'Significant' improvement in stroke care in England

Stroke care in England has improved significantly over the past four years, according to a National Audit Office report.

A patient's chance of dying within 10 years of having a stroke has decreased from 71% in 2006 to 67% in 2010, say the authors of the report.

The DoH launched the National Stroke Strategy in 2007 to address criticism suggesting stroke care had too low a priority within the NHS.

An additional £59m has since been used to develop stroke services in England, with more funding expected over the next year.

Increased coordination and provision of care has led to more patients receiving thrombolysis and a greater proportion undergoing a brain scan within 24 hours of admission to hospital.

In addition, the DoH's advertising campaign Stroke: Act FAST has led to raised public awareness of stroke: in 2009 the number of phone calls to emergency services regarding suspected stroke rose by 54% compared with 2008.

However, the report highlighted that there are still improvements to be made, and has called on health and social services to work more closely to improve after-care following stroke.

The National Stroke Strategy recommends that all stroke patients are offered a review of their health and social care at six weeks, six months and annually thereafter. However, less than a third of patients currently receive a follow-up appointment within six weeks of having a stroke.

Moreover, the report revealed regional variation and confusion about how follow-up should best be implemented, as well as the role that GPs should play in the after-care of stroke victims.

The authors emphasised the importance of primary and secondary prevention of stroke in primary care, and noted that there has been no improvement in the proportion of eligible patients receiving treatment from GPs for associated conditions such as hypertension since the National Stroke Strategy was launched.

In particular, it is felt that GPs should be more willing to prescribe warfarin to prevent stroke in patients with AF.

Although NICE guidelines recommend warfarin as the most effective treatment for AF patients after a stroke, under the QOF practices are rewarded for treating patients with any anticoagulant or antiplatelet, but not warfarin in particular.

The authors have recommended that NICE should now review whether the indicators in the QOF for GPs are supporting the delivery of its current AF guidance as well as its guidance on recommended BP and cholesterol levels.

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