state_of_the_nation_2017_final_1
stroke.org.uk
State of
the nation
Stroke statistics
January 2017
Together we can conquer stroke
Contents
3 Glossary
4 Key statistics
What is stroke?
6 Understanding stroke
7 Transient ischaemic attack (TIA), also known as mini-stroke
8 Vascular dementia
The stroke population
10 How common is stroke in the UK?
11 Age
12 Gender, ethnicity and social deprivation
13 Surviving stroke
14 Deaths from stroke in the UK
15 Stroke worldwide
The devastating effects of stroke
17 Effects of stroke
18 Disability after stroke
19 Living with the effects of stroke
20 Impact on daily life
Stroke risk factors and prevention
22 High blood pressure
23 Diabetes
24 Atrial fibrillation
25 Other risk factors
26 Lifestyle
Stroke treatment and care
28 Act FAST
29 Stroke units
30 Treatments for ischaemic stroke (due to a clot )
31 Rehabilitation and life after stroke support
Economic impact of stroke
34 The cost of stroke to health and social care
35 Research spend in the UK
References
36 References
2 State of the Nation Stroke statistics - January 2017
Glossary
••
Ischaemic stroke:
A stroke caused by a clot.
••
Haemorrhagic stroke:
A stroke caused by a bleed.
••
Transient ischaemic attack (TIA):
Sometimes referred to as a ‘mini-stroke’ or ‘warning stroke’ –
an event is defined as a TIA if the symptoms resolve within 24
hours.
••
Incidence:
The number of stroke occurrences.
••
Prevalence:
The number of living stroke survivors.
••
Mortality:
The number of deaths caused by stroke.
••
Aphasia:
Aphasia is a complex disorder of language and communication
caused by damage to the language centres of the brain. People
with aphasia may have difficulty speaking, reading, writing or
understanding language.
••
Daily living activities:
Everyday activities generally involving functional mobility and
personal care, such as bathing, dressing, going to the toilet and
meal preparation.
••
Onset:
When the symptoms of stroke first started. Also referred to
medically as ‘ictus’.
••
Thrombolysis:
A clot-busting treatment to dissolve the clot and restore blood
flow. Also referred to as ‘rt-PA’ and ‘alteplase’.
••
Door to needle:
The time it takes from admission to hospital (door) to
administering thrombolysis treatment (needle).
••
Thrombectomy:
A mechanical clot retrieval procedure that pulls the blood clot
out of the brain.
••
Early supported discharge (ESD):
Designed for stroke survivors with mild to moderate disability
who can be discharged home from hospital sooner to receive
the necessary therapy at home.
• • Speech and language therapy (SALT):
Speech and language therapy provides treatment, support
and care for people who have difficulties with communication,
or with eating, drinking and swallowing.
3 State of the Nation Stroke statistics - January 2017
Key statistics
x2
There are more than 100,000
strokes in the UK each year;
that is around one stroke every
five minutes.
There are over 1.2 million
stroke survivors in the UK.
Every two seconds, someone
in the world will have a stroke.
Stroke is the fourth single
leading cause of death in the UK.
There are over 400 childhood
strokes a year in the UK.
Black people are twice as likely
to have a stroke compared to
white people.
Stroke is a leading cause of
disability in the UK – almost two
thirds of stroke survivors leave
hospital with a disability.
More than 8 out of 10 people
in the UK who are eligible for
the emergency clot-busting
treatment thrombolysis
receive it.
Only 3 out of 10 stroke
survivors who need a six month
assessment of their health and
social care needs receive one.
The NHS and social care costs
of stroke are around £1.7 billion
a year in England.
4 State of the Nation Stroke statistics - January 2017
What is stroke?
5 State of the Nation Stroke statistics - January 2017
Understanding stroke
There are two main types of stroke – ischaemic (due to a blocked blood vessel in the brain)
and haemorrhagic (due to bleeding in the brain).
About 85% of all strokes are ischaemic and 15% haemorrhagic 1
Ischaemic strokes are caused by a blockage cutting off the blood supply to the brain. This can cause
damage to brain cells.
