3 Raising awareness of stroke
19. Public awareness of stroke is low. Only 21% of
respondents to the NAO's public survey mentioned stroke as one
of the top four causes of death, compared with 77% who mentioned
heart disease and 89% who mentioned cancer. Over three times as
many women died of stroke as died of breast cancer in England
in 2002, but 40% more women mentioned breast cancer than stroke
when asked what the top causes of death were.[20]
Better public awareness is key to preventing more strokes. Preventing
just 2% of the strokes that occur in England in a year would save
care costs of more than £37 million, over and above the human
benefits. The sorts of messages that could appear in a public
awareness campaign for stroke are shown in Figure 3.[21]
20. A key risk factor for stroke is high blood pressure,
yet this link is not generally being made by members of the public,
and knowledge varies by socio-economic group. In the NAO's survey,
30% of respondents in the two highest socio-economic groups mentioned
reducing blood pressure as a way of reducing risk of stroke, compared
with 15% in the lowest group. The Department's anti-smoking campaign
in 2004 had a significant effect in raising awareness of the dangers
of smoking and encouraging people to quit, and campaigns to encourage
healthy eating and exercise should have an impact in reducing
vascular disease generally, but campaigns to date have only had
modest success in raising awareness about stroke specifically
and the devastation a stroke can cause.[22]
21. People of Afro-Caribbean and South Asian origin
have an increased risk of stroke, as they are more susceptible
to high blood pressure, and more likely to have high blood pressure
that is resistant to treatment, than other groups. As well as
working to increase public awareness of stroke generally, the
Department needs to focus specifically on how to get public health
messages about stroke across to these groups.
Figure 3: Elements of a public awareness campaign
for stroke
| What is a stroke?
|
- The equivalent of a heart attack, but in the brain
- Affects people of all ages: a quarter of strokes occur in under 65s
|
| What is its impact?
|
- The biggest killer after heart disease and cancer
- The biggest cause of adult disability
Three times as many women die of stroke than of breast cancer each year
- Afro-Caribbean and South Asians are at higher risk
|
| What causes stroke?
|
- High blood pressure
- High blood cholesterol
- Smoking
- Unhealthy diet
- People with atrial fibrillation (irregular heart rhythm), diabetes, or who have had a previous stroke or transient ischaemic attack are at higher risk
|
| How can I prevent stroke?
|
- Know your blood pressure, and keep it under control
- Monitor cholesterol levels
- Eat healthily, including avoiding excess salt
- Stop smoking
- Take regular exercise
|
| How do I recognise a stroke?
|
- Sudden onset of one or more of
- Weakness or numbness in face or leg, especially on one side of the body
- Difficulty speaking or understanding
- Loss of balance or coordination
|
| What should I do if I think someone is having a stroke?
| Dial 999. Stroke is a medical emergency. Rapid treatment can make a big difference to outcomes.
|
Source: National Audit Office
22. Healthcare professionals, including radiologists,
ambulance paramedics, NHS Direct operators and emergency room
nurses, also need to understand that stroke is a medical emergency,
and should be treated as such. The Department is beginning to
take action to get this message across to medical staff. For example,
they have agreed with the Ambulance Service that stroke will be
treated as a category A emergency, and have revised the NHS Direct
protocols to increase the chance that a caller ringing and describing
the symptoms of a transient ischaemic attack will get the correct
advice, which is to go for an immediate assessment.[23]
23. However there is still more to be done. The NAO's
analysis of Sentinel Audit data for stroke patients showed that
risk factors had not been treated in some cases. For example,
one in five patients who were known to have had high blood pressure
before their stroke were not on blood pressure lowering medication,
and only 24% of patients with atrial fibrillation (irregular heart
rhythm, a risk factor for stroke) were on warfarin, whereas clinical
opinion suggests that at least 75% should have been.[24]
24. The General Medical Services contract for GPs,
in place since April 2004, has introduced some elements to help
provide better and more systematic prevention of stroke, although
around four times as many points in the contract are allocated
specifically to secondary prevention of coronary heart disease
as are allocated to secondary prevention of stroke. The re-negotiated
contract, which came into effect on 1 April 2006, includes new
points for the management of atrial fibrillation. Between 2004
and 2005 more people on GP lists were having their blood pressure
and cholesterol monitored and managed, and more smokers were being
given cessation advice. However the NAO found that there was a
very low referral rate from GPs for people who have had a stroke
(47.5% in 2004, down to 45.5% in 2005, compared with a target
of 80%).[25]
25. The public, GPs and NHS Direct operators also
need to be made more aware of the seriousness of transient ischaemic
attack as a risk factor for major stroke. The risk of stroke in
the seven days following a TIA can be up to 10%, or around 45
times the 'normal' risk, and the risk of stroke within four weeks
of a TIA can be 20%. TIAs need to be treated as urgent cases by
the ambulance service and NHS Direct, as it is impossible to tell,
while they are occurring, whether they are transient attacks or
the beginning of a major stroke.[26]
20 Q 99; C&AG's Report, paras 3.1-3.2 Back
21
Qq 79, 82, 95; C&AG's Report, para 24(a) Back
22
Qq 76-80, 96-98; C&AG's Report, para 3.6 Back
23
Qq 8, 106 Back
24
C&AG's Report, Figure 15 Back
25
Qq 2, 93; C&AG's Report, paras 3.11-3.12 and Figure 14 Back
26
Qq 105-106; C&AG's Report, para 3.20 Back
|
