Country lives on the line after stroke

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Rural and regional Australians are at greater risk of death or disability from stroke than people in our major cities because they are not getting the right treatment at the right time.

This concerning disparity has been highlighted in the Stroke Foundation's 2019 National Stroke Audit Acute Stroke Services Report, launched at Austin Health today.

Stroke Foundation Clinical Council Chair Professor Bruce Campbell said there have been significant advancements in emergency stroke treatment, meaning stroke is more treatable. However, the Audit Report showed regional health services and their patients were being left behind.

"While major city hospitals are innovating, enabling their patients to benefit from the latest break-throughs, regional patients have limited access to well established standard stroke treatments,'' Prof Campbell said.

"It is a travesty that there is such a wide gap in 2019. Surviving and living well after stroke should not be determined by your postcode.

"There is significant opportunity for improvements which will save lives and benefit all Australians."

The Audit also revealed, with investment and focus, improvements to stroke treatment and care have been made at a local and state level.

Victoria and South Australia are showing how telehealth technology can be used to link regional and rural centres with expert clinicians based in comprehensive stroke centres in the major cities providing them assistance with early diagnosis and referral pathways.

Austin Health was among those raising the bar in delivering best-practice stroke treatment and care.

Professor Campbell said there must be clear links and referral pathways to ensure the major city hospitals support regional hospitals in treating stroke.

"If we consider emergency stroke treatment of the most common type of stroke – caused by blood clot, it is estimated 20–25 percent of these patients could benefit from some form of clot dissolving [thrombolysis] or clot retrieval [endovascular thrombectomy] therapy, which means more than double the current numbers are likely to be eligible,'' he said.

"Subsequently thousands of patients may be missing out on treatments that reduce disability and death."

Stroke Foundation Chief Executive Officer Sharon McGowan said Australia has one of the most advanced trauma systems in the world and we need to apply the same critical care thinking to acute treatment. Every stroke is a medical emergency and needs to be prioritised to ensure rural and regional Australians are not denied access to best practice care.

"Times are tough for people in the bush. They are not only dealing with drought and bushfires, but inequality in the health system," Ms McGowan said.

"They must be given the best chance to survive and be well supported throughout rehabilitation and the transition home to live well after stroke.

"The Australian Government has paved the way with the development of the National Strategic Action Plan for Heart and Stroke. Improved access to emergency stroke treatment through telehealth and clinical pathways are highlighted as key actions in the Plan. Governments must now work together to enable all Australians to benefit from the advances that a national telestroke network can realise."

Key findings of the audit included:
  • 10 hospitals met all elements of a comprehensive stroke centre (an increase from six in 2017)
  • 35 percent of patients with stroke reached hospital within the critical 4.5 hour window for thrombolysis treatment.
  • Delivery of thrombolysis with appropriate patients has remained largely unchanged at 10 percent (11% in 2017)
  • Delivery of thrombolysis within targeted 60 minutes of hospital arrival lags internationally; 32 percent in Australia compared to 59 percent in the US and 62 percent in the UK.
  • Delivery of endovascular thrombectomy has risen steeply to 1907 patients in 2019 (872 in 2017).
  • 79 percent of metropolitan patients access a stroke unit compared to 55 percent of inner regional patients, 35 percent outer regional patients.
  • 24 percent of stroke units do not have a dedicated stroke coordinator.
  • 31 percent of patients did not receive a comprehensive discharge care plan (35% in 2017), 39 percent of patients assessed for rehabilitation needs and three in 10 patients were not given risk modification advice.
  • 69 percent of major city services reported routine use of evidence based clinical guidelines, care plans and protocols, 45 percent in regional areas.
In 2019, 120 hospitals participated in the Acute Services Audit, accounting for more than 35,000 patients.
 
Audit Report recommendations:
  • All patients must have access to specialist stroke assessment, including advanced brain imaging and early treatments. Formal policies and pathways across the whole system are needed including links between dedicated stroke centres to others via telehealth.
  • Rapid assessment, including stroke specialist input, and procedures to identify and ensure quicker delivery of reperfusion therapies.
  • Patient access to dedicated stroke unit care. Acute hospitals with more than 75 annual stroke admissions need a stroke unit with clear medical leadership and a dedicated stroke care coordinator.
  • Increased emphasis on prevention of stroke within hospitals. This includes:  Increased timely access to TIA clinics.
  • Ensuring all people after stroke receive appropriate secondary prevention information and support prior to hospital discharge.
  • Carers assessed, supported and trained to maximise recovery opportunities and live well.

About the audit The 2019 National Stroke Audit is a systematic and representative snapshot of acute stroke care provided within Australian hospitals. The National Report is a comprehensive document highlighting where the hospital system for acute stroke treatment is working well, and identifying where improvements or changes may be needed.

Information presented permits tracking the performance of Australia's stroke care against the evidence-based national clinical guidelines (2017), the Acute Stroke Services Framework 2019 and the Australian Commission on Safety and Quality in Health Care's Acute Stroke Clinical Care Standard .
 
Clinicians, healthcare administrators and governments alike use the data in this report to review services and clinical care in order to improve the quality of stroke management throughout Australia.

Data was collected in two parts: 120 services completed a survey on local resources, processes and infrastructure and 4,176 patient case notes were retrospectively audited.
  • Participating public and private hospitals reported admitting more than 35,000 stroke patients in the previous 12 months.
  • Of the 120 participating services, just over half (65) are based in major cities, with the others are in inner and outer regional centres.
  • Admission numbers across participating hospitals ranged from 20 to 1005 acute stroke patients in the last year.
 
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Stroke Foundation :
461 Bourke Street, Melbourne, Australia Wide
1800 787 653
Stroke Foundation
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