Fewer than one-in-ten stroke patients receive support for early hospital discharge - Irish National Audit of Stroke National Report

 The real question is how many are 100% recovered when discharged? THAT IS THE ONLY GOAL IN STROKE, anything less is wasteful! Are these dedicated units competent in getting stroke survivors 100% recovered? That is the news story.

Fewer than one-in-ten stroke patients receive support for early hospital discharge

Audit of services found that almost 2,000 stroke patients were not admitted to a dedicated unit in 2023

Fewer than one-in-ten stroke patients are supported with rehabilitation to leave hospital early, a national audit has found.

The analysis found that early supported discharge took place among just nine per cent of stroke patients here in 2023. This is well below rates seen in the UK, where more than half (52 per cent) have services in place to allow stroke patients to leave hospital earlier.

According to the Irish National Audit of Stroke National Report, a total of 6,461 people were admitted to hospital with a stroke diagnosis in 2023, an increase of eight per cent on the previous year.

However, nearly 2,000 people were not admitted to a dedicated stroke unit. (Are they any good? 100% recovery statistics?) Seven-in-ten stroke patients were admitted to such units in 2023, below the 90 per cent target set in the current National Stroke Strategy.

On a positive note, rates of thrombectomy – a procedure used to treat strokes caused by blood clots – rose to 11.2 per cent, nearly three times the rate reported in the UK.

There were also improvements in care times, with the median time from a patient’s arrival in hospital to their medical review decreasing from 14 minutes in 2022 to nine minutes in 2023.

But psychological assessment was found to be underprovided, with just six per cent of stroke patients receiving an assessment despite high rates of post-stroke depression and anxiety.

“The data show that Ireland continues to make progress in acute stroke care, particularly in areas such as thrombectomy and faster hospital assessment,” said Prof Joe Harbison, clinical lead for the Irish National Audit of Stroke.

“However, gaps remain in key areas, particularly in access to stroke units and post-hospital rehabilitation. We need enhanced public awareness campaigns to encourage rapid recognition of stroke symptoms and emergency response. It is critical that there is full implementation of the National Stroke Strategy to ensure access to high-quality stroke care”.

The audit assessed the performance of 23 hospitals in delivering stroke treatment. It highlighted the need for increased investment in stroke unit capacity, post-discharge rehabilitation, and mental health support for stroke survivors. It also stresses the importance of faster pre-hospital recognition of stroke symptoms to improve eligibility for time-sensitive treatments such as thrombolysis.

On the back of the study’s findings, the Irish National Audit of Stroke has recommended a review of the organisation of stroke services in acute hospitals to identify gaps in service provision which may impact on the ability of a hospital to provide evidence-based care.

The report, published today, includes the personal story of Jennifer, a Cork-based nurse who had a stroke at the age of 46 in December 2016.

“Despite my overall good health and healthy lifestyle, I still had a stroke that was caused by a bleed in the brain and it was devastating for me,” she said.

“I am not sure if there is anything more that I could have done to prevent the stroke, but I know that getting treatment quickly is important and I am lucky that I did get to hospital fast and was treated so quickly.

She outlined how practical brain injury supports from organisations such as Headway Ireland helped her return to her normal life.

“I had a keyworker and she used to continually say, ‘You are able’. That support and encouragement really helped a lot.

“I have problems with my peripheral vision and the Headway staff taught me how to scan a room, which meant I stopped bumping into things and bruising myself. The Headway staff would help me on the bus and give me tips on how to orientate myself.”

She added: “Life after stroke is so hard, but I never knew this. Although I am a nurse I only ever saw the acute side of stroke, but now I know that there is so much to learn.”

You might be interested in…Stroke: Irish Medical Times

 You'll be interested that there is NO discussion of 100% recovery which means they are NEVER going to do anything towards that! The takeaway is don't have a stroke because your stroke medical 'professionals' aren't really professional in my opinion!

Send me hate mail on this: oc1dean@gmail.com. I'll print your complete statement with your name and my response in my blog. Or are you afraid to engage with my stroke-addled mind? I would like to know what your definition of professionalism in stroke is.

