Wake up call about stroke incidence
5 September 2005
Wake up call about stroke incidence
New Zealand's annual Stroke Appeal Week kicks off next week (13th – 19thth September) with a compelling message about stroke in New Zealand. An overwhelming increase in the expected number of stroke patients will severely overload our hospitals and rest homes unless the current service model is changed and a population based cardiovascular stroke risk reduction programme is implemented.
Internationally recognized stroke research tells it as it is in New Zealand
One of the best population based stroke studies in the world is centred in Auckland. This latest ARCOS study confirms once again that the battle against stroke is not won. The study generated more unanswered questions.
Can we avoid strokes? YES
The latest ARCOS study which now covers three periods has shown a modest decline in the incidence of stroke. Success of the anti smoking message had a favourable impact upon stroke incidence. This was counterbalanced by an increase in the number of people with stroke suffering high blood pressure, obesity and diabetes.
Why when 80 strokes out of 100 could be avoided does stroke incidence continue at its high level of about 7600 new cases a year?
What can we do about it?
"We need to change the eating and behavioural habits of New Zealanders to overcome the high level of risk for cardiovascular diseases such as stroke, heart disease and diabetes." says Dr Harry McNaughton Honorary Medical Director Stroke Foundation NZ.
Have stroke services improved in 20 years?
The good news from ARCOS is that in Auckland over 90% of people with a stroke were admitted to hospital and over 87% received a CT/MRI scan both are vital for better stroke outcomes. However it takes more than hospitalization to improve stroke outcomes. Only one District Health Board out of 21 has implemented an evidence based organized stroke service. Recommendations have been available since 1996 in New Zealand to assist DHBs to establish stroke units which will reduce the number of deaths, improve stroke outcomes and reduce the number needing residential care.
All New Zealanders with a stroke should have equal opportunity to benefit from an organized stroke service.
Canterbury District Health Board took the initiative in 2004 and established the first stroke unit covering both acute stroke services and rehabilitation. The results have been as expected from international experience. Less deaths, better outcomes, shorter stay in hospital and better return home rates. Other District Health Boards are now in various stages of planning or setting up stroke units. Time is not on our side. Any delay in the establishment of stroke units will guarantee a blow out of residential care costs and for the stroke people a poorer chance of survival, or a much greater disability from the stroke.
The good news stories from people who have been through the stroke unit and rehabilitation programme in Canterbury DHB speak for themselves.
Acute Stroke Unit
Roy said "It was wonderful, every assistance was given me, always there to support and encourage, they gave me confidence that I would improve, they were a great team."
"The staff were so helpful it was a real team effort with a smooth return to my home."
Marie said "I couldn't eat or swallow, I couldn't walk when I arrived but now I can do all those things."
"No body could understand what I said but now I can talk and people understand me. They were marvelous, they got me walking again"
>From the Clinician's perspective:
Acute unit: Dr John Fink Consultant Stroke Specialist says "Team work is great and we are able to see better outcomes, we are not losing as many through stroke."
Rehabilitation unit: Dr Carl Hangar Consultant Physician/Geratrician says "The interdisciplinary team approach to stroke services has been very successful and the patient is treated as part of the team. We would never want to go back to the old approach. We can see the results and it makes all the effort worth while."
Are all New Zealanders stroke equal ?
Ethnic groups in New Zealand do not share an equal chance of having a stroke. Maori or Pacific Islanders can expect to have a stroke about 10 years earlier than a European New Zealander. Much poorer outcomes are also experienced. Current levels of stroke in both communities are well above average and could be heading for massive increases.
What's needed to change the impact of the stroke epidemic?
Brian O'Grady Stroke Foundation CEO says "Increase public knowledge about stroke risk factors and implement organised stroke services modeled on the latest Life after stroke guidelines. It is not a matter of spending millions on specialized equipment but reorganizing what is already being done. Delays will cost lives and increase costs."
When it comes to stroke services time is brain. Dr Fink says " In acute stroke services rapid access to diagnosis and treatment will save lives and improve outcomes." "In stroke rehabilitation services timely commencement of rehabilitation will improve outcomes and save money." Said Dr McNaughton
Brian O'Grady said "The battle against stroke starts much sooner than the race against the clock to emergency services. Every New Zealander should be aware of the risk factors that cause a stroke and take personal action to avoid one. Stop smoking, control blood pressure, control cholesterol levels, improve diet, reduce salt intake, deal with obesity and exercise regularly.
In 2004 there were an estimated 35, 000 stroke survivors in New Zealand.
•Already there are more than 7600 strokes per year in New Zealand.
Costs now at least $150 million/year
With current trends continuing we can expect at least 20,000 new strokes per year by 2031
•All District Health Boards should provide organised stroke services
•All people admitted to hospital where a stroke is the main issue, should expect to be managed in a stroke unit by a team of health professionals with expertise in stroke and rehabilitation.