Haemorrhagic strokes are caused when a blood vessel bursts within or on the surface of the brain.
Haemorrhagic strokes are generally more severe and are associated with a considerably higher risk of
dying within three months and beyond, when compared to ischaemic strokes. 2
••
10-15% of people with subarachnoid haemorrhage die before reaching hospital. 1 Subarachnoid
haemorrhage is an uncommon type of stroke caused by bleeding on the surface of the brain.
Haemorrhagic stroke research
As part of our five-year research strategy we made a commitment to work with others to achieve a clear vision about the future
priorities for stroke research. We want to ensure that these priorities reflect expert opinion as well as the views of stroke survivors
and their families.
One of these priorities is research into haemorrhagic stroke (bleeds on the brain). Our understanding and treatment of haemorrhagic
stroke lags behind what we know and what can be done for the more common, ischaemic (blood blockage) stroke. The Priority
Programme for haemorrhagic stroke research aims to fund research that will address these gaps.
6 State of the Nation Stroke statistics - January 2017
Transient ischaemic attack (TIA), also known
as mini-stroke
••
Transient ischaemic attack, or TIA (often referred to as a
‘mini-stroke’ or ‘warning stroke’) is the same as a stroke,
except that the symptoms last for less than 24 hours. When
symptoms first start, there is no way of knowing whether
someone is having a TIA or a full stroke. Always call 999 if you
spot the signs of a stroke.
••
A TIA should be treated as seriously as a full stroke.
••
About half of all strokes after TIA occur in the first 24 hours. 3
Risk of stroke following a TIA
Guideline on TIA
A new National Clinical Guideline for Stroke was published
in 2016. The fifth edition of the guideline on how stroke care
should be provided in the UK recommends that:
••
All patients with a suspected TIA should be given aspirin and
assessed urgently by a neurological specialist or on an acute
stroke unit. When symptoms first start, there is no way of
knowing whether someone is having a TIA or a full stroke.
Always call 999 if you spot the signs of a stroke.
••
Patients with a confirmed diagnosis of TIA should receive
the appropriate drug treatment to reduce their risk of stroke. 1
5%
at 48 hours
8%
at one week
12%
at one month
17%
at three
months 4 5
mini-stroke
It ’s not just a funny turn
••
1 in 12 people could have a stroke within a week of having
a TIA. 5
7 State of the Nation Stroke statistics - January 2017
Vascular dementia
Vascular dementia has similar symptoms to other types of
dementia, but it is caused by a loss of blood supply to the brain,
which often happens over a long period of time. Vascular dementia
can happen through a single stroke, and through diseases of the
small vessels of the brain. At the moment, relatively little is known
about how to diagnose, treat or prevent vascular dementia.
••
It is estimated that vascular dementia accounts for around
20% of all cases of dementia. 6
••
It is estimated that around 7 out of 10 65-year-olds and
almost all 90-year-olds show signs of small vessel disease in
the brain. 7 8 This is thought to be a contributing factor in 4 out
of 10 people with dementia. 9
••
Stroke and vascular dementia are linked by these small vessel
diseases. 10
Vascular dementia research
There is still a lot we do not know about vascular dementia and
the relationship with stroke, and we lack the of treatments
or preventative measures to stop progression of the disease
in people who develop it. The Stroke Association is working
in collaboration with the British Heart Foundation and
Alzheimer’s Society to fund urgent and important research
to discover more about this condition as well as how we can
diagnose, treat and prevent it.
8 State of the Nation Stroke statistics - January 2017
The stroke population
9 State of the Nation Stroke statistics - January 2017
How common is stroke in the UK?
• There are more than 100,000 strokes in the UK each year. 11
• That is around one stroke every five minutes in the UK.
• Stroke incidence rates fell 19% from 1990 to 2010 in the UK.
