Stroke Care In UK Severely Deficient

September 2007 - An editorial in the British Medical Journal (BMJ) recently argued that the UK urgently needs to reorganize stroke services to improve patient outcomes. Professor Hugh Markus from St George's University Hospital, London drew attention to a number of studies placing the UK at the bottom of western European league tables and considered the reasons for this variation in results.

The author suggested that differences in the care process are significant with many European countries integrating stroke treatment into neurology services. Until recently, the UK tended to treat it as a "Cinderella" diagnosis dealt with inconsistently by neurology, general or geriatric medicine. He commented that while it would be easy to conclude this has resulted in underinvestment, in reality the cost of stroke care appears to be at least as high as in countries with better outcomes.

Professor Markus identified organizational and structural problems including lack of focus on acute stroke care which has assumed even greater importance with the development of specific treatments such as thrombolysis (administration of anti-clotting drugs within three hours). Effective thrombolytic services exist in many countries in Europe, North America, and Australia, where as many as 20-30 per cent of eligible patients receive therapy compared to less than 1 per cent in the UK.

A 2005 National Audit Office report acknowledged these deficiencies concluding that improvements to care organization in England could save £20million annually with 550 deaths avoided and 1700 patients fully recovered who would not otherwise do so. The Department of Health National Stroke Strategy is due to publish its response and recommendations in autumn 2007.

Hugh Markus argued that the perception of stroke among health professionals and the public must be changed so that it is viewed as a condition requiring emergency treatment. He stressed that the UK also has a severe shortage of trained stroke specialists. Research shows that prompt brain scanning is the most cost effective diagnostic and treatment strategy. While many European countries perform a scan on admission, many UK units "struggle to provide it within 24 hours".

He concluded that improvements to early diagnosis with imaging, patient monitoring and treatment of physiological parameters will have a positive impact on outcomes independent of thrombolytic therapy. Professor Markus argued that if acute systems were effective, implementation of other new treatments would be facilitated.

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