Patients with symptoms of stroke or transient ischaemic attack (TIA or brain attack) are missing out on potentially life saving treatment because they are routinely considered by the NHS as low priority cases.
Instead of being fast-tracked into hospital for surgery the vast majority of patients are spending weeks and sometimes months on poorly managed referral pathways with the risk of going on to have more severe strokes. A joint audit commissioned by the Healthcare Quality Improvement Partnership (HQIP) and carried out by the Royal College of Physicians and the Vascular Society, published on the BMJ website, shows that these patients experience unacceptable delays; from the onset of symptoms, to diagnosis and GP referral to investigation to surgery. The report also highlights significant variations in quality of care provision across the UK and a complete lack of cohesive referral pathways in most hospital Trusts. Firm evidence exists that shows timely surgery of the neck arteries (Carotid Endarterectomy or CEA) for those experiencing symptoms of TIA, can prevent a major stroke, but the vast majority of patients are receiving treatment far too late too make a difference. The most comprehensive study of CEA of its kind looking at 56% of operations carried out between 2005-7 shows that over 90% of patients failed to meet the standard set by the Department of Health’s National Stroke Strategy of 48 hours from symptoms to the operating theatre, and 80% failed to meet the two week standard set by NICE. Over 30% of patients waited over 12 weeks for an operation. At this point benefits are minimal and the opportunity to prevent early stroke is gone. Tony Rudd, associate director, Royal College of Physicians’ Clinical Effectiveness and Evaluation Unit, and chair of the Intercollegiate Stroke Working Party said: “Urgent treatment is needed for many people after a TIA to prevent the development of a major stroke. This study shows that services are not yet organised well enough to deliver the standards of care set out in the National Stroke Strategy and the NICE Acute Stroke and TIA guidelines and as a result there will be people having unnecessary strokes.”