14
Age standardised
stroke incidence per
100,000 people
1990 2005 2010
142 116 115
Recurrence
• Stroke survivors are at greatest risk of having another
stroke in the first 30 days following a stroke. 15
Around 1 in 4 stroke survivors
will experience another
stroke within five years. 15
150
120
Over a quarter of people
who have a stroke have had
a previous stroke or TIA. 12
90
1990 2005 2010
• 1 in 20 stroke patients have another stroke while still
in hospital. 12
10 State of the Nation Stroke statistics - January 2017
Age
• In England, Wales and Northern Ireland the average age for men to have a
stroke is 74 and the average age for women to have a stroke is 80. 12
• In Scotland the average age for men to have a stroke is 71 and the average age
for women to have a stroke is 76. 13
• Around a quarter of strokes happen in people of working age. 16
• The average age of stroke has decreased in recent years.
• People are most likely to have a stroke over the age of 55. 17
Childhood stroke
• There are over 400 childhood strokes a year in the UK. 16
• Around a quarter of these are in children under a year old, half are in children
aged 1-10 and a quarter are in children aged 11 and over.
• Strokes caused by a bleed are more common in children than in adults.
• Only around 15% of adult strokes are due to a bleed, but it is thought that up
18 19 20
to half of childhood strokes are due to a bleed.
Childhood stroke risk
• In children, the risk of a stroke caused by a clot is six times higher following
recent illness, such as cold and flu. 21
• For children who have had none or some of their routine vaccinations, the risk
of a stroke caused by a clot is eight times higher compared to those who had
all their routine vaccinations. 21
• Risk of stroke in children is 19 times higher in children with congenital heart disease. 22
11 State of the Nation Stroke statistics - January 2017
Gender, ethnicity and social deprivation
Gender
• Men are at higher risk of having a stroke at a younger age than
12 16
women.
• There are a greater number of stroke related deaths in
women. 23 24 25 This is because women live longer than men, and
women tend to have their strokes when they are older.
Ethnicity
Social deprivation
• In general, people from more deprived areas have an increased
risk of stroke. 29
• In general, people from more deprived areas are likely to
experience more severe strokes. 29
• On average, people from low and middle income countries
have strokes at a younger age than people from higher income
countries. 14
••
White people are more likely to have an irregular heartbeat
(such as atrial fibrillation), smoke and drink alcohol than black
people. 26 These are all factors that increase the risk of stroke.
••
Black people are twice as likely to have a stroke and at a younger
age than white people. 26
••
Black people are more likely to have high blood pressure and
diabetes than white people. This may contribute to higher
stroke risk in black people. 26
••
Black people are also more likely to have sickle cell disease,
which increases the risk of a stroke. 27
••
People with their origins in South Asian countries like India,
Pakistan, Nepal, Sri Lanka and Bangladesh, are more likely to
have a stroke at a younger age than white people. 28
••
People with South Asian origins are more likely to have high
blood pressure, high cholesterol and diabetes than white
people. These are all factors that increase the risk of stroke. 28
men
are at higher risk of
having a stroke at a
younger age than
women.
There are a greater
number of stroke
related deaths in
women
12 State of the Nation Stroke statistics - January 2017
Surviving stroke
• More people are surviving stroke than ever before. 14
• 9 out of 10 stroke survivors in England, Wales and Northern
Ireland are living at home six months after their stroke. 12
•
30 31 32 33
There are over 1.2 million stroke survivors in the UK.
• A quarter of all stroke survivors in England, Wales and Northern
Ireland who return home live alone. 12
Stroke prevalence:
% of UK population who are stroke survivors
Scotland
2.2%
A quarter
Wales
Northern Ireland
2.0%
1.8%
England
1.7%
0.0 0.5 1.0 1.5 2.0 2.5
• 85% of stroke patients in England, Wales and Northern Ireland
survive their stay in hospital, and two thirds of stroke survivors
return home or have supported discharge in their community
of all stroke survivors
in England, Wales and
Northern Ireland who
return home live alone.
13 State of the Nation Stroke statistics - January 2017
Deaths from stroke in the UK
• Stroke is the fourth biggest killer in the UK, but the third biggest
23 24 25
killer in Scotland.
