 2016, 82% of patients in Scotland
were cared for at a stroke
unit; this is a significant
improvement from 2015, when only
78% of patients were cared for on a
stroke unit.
·
According
to NICE (National Institute for Health and Clinical
Excellence), 1 in 20 strokes in
Wales, England and Northern
Ireland are treated in hospital
facilities which are not adequate.
·
Stroke
care is improving in England, Wales and Northern Ireland.
·
Four
years ago, 20% of stroke patients were treated in general
wards rather than a stroke unit. Now,
17% of patients are
treated in facilities other than
stroke units.
·
4
out of 10 hospitals in England, Wales and Northern Ireland
have a shortage of stroke
consultants.
·
In
England, Wales and Northern Ireland, only 51% of hospitals
have adequate.
Hyper-acute stroke units
(HASU)
·
HASUs
are a type of stroke unit that exist in some hospitals
in the UK.
·
HASUs
bring experts and specialist equipment for the
emergency treatment of stroke under
one roof to provide
world-class treatment, 24 hours a
day, seven days a week.
·
This
model was first adopted in London and then in Greater
Manchester.
·
In
London, the HASU model saves about 96 extra lives a year;
and in Greater Manchester, they have
reduced the length of
hospital stays by two days. Other
areas across the UK are
centralising their acute stroke
care and introducing the HASU
model.
Clot-busting treatment 6,15
(thrombolysis)
·
Thrombolysis
is a treatment that uses drugs to break down and
disperse a clot for people who have
had an ischaemic stroke. It is
licensed to be used up to four and a
half hours from the onset of
stroke symptoms.
·
In
2016-2017, more than half of the patients who received the
clot-busting treatment, thrombolysis, in the
UK received it
within an hour of arriving in hospital. If
the time when symptoms
started is unknown, or it is more
than four and a half hours after
symptoms started, the treatment
cannot be provided.
·
Clot-busting
drugs increase the chance of a good outcome by
30%.
·
12%
of stroke cases in England, Wales and Northern Ireland are
eligible to receive thrombolysis5, equivalent
to around 10,000
people. Of these, 85% received
thrombolysis treatment in 2016.
·
In
Scotland eight years ago, only 3% of all stroke patients
received thrombolysis; today 10%
receive it. Half of these
received thrombolysis within one hour
of their arrival in hospital.
·
6
out of 10 patients in England, Wales and Northern Ireland
arrived at hospital after the four
and a half hour time window,
or had a stroke during their sleep so
the time could not be
calculated.
·
The
average door-to-needle time (the time gap between
the patient’s arrival at the
emergency department and being
administered anaesthetic) in the UK
is around 55 minutes.
·
The
number of patients who survive a stroke and are able to
return to their lives without any
added assistance increases by
2% when
thrombolysis is given within three hours.
Mechanical clot retrieval
(thrombectomy)
·
Thrombectomy
is a procedure used to mechanically pull a blood
clot out of the brain. It can be
performed up to six hours after a
stroke.
·
Although
a relatively small number of patients are eligible
for thrombectomy, it is shown to
provide significant benefits
and NICE guidance says it is safe and
effective.
·
There
are a few centres where thrombectomy is available
in the UK, but there are currently
not enough trained
professionals for the service to be rolled out across the UK:
·
Almost
a third of hospitals have no access to
thrombectomy either on site or by
referring to another
hospital.
·
In
order to have full UK coverage 150 trained consultants
are required. However, in 2016 only
83 consultants
across England, Wales, and Northern
Ireland could
undertake the procedure.”
·
The
adoption of thrombectomy treatment has been slow in
the UK compared to Germany, France
and the US. However
over 400 patients received
thrombectomy in England, Wales
and Northern Ireland in 2015–16.
·
In Scotland, fewer than 10
thrombectomies took place 2015
and 2016.
·
Clot
retrieval treatment increases the chance of a good
outcome by more
than 50%.
·
Other major advances are
represented in the second generation of devices for the extraction of
thrombi.like intracranial stents. 1,4
(Infobae-July
2nd, 2016)
https://www.infobae.com/salud/ciencia/2016/07/09/acv-en-la-mira-lo-ultimo-que-plantea-la-ciencia-en-busca-de-la-cura/
Rehabilitation
·
Patients
receive post-acute treatment after their stay in
hospital. This happens when patients
are considered clinically
stable and the focus moves to their
ongoing rehabilitation,
or which occurs in rehabilitation
units where patients are
transferred following their treatment
in a stroke unit.
