Evolution in stroke treatment does not reach our regions

Despite advancements in acute stroke treatment in the past two decades, the disease continues to place a heavy burden on Australia as numbers rise.

There will be more than 56,000 strokes in Australia in 2019 alone and that figure is on track to reach more than 132,000 by 2050, equating to one stroke every four minutes. 

An evaluation of 20 years of the Stroke Foundation’s National Stroke Audit Program has found while more Australians are surviving stroke than ever before, not all treatment is equal. It showed more needs to be done to increase access to best practice stroke treatment and care for regional and rural Australians.

Stroke Foundation Clinical Council Chair Professor Bruce Campbell said stroke attacks the brain, the human control centre, and can change lives in an instant. 

“Stroke is always a time-critical medical emergency, but it is highly treatable and a good recovery is possible,” Professor Campbell said.

“The challenge is to ensure all Australians can access life-saving treatment when they need it. At the moment, they are not.

“Ongoing inequalities in acute stroke care and services are costing lives and leaving thousands of patients with unnecessary disability. Australians living in regional and rural areas are among those most impacted due to geographical barriers to stroke specialists, but this inequity can be addressed by stroke telemedicine.”

Some States and Territories have invested in stroke telemedicine systems which provide regional hospitals with 24/7 access via video to stroke specialists based in metro areas. We now need a national approach to stroke telemedicine to ensure all Australians can access time critical stroke treatment no matter where they live.

The Stroke Foundation’s National Audit program delivers an annual snapshot of stroke treatment and care, highlighting areas where the system is working well and where changes are needed.  

It empowers clinicians, health administrators and government to drive quality improvement. 

Stroke Foundation Chief Executive Officer Sharon McGowan said the 20 year audit evaluation highlighted how much the state of stroke has changed in this time.

“The good news is the number of hospitals providing the blood clot dissolving therapy of thrombolysis has increased, and breakthrough clot removing endovascular thrombectomy has become standard, as well as a significant increase in the number of patients receiving care in a specialised stroke unit,” Ms McGowan said. 

“However, there is still not enough emphasis on mood assessment for patients, psychology services and risk factor modification.

“We know mood or mental health issues are barriers to recovery from stroke, we also know four in 10 survivors will go onto experience another stroke within 10 years even though many of these could be prevented.

“This report highlights we must do more in these areas.”

Ms McGowan said with more Australians surviving stroke thanks to improved stroke treatments, we must now focus our energies on rehabilitation and secondary stroke prevention. 

“Demand is growing for high quality rehabilitation services that will allow patients to recover and live their best life possible after stroke. We must ensure stroke survivors are not denied access to these vital supports,” she said.

Potential quality improvement programs and initiatives, which could address a number of the issues identified in the 20 year Audit analysis have been included in the recently completed National Action Plan for Heart Disease and Stroke. The Action Plan outlines immediately achievable actions Australian governments at all levels can implement to reduce the impact of stroke on survivors, their families and carers, the community and healthcare system. 

In addition to demonstrating the evolution of stroke care in Australia, this report also showed that improving the quality of acute stroke care provided to Australian patients between 2007 and 2017 would have avoided the loss of more than 17,000 healthy years of life. 

This evidence supports further investment in initiatives to drive quality improvement.

Key insights from 20 years of stroke audit report: 
Number of hospitals providing blood clot busting drugs(thrombolysis) increased from 4 percent (1999) to 77 percent (2017).
Patients who receive treatment in a stroke unit up from 53 percent (2007) to 70 percent (2017).
Patients receiving advice on risk factor modification up from 42 percent (2007) to 62 percent (2017).
Mood assessment 34 percent (2012) to 56 percent (2018).
Discharge care plan 50 percent (2010) to 68 percent (2018). 

Stroke Foundation stroke audits 
The Stroke Foundation monitors and measures stroke care against the Clinical Guidelines for Stroke Management through the National Stroke Audit program. The program alternates annually between the Acute services audit and the Rehabilitation services audit.

Audit information can be found on InformMe, the Stroke Foundation's dedicated website for health professionals working in stroke care. 
Audit data is collected using the Australian Stroke Data Tool (AuSDaT).