Stroke mortality trend in the UK
Stroke mortality trend in the UK
• Over 40,000 people died of stroke in the UK in 2015. 23 24 25 That’s
a life lost every 13 minutes.
• 7% of all deaths in the UK are caused by stroke (6% of all deaths
in men, and 8% of all deaths in women. 23 24 25 )
• 1 in 8 strokes are fatal within the first 30 days. 34
• Stroke death rates in the UK fell by almost half in the period from
1990 to 2010. 14
• Stroke causes twice as many deaths a year in women than
23 24 25
breast cancer.
• Stroke causes twice as many deaths a year in men than prostate
23 24 25
and testicular cancer combined.
Morality rate per 100,000
80
70
60
50
40
30
20
10
0
71.20
1990
YEAR
2005
44.85
38.22
2010
Stroke mortality in the UK 2015
Country Male Female Total
England and Wales 14,414 20,469 34,883
Scotland 1,728 2,574 4,302
Northern Ireland 419 569 988
Total 16,561 23,612 40,173
14 State of the Nation Stroke statistics - January 2017
Stroke worldwide
• Every two seconds, someone in the world will have a stroke.
• There were almost 17 million incidences of first-time stroke
worldwide in 2010. 14
• Stroke is the second most common cause of death in the world,
causing around 6.7 million deaths each year, taking a life every five
seconds. 35
• The burden of stroke due to illness, disability and early death it
causes is set to double worldwide within the next 15 years. 14
• Almost 1 in 8 deaths worldwide are caused by stroke. 35
The 10 leading causes of death in the world
Ischaemic heart disease 7.4m
Stroke 6.7m
Our international work
The Stroke Association is the second largest Stroke Support
Organisation (SSO) in the world. In partnership with the World
Stroke Organisation (WSO) and the Stroke Alliance for Europe,
the Stroke Association supports new and emerging Stroke
Support Organisations across the world. These emerging
Stroke Support Organisations add a vital lifeline to stroke
survivors in their communities by:
••
helping people who make decisions about stroke care
understand what is important to people affected by stroke
••
providing support for people affected by stroke that nobody
else can or will provide
••
advocating on behalf of people affected by stroke.
In 2016 there were 23 SSOs registered as members of the
WSO from across Europe and 12 other countries worldwide.
COPD 3.1m
Lower respiratory infections 3.1m
Trachea bronchus lung cancers 1.6m
HIV / AIDS 1.5m
Diarrhoeal diseases 1.5m
Diabetes mellitus 1.5m
Road injury 1.3m
Hypertensive heart disease 1.1m
0 2 million 4 million 6 million 8 million
15 State of the Nation Stroke statistics - January 2017
The devastating
effects of stroke
16 State of the Nation Stroke statistics - January 2017
Effects of stroke
The effects of a stroke depend on where it takes place in the brain, and how big the
damaged area is.
Some effects of a stroke:
••
weakness in arms and legs
••
problems with speaking, understanding, reading and writing
••
swallowing problems
••
losing bowel and bladder control
••
pain and headaches
••
fatigue – tiredness that does not go away
••
problems with memory and thinking
••
eyesight problems
••
numb skin, and pins and needles.
Brain
Vision
Right arm
Bowels
Speech
Swallowing
Left arm
Bladder
Right leg
Left leg
17 State of the Nation Stroke statistics - January 2017
Disability after stroke
• Stroke is a leading cause of disability in the UK – almost two
thirds of stroke survivors in England, Wales and Northern
Ireland leave hospital with a disability. 36
• Stroke causes a greater range of disabilities than any other
condition. 36
• In a survey of over 1000 stroke survivors last year, 4 in 10 told
us the physical impact of stroke was the hardest to deal with. 37
• It is estimated that 60% of stroke survivors have visual
problems immediately after their stroke and this reduces to
about 20% by three months after stroke. 38
• Around a third of stroke survivors experience some level
of aphasia (sometimes called dysphasia). 39 40 41 Aphasia is a
complex disorder of language and communication caused by
damage
to the language centres of the brain. People with aphasia may
have difficulty speaking, reading, writing or understanding
language.
