Australian stroke care a cruel lottery

By Dr Bruce Campbell Clinical Council Chair National Stroke Foundation

Whenever I think back to the incredible advances in stroke treatment that have occurred in the space of my time working in the field I am amazed at how far we’ve come.

If someone had told me as a freshly minted doctor that a stroke patient could walk out of hospital mere days after having a major stroke I wouldn’t have believed it possible.

But thanks to new treatments – many being led by Australian doctors and researchers – stroke patients can achieve excellent recoveries and go on to lead independent lives.

These incredible results, although theoretically possible for many stroke patients, are sadly far from the norm. 

A National Stroke Foundation report has revealed that most Australian stroke patients are being denied access to best practice care – costing lives and leaving thousands with unnecessary disability. 

As a stroke clinician, to say that I was bitterly disappointed with the results is an understatement. 

The audit shows that our health system is categorically failing our patients, their families and their community. It shows that in four years our acute stroke care system has made little to no improvement. This stagnation is costing us too many lives every year.

The current landscape

In Australia if you have a stroke there is no guarantee you will get treatment and care recommended by best practice guidelines.  Patient outcomes vary wildly depending on where you live and what hospital you go to.

One of the most common types of stroke is a blood clot in the brain (ischemic stroke). Thankfully there are effective treatments for strokes of this nature – sadly most eligible patients aren’t receiving them.

Across the country, only seven percent of all ischemic stroke patients are receiving life-saving clot busting medication. This figure has not moved since 2011. We know at least two thirds of suitable patients around the country are missing out.

The neurointerventional team at The Royal Melbourne Hospital have been removing blood clots from patients’ brains for many years and we now have the evidence that this dramatically reduces disability for stroke survivors. If these patients had gone to a hospital not offering this surgery they may not be here today. 

Currently only a handful of Australian hospitals offer clot removal surgery 24 hours a day, seven days a week (endovascular treatment).

What this means for patients who miss out is that instead of being able to go home to their families they may end up spending their days in a care facility or not survive. We need carefully located comprehensive stroke centers embedded in an organised service network to provide access to this highly specialised therapy.

Stroke is a time-critical medical emergency. As a neurologist the only thing worse than seeing a patient who has arrived in hospital outside the treatment window, is to hear they had arrived on time but missed out on treatment because of delays. 

It is crucial that there are processes in place to ensure stroke patients are screened for stroke, either by stroke health professionals, or in the Emergency Department on arrival. 

We know that stroke patients have the best outcomes when they are treated in a stroke unit. Despite the increase in the number of stroke unit beds, more than two thirds of stroke patients, nearly 20,000 people across the nation, are being denied the full benefits of stroke unit care. 

If a stroke patient is not admitted to a stroke unit they miss out on specialised, multi-disciplinary stroke care proven to reduce death and disability associated with stroke. 

They may also miss out on getting an ongoing care plan for their recovery and receiving vital life-saving advice or medication to help them prevent a second stroke.