You'll want 100% recovery when you become the 1 in 4 per WHO that has a stroke 

You might be interested in…Stroke   Irish Medical Times     

By Dr Ray O'Connor 5th November 2024

Dr Ray O’Connor takes a look at the latest clinical papers on the treatment of stroke, and how high-quality rehabilitation can minimize(NOT RECOVER!) the impact of the condition

Globally, stroke is the second leading cause of death, and the third leading cause of death and disability combined. Around 100,000 people have strokes each year, and around 1.3 million people in the UK have survived a stroke. High-quality rehabilitation can minimise the physical, emotional, cognitive, and social impacts for people who have had a stroke, and their carers. It can also yield substantial cost savings to society.

The National Institute for Health and Care Excellence (NICE) guidance on stroke rehabilitation in adults was updated in October 2023.1 The guideline summary published in the BMJ earlier this year2 covers selected new and updated recommendations and focuses on those most relevant to primary care and community rehabilitation settings.

Dr Ray O’Connor

The main recommendations are as follows. Stroke rehabilitation total therapy time should be based on the person’s needs, with the amount increasing to at least three hours a day, on at least five days a week. Fatigue is common; use a validated scale for early assessment. Offer vision and hearing assessment. Consider referral to community participation programmes suited to the person’s rehabilitation goals.

Interestingly the American Heart Association and the American Stroke Association also jointly published stroke prevention guidelines this year3 It is an extensive document covering over 80 pages with 735 references.

The ‘Top Ten Take-home Messages’ for busy clinicians are listed. A brief summary is as follows. Everyone should have access to and regular visits with a primary care health professional to identify and achieve opportunities to promote brain health. Screening for and addressing adverse social determinants of health is important in the approach to prevention of incident stroke.  

The Mediterranean diet is a dietary pattern that has been shown to reduce the risk of stroke. Physical activity is essential for cardiovascular health and stroke risk reduction. Glucagon-like protein-1 receptor agonists have been shown to be effective not only for improving management of type 2 diabetes but also for weight loss and lowering the risk of cardiovascular disease and stroke.

Blood pressure management is critical for stroke prevention. Antiplatelet therapy is recommended for patients with antiphospholipid syndrome or systemic lupus erythematosus without a history of stroke or unprovoked venous thromboembolism to prevent stroke. Prevention of pregnancy-related stroke can be achieved primarily through management of hypertension.

Treatment of verified systolic blood pressure ≥160 mm Hg or diastolic blood pressure ≥110 mm Hg during pregnancy and within six weeks postpartum is recommended. Endometriosis, premature ovarian failure (before 40 years of age), and early-onset menopause (before 45 years of age) are all associated with an increased risk for stroke.

Therefore, screening for all three of these conditions is a reasonable step in the evaluation and management of vascular risk factors in these individuals to reduce stroke risk. Finally, the authors recommend that understanding transgender health is essential to truly inclusive clinical practice.

Treatment of acute stroke, before a distinction can be made between ischemic and haemorrhagic types, is challenging. This randomised controlled trial4 studied whether very early blood-pressure control in the ambulance improves outcomes among patients with undifferentiated acute stroke.

The subjects were 2404 Chinese patients with mean age of 70 years with stroke that caused a motor deficit and with elevated systolic blood pressure (≥150 mm Hg). The authors randomly assigned patients who were assessed in the ambulance within two hours after the onset of symptoms, to receive immediate treatment to lower the systolic blood pressure (target range, 130 to 140 mm Hg) (intervention group) or usual blood-pressure management (usual-care group).

The results were that prehospital BP reduction did not improve functional outcomes. Interestingly, 46.5 per cent subsequently received a diagnosis of haemorrhagic stroke.

Inflammation has been associated with incidence and recurrence of stroke, and risk of stroke was reduced in patients who have coronary artery disease and who were treated with colchicine. This multicentre, double blind, randomised, placebo controlled trial from China5 looked to assess the efficacy and safety of colchicine versus placebo on reducing the risk of subsequent stroke after high risk non-cardioembolic ischaemic stroke or transient ischaemic attack within the first three months of symptom onset.