• Limb weakness is common after stroke:
• Over three quarters of stroke survivors report arm
weakness 42 , which can make it difficult for people to carry
out daily living activities.
60% 1 in 3
• Almost three quarters of stroke survivors report leg
weakness 42 , which can cause difficulty walking and
balancing.
of stroke survivors have visual
problems immediately after
their stroke.
stroke survivors have aphasia.
18 State of the Nation Stroke statistics - January 2017
Living with the effects of stroke
• Around half of stroke survivors require speech and language
therapy during their hospital stay after a stroke in England,
Wales and Northern Ireland. 12
• Fatigue is common after a stroke: half of stroke survivors report
fatigue. It can affect many aspects of daily life. It can be a
serious problem for people returning to work and is associated
with depression after stroke. 1
• Around half of stroke survivors have problems swallowing. 42
This can make eating and drinking difficult, and delays in
hospital assessments for swallowing are associated with a
higher risk of pneumonia. 43
• Loss of bladder and bowel control is a common problem for
stroke survivors. Around half of stroke survivors experience
problems with bladder control. 42
• Emotionalism, or difficulty controlling emotional responses
such as crying or laughing, is common after stroke.
Emotionalism affects about 1 in 5 stroke survivors in the first six
months after stroke. 44
Frontal Lobe
Behaviour and motivation
Temporal Lobe
Memory and Emotion
Parietal Lobe
Movement, sensation and
understanding language
Occipital Lobe
Understanding
what you see
Cerebellum
Balance and
Coordination
Brain Stem
Essential life
functions
19 State of the Nation Stroke statistics - January 2017
Impact on daily life
• 4 out of 10 stroke survivors leave hospital requiring help with daily
living activities but almost a third receive no social service visits. 12
• In Scotland, over half of people who have a stroke need help
from another person to be able to walk. 13
• Around a third of stroke survivors experience depression after
44 45
their stroke.
• Over half of stroke survivors experience symptoms of anxiety
at some point in the 10 years after their stroke. 46
• In a survey of over a thousand stroke survivors last year, 1 in 5
told us the emotional impact of stroke was hard to deal with. 37
• 42% of people report a negative change in their relationship
with their partner after a stroke. 47
• A quarter of people report that stroke had a negative impact on
their family. 47
• People of working age who have had a stroke are two to three
times more likely to be unemployed 8 years after their stroke. 48
• Around 1 in 6 stroke survivors experience a loss of income after
stroke. 47
• Almost a third of stroke survivors say they have to spend more
on daily living costs. 47
20 State of the Nation Stroke statistics - January 2017
Stroke risk factors
and prevention
21 State of the Nation Stroke statistics - January 2017
High blood pressure
• There are 9.5 million people in the UK diagnosed as having high
blood pressure, also known as hypertension. 30 31 32 33 That is 1 in 7
people in the UK.
• For every 10 people diagnosed with high blood pressure, seven
remain undiagnosed and untreated - this is more than 5.5 million
people in England alone. 49
• Treatment for high blood pressure significantly reduces the risk
of heart attacks, stroke and heart failure: Every 10mmHg
reduction in systolic BP reduces the risk of major cardiovascular
events by 20%. 49
• High blood pressure is a contributing factor in around half of
strokes in England, Wales and Northern Ireland. 12
Year
• The number of people diagnosed as having high blood pressure
30 31 32 33
has consistently increased since 2005.
Country (2014/15)
Wales 15.6%
Scotland 14.1%
England 13.8%
Northern Ireland 13.3%
UK average 13.9%
% High blood pressure
Prevalence of high blood pressure in the UK
Prevalence
14.0%
13.5%
13.0%
12.5%
12.0%
11.5%
11.0%
2005
11.4%
12.0%
12.6%
12.9%
13.2%
13.6%
13.4%
13.8%
13.7%
13.9% 13.9%
2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Blood pressure is the measure of how strongly blood presses
against the walls of the arteries when it is pumped around the
body. Blood pressure is measured in millimetres of mercury
(mmHg) and is given as two figures:
1. systolic pressure – the pressure when your heart pushes
blood out.
