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Stroke Foundation: Targets set to boost Australia’s ‘lagging’ stroke care standards

In 2023, the national leaders in stroke agreed to new targets to ensure Australians have access to world-leading stroke care. 


Stroke Foundation, Stroke Society of Australasia, the Australian Stroke Clinical Registry and Angels Initiative joined forces at the National Stroke Targets Roundtable to develop a set of proposed targets for Australian hospitals to meet by 2030. 


These include: 


  • national median endovascular clot retrieval door to puncture time <30mins for transfers.

  • national median thrombolysis door to needle time <60mins.

  • national median door in door out time for endovascular clot retrieval <60mins.

  • national median endovascular clot retrieval door to puncture time <90mins for primary presenters.

  • certified stroke unit care provided to >90% of patients with primary stroke diagnosis.

Stroke Society of Australasia President Professor Timothy Kleinig said every Australian stroke patient deserves best-practice, timely stroke care.


“We know that fast access to expert treatment leads to improved patient outcomes and that’s exactly what the National Stroke Targets aims to achieve,” Professor Kleinig said.

“This is the first step in a collaborative effort to support hospitals, stroke teams and Australian states and jurisdictions to provide best-practice, time-critical stroke care for their patients, to reduce avoidable stroke-related deaths and disability.”


There are many Australian pockets of stroke care excellence, with progress in treatment options, assessment, and access to specialist care. However, the care of the average Australian stroke patient lags behind other developed countries in the timely delivery of acute stroke reversal treatments and stroke unit access. 


When compared to other developed countries, the time it takes for an Australian patient to receive clot-busting drugs (known as door-to-needle time) is significantly longer. The longer stroke is left untreated, the more brain dies, and the lower the chances of survival and recovery. 


An accepted international door-to-needle target is within 60 minutes of a patient arriving at the hospital. In the United States, 68 per cent of patients are treated with clot-busting drugs within that time, and in the United Kingdom, 61 per cent are treated within that time. But in Australia, it’s significantly lower – at 32 per cent. 


Stroke Foundation Chief Executive Officer Dr Lisa Murphy said this was unacceptable. 

“Access to stroke units and median door-to-needle times have not shifted between 2017 and 2022,” Dr Murphy said. 


“These targets are just the beginning – with a united effort and voice, support from governments and increased investments, we have an opportunity to change this situation.” 


The new targets were announced on the final day of the combined Stroke Society of Australasia and Smart Strokes Nursing and Allied Health Scientific Meeting in Melbourne this year.


Further research was showcased at the event, including new Australian research about bridging the gap between urban and regional stroke care.


A 12-month pilot at Echuca Regional Health, led by Stroke Neurologist Dr Philip Choi and Stroke Coordinator Lauren Arthurson, investigated the viability and effectiveness of Tele-Stroke in regional hospitals. 



The pilot involved providing 85 patients with either video or telephone consultations with stroke specialists. A stroke neurologist and the local team reviewed each patient's progress, brain images and care plan before moving to a detailed bedside discussion with the patient and family. A treatment plan was then developed with the patient and local team. 


Ms Arthurson said the majority of stroke patients admitted to regional hospitals have no access to bona fide stroke unit care despite the recent uptake of acute Tele-Stroke programs.


The results from the pilot showed that this service model improved diagnostic accuracy and is a viable model that can be used to improve access to stroke care in regional areas. 


“We want to bridge that gap between regional and urban stroke care and give all stroke patients, regardless of where they live, the opportunity to have access to the best stroke treatment and care,” Ms Arthurson said. 


“Our vision is that this simple model is expanded Australia-wide to ensure all patients receive evidence-based Stroke Unit Care.” 


Furthermore, Western Australian researchers have developed and trialled a world-first service that will enhance the rehabilitation experience for Aboriginal Australians who have had a stroke or traumatic brain injury. 


From 2018 to 2022, an Aboriginal Brain Injury Coordinator position was rolled out. This position was filled by Aboriginal health professionals and was developed as a way of providing culturally appropriate care and support for Aboriginal people duringtheir recovery. 


The Aboriginal Brain Injury Coordinator service was trialled in Western Australia as part of the Healing Right Way study, led by Professor Beth Armstrong and a team of Aboriginal and non-Aboriginal clinicians and researchers. It was performed in partnership with Aboriginal Medical Services, eight hospitals across Western Australia, and the Stroke Foundation. 