The participants were 8,343 patients aged 40 years of age or older. Patients were randomly assigned 1:1 within 24h of symptom onset to receive colchicine (0.5 mg twice daily on days 1-3, followed by 0.5 mg daily thereafter) or placebo for 90 days. Unfortunately, no differences were noted in treatment effects on subsequent stroke between the low dose colchicine and the placebo groups.

Increasingly, the effects of global warming are resulting in extremes of heat. This ecological study6 considered what is the burden of stroke worldwide associated with extremes in temperature. The authors collected data from the Global Burden of Diseases Study 2019, the Climate Research Unit Gridded Time Series, and the World Bank database to estimate stroke burden attributable to nonoptimal temperature and its distributional characteristics at the global, regional, and national levels. The conclusion was that the burden of stroke attributable to nonoptimal temperature conditions continued to increase, and aging was a key factor in this increase. In 2019, 521,031 deaths and 9,423,649 disability adjusted life years (DALYs) were attributable to stroke due to nonoptimal temperature globally.               

Brain injury and rehabilitation - Irish Times opinion

You need to call for EFFECTIVE STROKE REHAB, not just more funding for all the existing failures.  If you know Barbara O'Connell you need to educate her on what is actually needed in stroke rehab, it is not more funding.

Brain injury and rehabilitation - Irish Times

Sir, – We hear every day about the crisis in our acute health services but what about the people left to exist after surviving a massive trauma like brain injury? We need to fight for them too.

There are 19,000 brain injuries acquired every year in Ireland and worldwide, and brain injury is set to surpass other diseases as the biggest cause of death and disability. There is hardly a family in the country that hasn’t been touched by brain injuries caused by stroke, road traffic accidents, falls, tumours and assault.

Right now brain injury survivors face a lottery to access neuro-rehabilitation services in Ireland and this is not good enough. This country cannot continue to save a life on the one hand but rob quality of life on the other hand by not investing in community rehabilitation.

Our hospitals are clogged up unnecessarily by keeping brain-injury survivors in acute beds that don’t need to be there. Some young survivors are forced to live indefinitely in nursing homes or community hospitals without access to any rehabilitation to aid their recovery. Families are pushed to breaking point because of severe under-resourcing of neuro-rehabilitation. The reality is if you have a brain injury outside of Dublin, there are no specialist beds for you and very little rehabilitation in your community.

As voters put election candidates through their paces on the doorsteps, Acquired Brain Injury Ireland is calling on the public to demand more funding for community rehabilitation in the next programme for government.

This will save time and money across the health system by improving the flow of brain injury survivors from hospital to home, free up acute beds, reduce stress on families as caregivers, and improve health outcomes. – Yours, etc,

BARBARA O’CONNELL,

Chief Executive,

Acquired Brain

Injury Ireland,

Dun Laoghaire,

Irish scientist developes soft robotic suit to overcome disability

What other ones is your stroke hospital comparing this to? Like these 3 posts on soft roboticss? Or these 3 posts on soft exosuit?
http://www.irishtimes.com/news/science/irish-scientist-developes-robotic-suit-to-overcome-disability-1.2870522

A volunteer using the “soft” robot device that can help help stroke patients to walk again

 I bet that volunteer is not a stroke survivor. Left arm would likely not be usable and the left leg is bent too much.

An Irish bioengineer has won an international prize for developing a robotic suit to help stroke patients walk again.

Prof Conor Walsh of Harvard University was one of five individuals to win an enterprise award for research, sponsored by watch manufacturer Rolex. The award includes a cash prize of €97,000.

Prof Walsh (35) is a mechanical and biomedical engineer who completed his primary degree in 2003 at Trinity College Dublin, before going on to complete masters and PhD degrees at the Massachusetts Institute of Technology. He is the founder of the Harvard Biodesign Lab, a centre that designs “soft” robotic technologies to help augment and restore human performance.