2. diastolic pressure – the pressure when your heart rests
between beats.
Normal blood pressure is around 120/80.
High blood pressure is considered to be 140/90 or higher.
22 State of the Nation Stroke statistics - January 2017
Diabetes
• There are 3.6 million people over 17 years old diagnosed as
30 31 32 33
diabetic in the UK – about 5% of the population.
• It is estimated there are another 850,000 people with
undiagnosed diabetes. 50
• Diabetes almost doubles the risk of stroke 50 and is a
contributing factor in up to 1 in 5 strokes in England, Wales
and Northern Ireland. 12
Country (2015-16)
Wales 5.9%
England 5.3%
Scotland 5.0%
Northern Ireland 4.5%
UK average 5.2%
% with diabetes
Diabetes is a condition that causes a person’s blood sugar level
to become too high. There are two main types of diabetes:
1. Type 1 diabetes develops when the immune system attacks
and destroys the cells producing insulin. Insulin is a hormone
that moves glucose from the bloodstream into body cells to
produce energy.
2. Type 2 diabetes develops when the body does not produce
enough insulin or when the body does not react to it in the
right way.
Persistently elevated glucose levels from diabetes can
increase the likelihood of atherosclerosis, where the
blood vessels become clogged up and narrowed by fatty
substances. This can increase the risk of stroke. 51
23 State of the Nation Stroke statistics - January 2017
Atrial fibrillation
• Atrial fibrillation (AF) is a heart condition that causes an irregular
and often abnormally fast heart rate.
30 31 32 33
• There are about 1.2 million people with AF in the UK.
• Stroke risk increases five-fold for people with AF. 53
12 13
• AF is a contributing factor in up to 1 in 5 strokes in the UK.
• AF often goes undiagnosed. It is estimated there could be
another half a million people in the UK with undiagnosed AF. 52
Treatment for AF
• Anticoagulant drugs, such as warfarin, can be given to people
with AF to reduce the risk of blood clots forming.
But, anticoagulants continue to be under-prescribed.
• In the UK, around a quarter (24%) of eligible patients with AF do
not receive anticoagulation. 52
• It is estimated that if AF were adequately treated, around 7,000
strokes would be prevented and over 2,000 lives saved every
year in England alone. 54
• Less than half (45%) of UK patients with known AF are on
anticoagulant medication when they go to hospital with
12 13
a stroke.
• 8 out of 10 UK stroke survivors with AF are prescribed
12 13
anticoagulant medication on discharge from hospital.
Example of AF heartbeat
24 State of the Nation Stroke statistics - January 2017
Other risk factors
A hole in the heart (PFO)
A patent foramen ovale (PFO) is also known as a hole in the heart.
It is an abnormal opening between the left and right upper chambers
of the heart, which can allow a clot to travel through the heart to the
brain. It is unclear, though, whether a PFO increases the risk of stroke
as some studies have shown that someone with a PFO is at no higher
risk of stroke than someone who does not have a PFO.
High cholesterol
••
Cholesterol is a fatty substance in the blood. It is a vital to the
healthy working of the body, but too much cholesterol in the
blood can cause deposits on artery walls and restrict blood
flow. 55 It can also raise the risk of developing a blood clot which
can lead to stroke.
Sickle cell disease
••
In sickle cell disease, red blood cells change from a round
shape to a crescent shape which can become stuck in the
blood vessels. This can cause health problems. It mainly
affects people of African, African-Caribbean, Asian and
Mediterranean heritage. 58
••
A quarter of people with sickle cell disease will have a stroke
before the age of 45. 27
••
Children with sickle cell disease have 333 times greater risk of
stroke than children without sickle cell disease. 59
••
The use of statins in people at high risk of a cardiovascular
event reduces the risk of stroke by 25%. 56
••
Reducing cholesterol by 1mmol/L reduces stroke risk by 21%. 57
The most common causes of high cholesterol are:
••
eating a diet that is high in saturated fat
••
smoking
••
lack of exercise
••
high alcohol intake
••
liver and/or kidney disease
••
genetics.