“Aboriginal Australians experience stroke and traumatic brain injury at significant rates and a culturally appropriate response to rehabilitation and recovery has been really lacking,” Chief Investigator Professor Beth Armstrong said. 


Over 100 Aboriginal people who had experienced a stroke or traumatic brain injury participated in Healing Right Way. They came from across Western Australia, with many people living in rural and remote areas where there are few support and rehabilitation services. 


In studies prior to Healing Right Way, Aboriginal stroke survivors had shared with Professor Armstrong’s team that their care would have been enhanced had there been greater cultural responsiveness, including in the communication with health professionals and by having more Aboriginal health professionals involved in their care. 

“Healing Right Way was the direct result of these recommendations, and the Aboriginal Brain Injury Coordinator role was developed,” Professor Armstrong said.


During the study, nine Aboriginal Brain Injury Coordinators met with patients while they were in hospital, delivering them face-to-face and over-the-phone support and then followed them up for six months. The study also delivered cultural security training to hospital staff, with a focus on the needs of Aboriginal stroke and traumatic brain injury survivors. 


“We found that this is an acceptable delivery of care model and a feasible role that can make a difference,” Professor Armstrong said. 


Stroke in Australia at a glance

Stroke is one of Australia’s biggest killers and globally, one in four people will have a stroke in their lifetime.1 It kills more women than breast cancer and more men than prostate cancer. (2)


There are two types of stroke:


  • ischaemic stroke (an artery in the brain gets blocked by a clot)

  • haemorrhagic stroke (a wall of a blood vessel in the brain breaks).


Both types of stroke attack the brain, which needs oxygen and nutrients carried in a person’s blood. By stopping blood from getting to areas of the brain, stroke happens. As a result, brain cells die quickly – up to 1.9 million brain cells may die every minute. 

The brain is divided into areas that control different parts of the human body, so the impact of stroke depends on the area of the brain it damages. 


Damage to an area of your brain can impact how you think, behave, use words, swallow, see, feel, touch, and move your body. It can cause muscle weakness and problems with speaking, memory, hearing or vision. 


Signs of a stroke:

Face – check their face. Has their mouth drooped?

Arms – can they lift both arms?

Speech – is their speech slurred? Do they understand you?

Time – time is critical.


Stroke is always a medical emergency, and getting fast treatment can be the difference between death, disability and a good recovery. If you or someone else experiences the signs of stroke, no matter how long they last, call triple zero (000) immediately. 


Stroke affects everyone differently and can happen to anyone at any age. Men are at greater risk of stroke and as we get older, our risk increases. Regional Australians are also 17 per cent more likely to suffer a stroke than those in metropolitan areas. (3)


In saying that, stroke is preventable for many – more than 80 per cent of strokes can be prevented. (4) Some of the causes within our control include high blood pressure, being overweight, smoking, high cholesterol, a high intake of alcohol and diabetes.


As a result, here are five tips for a healthy life to assist in stroke prevention: 

make time for a health check


  • eat well

  • stay active

  • avoid alcohol

  • be smoke free.


Currently, more than 445,087 Australians are living with the effects of stroke.5 Each year, an estimated 27,000 people experience their first stroke, which is one person every 19 minutes.


Aside from the health impact strokes can have, there are also major financial repercussions. In 2020, the estimated cost of stroke in Australia was $6.2 billion in direct financial impact, and a further $26 billion in mortality and lost wellbeing. (6)


Without action by 2050, it is predicted that the number of first-ever strokes experienced by Australians annually will increase to 50,600, or one stroke every 10 minutes, and there will be 819,900 survivors of stroke living in the community. (5)


References

1. GBD 2016 Lifetime Risk of Stroke Collaborators, Feigin VL et al. Global, Regional, and Country-Specific Lifetime Risks of Stroke, 1990 and 2016. N Engl J Med. 2018; 379(25):2429-2437.

2. Australian Institute of Health and Welfare 2018. Australia’s health 2018. Australia’s health series no. 16. AUS 221. Canberra: AIHW.

3. Ibid.

4. O’Donnell M et al. Global and regional effects of potentially modifiable risk factors associated with acute stroke in 32 countries (INTERSTROKE): a casecontrol study. Lancet 2016; 388: 761–775.

5. Deloitte Access Economics. 2020. No postcode untouched, Stroke in Australia 2020.

6. Deloitte Access Economics. 2020. The economic impact of stroke in Australia, 2020.


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