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| UK has worst outcome for stroke in Western Europe |
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August 2007
Studies have found that the UK has the worst outcome for stroke in Western Europe. In one study, the differences for the proportion of patients dead or dependent between the UK and eight other European countries were between 150 and 300 events per 1,000 patients.
Differences in the process of care are likely to be important, writes Professor Hugh Markus from St George's University of London. In many European countries, stroke care is an integral part of neurology. In contrast, in the UK it has, until recently, been a 'Cinderella' subject, often falling between neurology and general and geriatric medicine.
Paradoxically, the cost of care of stroke patients appears to be higher in the UK than in European countries with better outcomes, writes Markus.
A major challenge is to change the perception of stroke among both health professionals and the public, so that stroke is viewed as a condition that requires emergency action. The UK also has a severe shortage of specialists trained in acute stroke care and access to imaging technology, says Markus.
After Markus had claimed that the UK has the worst outcome for stroke victims in Western Europe, the Department of Health came under fire from the Northern Ireland Chest Heart and Stroke Association—accused of failing to provide the drug which has proven to guard against the chances of long-term disability.
The charity's chief, Andrew Dougal, said that Northern Ireland is the only UK region where treatment with tissue plasiminogen activator (tPA) is not offered to patients. He said he has been lobbying the Government for 10 years for the drug to be made available.
Despite spending the same amount or more as other countries on care, the UK still lags behind, he argued.
Prof Markus said that three different studies had put the UK at the bottom, among several other western European countries.
Mr Dougal said that around 4,500 strokes are suffered in Northern Ireland every year, making it the biggest cause of disability. It is also one of our biggest killers, with 1,450 dying from a stroke each year.
He stated that if tPA were made available in Northern Ireland, it could drive down the numbers of stroke patients affected by long-term disability. The patient must receive the drug within three hours of the onset of an ischaemic stroke, if it is to be effective.
"It is of no use to a patient after three hours, so this highlights the need for quick action," he said.
"tPA would bring down the number of those suffering long-term disability by about 5% and that could grow. It's been available in Great Britain for a number of years. This is just another example of how we in Northern Ireland lag behind."
Reference:
BMJ 2007; 335 (7616): 359–360.
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