Stroke services ‘heading for a crisis’

Major advances in acute stroke care are being missed because of a lack of funding in services, according to Prof Joe Harbison, the outgoing head of the HSE's National Stroke Programme.

The rate of stroke in Ireland is due to rise by 50 per cent in the next eight years because the country's population is ageing. The average age for a stroke is 74 and there are about 8,000 new cases of stroke every year.

Speaking at the launch of the Irish Heart’s Stroke Manifesto in Dublin, Prof Harbison said: “We are heading for a crisis. Our stroke services can’t even deal with the numbers we have now, let alone the surge in cases that has already started. ”

Strokes are the third biggest cause of death after heart disease and cancer in Ireland with about 1,900 deaths annually: "There are more acute stroke unit beds in Northern Ireland than there are in the south of Ireland despite them only having a third of the population."

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“Up until 2009 we were getting this rise in stroke numbers, but this evened out for a few years and came down a little bit. But unfortunately it’s started increasing again. We can’t stop it forever; the reason being is the population is getting older. There are more people who are 74 around,” he said.

Younger men

However, younger men are getting more strokes: “It’s something we do not understand and the same thing has been found in the UK.”

In its manifesto, Irish Heart says that every hospital treating stroke should be able to carry out immediate investigation, assessment and treatment of all mini strokes. Thrombolytic therapy, which involves the use of drugs to break up or dissolve blood clots, should be available in all units, too. Thrombectomy, a surgical clot removal treatment, should be available to all stroke patients, regardless of where they live. Thrombectomy is carried out on large clots as thrombolysis drugs are not powerful enough to dissolve them without causing a brain haemorrhage, according to Prof Harbison.

The procedure is available at Beaumont Hospital and Cork University Hospital. Last year more than 200 procedures were carried out.

Just one in 20 stroke patients require the procedure, he said, but an extra consultant is needed in Cork University Hospital and more support staff for Beaumont Hospital.

“The problem we have with Beaumont at the moment, we have to send people down and then send them back after the procedure which is not so great if you’re coming from Galway,” he said.

“We’d much prefer them to stay in Beaumont for a day following the procedure. But that isn’t possible. There isn’t the staff or capacity to do that in Beaumont.”

Local rehabilitation

More rehabilitation should be available locally, while a register to collect best quality data on strokes should be kept in all Irish hospitals.

People should be helped to spot signs of stroke: the so-called FAST programme, face drooping, arm weakness, speech difficulty and time to call 999. Patients should be treated at home, where possible, while public information campaigns should be run to increase knowledge about blood pressure and atrial fibrillation, the most common form of irregular heartbeat.

GPs should test patients’ heartbeats and blood pressures annually.

“We’re now hoping that this comes through to the GP contract negotiations, that this becomes part of the GP role in identifying atrial fibrillation and treating it, identifying high blood pressure and treating it,” he said.

Intensive care

One survivor, Gerry Byrne (60) suffered a stroke at his home in Athy, Co Kildare in May 2013. By day he was a lorry driver and at the weekends he drove a taxi. "I went to bed about half nine that night and everything started spinning," Mr Byrne said. "I started vomiting and I couldn't lie on my back. My wife phoned the ambulance that was luckily in the vicinity and so they were up to me within four minutes."

The ambulance went to Naas because “they didn’t think I’d make it to Dublin”, he said. He spent three days in the hospital’s intensive care unit and another three weeks in rehabilitation.

“I used to live on four or five hours of sleep. I thought I was a young lad but I wasn’t obviously. It all caught up on me.”