Stroke is the third cause of death and greatest cause of adult disability within the UK.
Stroke has a devastating impact on both the individual and their families, and the effects can last a lifetime. After suffering a stroke, people are often left with a long-term disability; this puts substantial demand on the NHS and the economy.
Working with our stakeholders the South West Cardiovascular Strategic Clinical Network (SW CV SCN) will be focussing on the delivery of projects correlated to the National directives and the following Stoke priorities:
- Improving the management of Atrial Fibrillation (AF) to improve the prevention of stroke
- Improving access to timely acute care – thrombolysis and acute stroke units within 4 hours of admission to improve patient outcomes and prevent complications e.g. Deep Vein Thrombosis (DVT).
- Developing cost-effective methods of follow-up to support the recovery and survivorship of stroke patients.
- Optimising emergency stroke treatment to reduce disability in South West England
The only licensed treatment worldwide for acute ischemic stroke is thrombolysis, also known as a ‘clot-busting’ drug. The benefits of thrombolysis are critically time-sensitive – the earlier treatment is received, the greater the chance of recovery with minimal or no disability.
The 10-year target for stroke thrombolysis in the Department of Health’s 2007 National Stroke Strategy was 10% of all acute strokes. Service redesign in the London area with the development of some hyper acute stroke centres has yielded treatment rates of 14-25%. The SW CV SCN has a priority to reproduce the speed and rate of treatment seen in the London hyper acute centres. However, we must acknowledge that the rural environment of the South west presents challenges.
The Network is working collaboratively with the South West Academic Health Science Network and National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care South West Peninsula (PenCLAHRC), to accelerate the implementation of clinical evidence for thrombolysis. PenCLAHRC has already completed award-winning work with the Royal Devon and Exeter hospital.
- Reducing mortality by preventing deep vein thrombosis (DVT)
DVT is a common cause of death in immobile hospital patients, but is potentially avoidable. Stroke patients in particular have a high risk of developing DVT due to restricted mobility. There is now good evidence from the CLOTS3 trial[1] to suggest that Intermittent Pneumatic Compression (IPC) is effective in preventing DVT and consequently reducing mortality in patients who are initially immobile after being hospitalised with acute stroke.
The SW CV SCN is participating in a national programme in collaboration with NHS Improving Quality (IQ) to support the rapid roll-out of the trial findings into clinical practice. The aim of the CLOTS3 implementation project is a uniform adoption of IPC treatment across the South West for the approximately 50% of in-patients with stroke for whom the treatment is applicable, in all acute settings. Initial network data indicated that the implementation of CLOTS3 was patchy across the SW, with some centres having fully implemented IPC, some with alternative devices or suppliers to the Covidien system used in the trial, and others at various stages of developing or approving business cases for procurement of the Covidien or other systems. The next phase will be to provide training and education resources to maintain the safe applications of the IPC systems.
[1] Does intermittent pneumatic compression reduce the risk of post stroke deep vein thrombosis? The CLOTS 3 trial: study protocol for a randomized controlled trial Trials 2012, 13:26 doi:10.1186/1745-6215-13-26; http://www.medscape.com/viewarticle/805174.