25 State of the Nation Stroke statistics - January 2017
Lifestyle
Alcohol
••
Regular consumption of large quantities of alcohol greatly
increases the risk of having a stroke. 60
••
When asked, 31% of adults in the UK reported drinking more
than recommended at least one day in the previous week. 61
Drinking over the recommended weekly amount of alcohol was
most common among adults aged 55 to 64.
Smoking
••
Smoking doubles the risk of death from stroke. 62
••
1 in 6 (18%) people in the UK are active smokers. 61
••
There are about 1.9 million visits to UK hospitals a year for
63 64 65 66
conditions related to smoking.
••
Shisha smoking carries the same risks as cigarette smoking.
••
In 2012, a study found that half of those younger than 45 who
had a stroke were active smokers; this rose to two thirds when
including ex-smokers. 67
Drugs
••
The same study found that 1 in 5 (20%) of those under 45 who
had a stroke had used illegal drugs.
••
Cocaine increases risk of stroke in the 24 hours following use. 68
Physical activity
••
Physical inactivity and a sedentary lifestyle increases your risk
of an ischaemic stroke by 50%. 84
••
Being overweight increases your risk of ischaemic stroke by
22% and being obese by 64%. 85
••
Moderate exercise can reduce your risk of stroke by up to 27%. 86
Modifiable risk factors
Many stroke risk factors are known as modifiable risk factors:
factors that people can try to manage or improve through their
own behaviour. Managing modifiable risk factors, such as poor
diet, smoking or being overweight can help with other risk
factors, such as high blood pressure and diabetes, and in turn
reduce stroke risk.
A large international study published in 2016 found that
10 modifiable risk factors are associated with 9 out of 10
strokes worldwide. 69
26 State of the Nation Stroke statistics - January 2017
Stroke treatment
and care
27 State of the Nation Stroke statistics - January 2017
Act FAST
To receive the best possible treatment and care it is vital that everyone with
a suspected stroke arrives at hospital as quickly as possible and receives
timely diagnosis. Public awareness of the FAST test can help people
to identify the signs of stroke and call 999 as quickly as possible.
• Almost a third of people who went to hospital with a stroke in England,
Wales and Northern Ireland in 2015–16 did not know what time their symptoms
started. 12
• 82% of people having a stroke arrived at hospital by ambulance. 12
Facial
weakness
Arm
weakness
Speech
problems
Time
to call 999
• About half of patients who go to hospital while having a stroke in England, Wales
and Northern Ireland receive a brain scan within an hour of arriving. In Scotland,
12 13
just over half receive a brain scan within four hours.
• Across the UK, almost 9 out of 10 of stroke patients receive a brain scan within
12 13
12 hours.
• More than half of patients who received the clot-busting treatment,
thrombolysis, in the UK received it within an hour of arriving in hospital in 2015–
16. If the time when symptoms started is unknown, or it is more than four and a
12 13
half hours after symptoms started, the treatment cannot be provided.
• 1 in 5 patients are not assessed to see if they can swallow properly within four
hours of arriving in hospital. In Scotland, 20% do not have their swallow assessed
on the day they are admitted, 12 13 although this is improving each year.
• It takes an average of seven hours from the onset of symptoms to be admitted
to a stroke unit. 12
Guideline for scanning times
A new National Clinical Guideline for Stroke
was published in 2016. The fifth edition of
the guideline on how stroke care should be
provided in the UK recommends that patients
with suspected acute stroke should now
receive a brain scan within one hour of arrival
at hospital. The previous edition of the
guideline, published in 2012, recommended
scanning some patients within one hour
(such as people who may be eligible for
thrombolysis) and all other patients should be
scanned within 12 hours. 1
• In Scotland, 8 out of 10 people are admitted to a stroke unit within 24 hours. 12
28 State of the Nation Stroke statistics - January 2017
Stroke units
• A stroke unit is a specialist hospital ward where stroke patients
are cared for by a team of professionals who specialise in stroke
care. 70
12 13
• 9 out of 10 stroke patients are cared for on a stroke unit.
