Hospital arrival delays causing increased risks for stroke patients

Irish Heart Foundation says only 60% of people got to hospital within crucial 4½-hour window for thrombolysis in 2020

An extra 800 stroke sufferers a year are at increased risk of death and disability due to an “alarming” fall in patients getting clot-busting treatment on time, according to the Irish Heart Foundation.

Just 60 per cent of patients got to hospital within a crucial 4½-hour window for thrombolysis in 2020, compared with 73 per cent six years earlier, analysis by the charity of Health Service Executive data shows.

The latest Irish National Audit of Stroke, due to be published on Tuesday, is expected to confirm a further decline in 2021 – a situation the charity describes as “shocking and avoidable”.

Separate research carried out by the foundation shows that fewer people recall the vital Fast (face, arm, speech and time) set of warning signs used to check for one of Ireland’s biggest killers.

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“We need to encourage people to learn about the signs of stroke and to act as fast as possible in calling an ambulance, as the faster the presentation to the emergency department, the better the outcomes from acute treatment,” said Prof Rónán Collins, the HSE’s national clinical lead in stroke.

Mr Collins was speaking on Monday at the start of a new Act Fast – Minutes Matter campaign by the heart foundation aimed at reversing the worrying trend. “Delays in presentation undo much of the progress we have made with stroke treatments and improving outcomes and can result in extra disability or even death,” he added.

“We want people to fundamentally realise that your chances of recovery after what might be a very serious event are better the sooner you call an ambulance and present for treatment.

“Delaying or ‘waiting to see’, for whatever reason, often leads to regret.”

In some cases, where a patient has a stroke in their sleep or lives alone and cannot raise the alarm, arrival at hospital outside the 4½-hour time frame is unavoidable.

The average stroke destroys about 2 million brain cells every minute; the condition was responsible for 1,423 death in Ireland in 2021, and hospitalised more than 6,000.

Director of advocacy at the foundation, Chris Macey, said both the reduction in prompt stroke treatment and the charity’s research on knowledge of the Fast signs show “low public awareness” of the need to get to hospital without delay.

The survey of more than 1,000 adults shows facial weakness or drooping is the most commonly recognised word in the acronym at 35 per cent, down from 41 per cent.

Slurred speech is identified by 16 per cent, down 2 per cent; arm weakness or numbness is at 14 per cent, down 4 per cent; while awareness of the most vital component, Time to call 999, stands at just 12 per cent. Only one in 10 know what all four Fast letters stand for.

“This is both shocking and avoidable, especially when we see the reduction in people getting to hospital on time,” said Mr Macey. “People are needlessly dying or suffering disability by stroke, which is one condition where you can have a massive say in your own outcome.

“Twenty years ago, having a stroke was effectively a death sentence, but if we’re not getting patients into hospital on time, we are turning the clock back.”

Fast warning signs

Face: Can the person smile or has their mouth or eye drooped?

Arm: Can the person raise both arms?

Speech: Can they speak clearly and understand what you say?

Time: Call for an ambulance if you spot any one of these signs.

Paul Cullen

Paul Cullen

Paul Cullen is a former heath editor of The Irish Times.