Cash injection could ease UK stroke burden
SummaryStroke is the third leading cause of death in adults in developed countries. It can also leave survivors severely disabled and dependent on long-term care, placing an enormous financial burden on national healthcare systems. This burden is likely to further increase as the incidence of stroke increases concurrent with the aging population.
However research from Datamonitor reveals that if patients suffering stroke were taken immediately to stroke units by medical emergency services where they can receive immediate treatment from stroke specialists, much of this suffering and expense could be avoided. Unfortunately throughout the world, including the , budget constraints prevent this from being standard practice.
Leading cause of death
Stroke is the second leading cause of death in Europe and the third leading cause of death in the . In the seven major pharmaceutical markets incidence of stroke is expected to increase to 1.5 million by 2012. According to the American Stroke Association, the estimated direct and indirect cost of stroke in the in 2004 will be $53.6 billion.
The prevalence of a number of risk factors associated with the incidence of stroke, such as blood pressure, smoking, pre-existing coronary heart disease, obesity and diabetes are also increasing. Approximately 25% of men and 20% of women can expect to suffer a cerebrovascular event if they reach the age of 85 years. The incidence of stroke is similar to that of acute coronary events, however the burden of stroke lies with long-term disability as opposed to death. Stroke patients frequently require longer hospital stays followed by lengthy periods of rehabilitation, long-term nursing care or indefinite dependency on community care.
Inevitably stroke is a major economic burden on healthcare systems. Without more effective management strategies for stroke victims, the cost of this disease will continue to escalate.
Increasing awareness of the symptoms and urgency of stroke are the keys for improved patient outcomes. One of the biggest delays in patients receiving treatment is late presentation to hospital. Patients often perceive symptoms as not serious or do not recognize they are having a stroke. To improve patient outcomes radically for ischemic stroke patients, 'time to treatment' needs to be improved so that suitable patients can receive tPA (tissue plasminogen activator) therapy.
Catching it early
Across the seven major markets, most patients presented within the six- to 24-hour time frame, with the exception of and , which were within the first three hours. A study carried out in 1997 found that only 25% of patients knew that they were having a stroke and even when patients know that they are having a stroke, most present late because they perceive their symptoms as 'not serious'.
tPA is the only acute intervention that offers any significant chance of the patient making a good, if not full recovery from an ischemic stroke. But to be effective, tPA must be given within three hours of the onset of symptoms. This means the patient must present to the appropriate facility, be diagnosed, assessed and treatment initiated, all within three hours.
Hospital and emergency services' protocols can go a long way to reducing the 'time-to-needle' delays that can often lead to otherwise eligible candidates being excluded from tPA treatment. Nevertheless, whether or not a patient is eligible for tPA will depend on the time at which a patient, relative or onlooker identifies the stroke and seeks medical help. Crucial to this is knowledge of the symptoms that indicate a stroke.
Awareness of the options
In addition to increased familiarity with stroke symptoms, patients need to know what treatment options are available in their country and what facilities are provided locally. If tPA is available, then patients need to know that if they present promptly this treatment may be available to them. Developing patient awareness in this area of stroke management requires considerable investment and resources.
Stroke patients that arrive at the emergency department are often then transferred onto wards, which could be anything from neurology to geriatrics. Delays are also caused by waiting for specialists and diagnostic test results to be carried out and interpreted. Ideally the emergency medical services should be trained to recognize stroke and transport patients directly to stroke units equipped to treat stroke patients, as one German opinion leader pointed out:
"In many countries there are problems in the referral system. Many of these units are run by emergency doctors and they say, 'okay, a stroke which is not a myocardial infarction, we'll call the neurologists'. Then you have another five to 20 minutes time passing until somebody shows up in the emergency room. In , many of those units are run by neurologists so the first contact with a doctor is already the specialist."
While the has a high percentage of stroke units, it also has the longest time to obtain test results. This further highlights the fact that even though the government has spent a lot of money in developing stroke units, more money needs to be ploughed into resources, such as equipment and stroke specialists.
Stroke units need to be adequately equipped in order for patients to receive optimum care. In its simplest form, it boils down to the government either spending money on facilities and resources or spending it on long term care for those living with the after effects of stroke. With an aging population only increasing the incidence of stroke, it seems both more practical and prudent to loosen the purse strings.