·
One
million stroke survivors in England, Wales and Northern
Ireland need post-acute care.
·
Although
the biggest steps in recovery are usually in the first
few weeks after a stroke, the brain’s
ability to ‘re-wire’ itself,
known as neuroplasticity, means it is
possible to continue to
improve for months or years.
·
In
England, Wales and Northern Ireland, over a third of stroke
survivors are discharged to an Early
Supported Discharge
(ESD) or community rehabilitation
team. The majority of stroke
survivors discharged via these routes are cared for by stroke or
neurology specialist teams.
·
2
out of 10 hospitals in England, Wales and Northern Ireland do
not offer ESD services.
·
Only
approximately half of the stroke survivors in England,
Wales, and Northern Ireland are
discharged from hospital having
been assessed for all appropriate
therapies and with agreed
goals for their
rehabilitation.
Life
after a stroke
·
In England,
Wales and Northern Ireland, only 3 out of 10 stroke
survivors who need a six month
assessment receive one.
·
A
six month review monitors how well stroke survivors are
recovering and identifies
additional, tailored support that may
be needed to prevent unnecessary
readmissions to hospital
and care homes.
·
1 in
5 stroke survivors in England Wales and Northern Ireland
ask for psychological support at
their six month review.
However, stroke survivors wait an average of 10 weeks after
referral to receive psychological treatment.
·
Only
15% of post-acute services in England, Wales and
Northern Ireland have the resources
to help people return to
work after their stroke.
·
1 in
3 areas in England, Wales and Northern Ireland do not
provide support to the carers and
families of stroke survivors.
1 in 5 commissioning areas in
England, Wales and Northern
Ireland do not
offer Access.
Guideline for six month
reviews
The new National Clinical Guideline for Stroke published in 2016
recommends that stroke survivors,
including those living in a
care home, should be offered a
structured health and social
care review at six months and one year
after the stroke, and
then annually. The review should
consider whether further
interventions are needed, and the
person should be referred for
further specialist assessment if:
·
New
problems are present
·
The
person’s physical or psychological condition, or social
environment has changed.
The
economic burden 14
·
The
economic burden of stroke falls on different sectors of
society. Every new case of stroke
represents significant costs
to the NHS, social care services, the
stroke survivor and their
family, and may signify a loss of
productivity for the economy
(when
stroke survivors or their carers can no longer work).
These
costs are borne by different people throughout the
stroke
pathway.
·
The
estimated cost of stroke to UK society is £26 billion a year.
·
The
total cost to UK society for all new cases of stroke is £5.3
billion a year.9 Around 30% of this
sum will be costs to the
NHS.
·
The estimates for Argentina establish a total of 52,155 hospitalizations
per stroke and a total of 277,408 hospital days for this cause. 5
·
The
informal care sector (relatives and friends providing care)
contributes a total of £15.8 billion
a year to look after someone
who’s had a stroke.
·
The
older you are when you have a stroke, the more expensive
the care.
·
The
NHS could save £4,100 over five years for each stroke
patient given thrombolysis, and
£1,600 over five years for each
patient discharged
with Early Supported
·
It
is difficult to estimate the financial burden of stroke to the
family, as each case is unique.
·
One
report estimates the average cost of stroke to a family in
the UK is £22,377.
·
The
report claims the costs may vary between £5,000 and
£100,000, depending on how severe the
impacts of the
stroke are.
·
People
of working age who have had a stroke are two to three
times more likely to be unemployed 8
years after their stroke.
·
Around
1 in 6 stroke survivors experience a loss of income after
stroke.
·
Almost
a third of stroke survivors say they have to spend more
on daily living
costs.
research in the UK. This figure is
dwarfed when compared to the
amount spent on cancer research (£544
million). Stroke also
receives considerably less funding
from the government and
charities than coronary heart disease
(£166 million) and dementia
research (£90 million).
·
£48
is spent on stroke research for each person in the UK who
had a stroke. This is a one fifth of
the amount spent on cancer
research (£241) and less than half of that spent on dementia
research (£118).
·
Primordial
and Primary Prevention -
·
Community
education
·
Notification
and response of emergency medical services
·
Acute stroke
treatment, including the hyperacute and emergency department phases
·
Subacute
stroke treatment and Secondary Prevention
·
Rehabilitation
·
Continuous quality
improvement (CQI) activities
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