• Only 77% of patients are taken straight to a stroke unit in
England, Wales and Northern Ireland. This means that 23% of
people are treated on general wards without stroke specialists
early in their treatment. 12
Hyper-acute stroke units (HASU)
HASUs are a type of stroke unit that exist in some hospitals in
the UK. HASUs should bring experts and specialist equipment
under one roof to provide world-class treatment 24 hours a
day, seven days a week.
HASUs have been adopted in several locations. In London the
model saves an extra 96 lives each year. In Greater Manchester
it has reduced the length of hospital stays by two days.
• Stroke patients who are cared for on stroke units are more
likely to be alive and living independently a year after having a
stroke than those cared for on other wards. 71
• 4 out of 10 hospitals in England, Wales and Northern Ireland
have a shortage of stroke consultants. 72
29 State of the Nation Stroke statistics - January 2017
Treatments for ischaemic stroke (due to a clot )
Clot-busting treatment
(thrombolysis)
Thrombolysis is a treatment that uses drugs to break down and
disperse a clot for people who have had an ischaemic stroke. It is
licenced to be used up to four and a half hours from the onset of
73 74
stroke symptoms.
• An estimated 1.9 million neurons are lost every minute a stroke
is untreated. 75
• 12% of stroke emergencies in the UK are eligible to receive
thrombolysis 12 , this is around 10,000 people. Of these, 85%
12 13
receive thrombolysis treatment.
• 6 out of 10 stroke patients in England, Wales and Northern
Ireland arrived at hospital after the 4.5 hour time window in
2015–16, or had a stroke during sleep so the time could not be
calculated. 12
• The average door-to-needle time in the UK is around 55
1213
minutes.
••
When thrombolysis is given within three hours, 1 in 10 more
eligible patients will be alive and living independently. 76
Mechanical clot retrieval
(thrombectomy)
Thrombectomy is a procedure that mechanically pulls the blood
clot out of the brain. It can be performed in the early hours after a
stroke happens.
••
About 9,000 patients per year may be eligible for
thrombectomy, 77 it is shown to reduce the chance of disability
after stroke and NICE guidance says it is safe and effective. 78
••
There are a few centres where thrombectomy is available in the
UK, but there are not enough of trained professionals for the
service to be rolled out across the UK:
••
Because the treatment is not fully commissioned
yet, almost a third of hospitals have no access to
thrombectomy either on site or by referring to another
hospital. 72
••
Just 83 consultants in England, Wales and Northern Ireland
reported they could undertake the procedure as of 2016. 72
••
Adoption of thrombectomy treatment has been slow in the UK
compared to Germany, France and the US.
••
About 400 patients received received thrombectomy
treatment in England, Wales and Northern Ireland in 2015-16, 72
but as many as 9,000 UK patients could have been eligible. 77
30 State of the Nation Stroke statistics - January 2017
Rehabilitation and life after stroke support
Rehabilitation
• Although the biggest steps in recovery are usually in the first
few weeks after a stroke, the brain’s ability to ‘re-wire’ itself,
known as neuroplasticity, means it is possible to improve for
months or years. 79
• Over a third of stroke survivors are discharged to an Early
Supported Discharge (ESD) or community rehabilitation team
in England, Wales and Northern Ireland. The majority of stroke
survivors discharged via these routes are cared for by stroke
or neurology specialist teams. 12
• 19% of hospitals in England, Wales and Northern Ireland do not
offer ESD services. 72
• 56% of stroke survivors are discharged from hospital having
been assessed for all appropriate therapies and with agreed
goals for their rehabilitation. 72
• 1 million stroke survivors in England, Wales and Northern
Ireland need post-acute care (care received after a stay
in hospital). 80
Early Supported Discharge (ESD)
ESD is the discharge of a stroke survivor from hospital to their
own home, co-ordinated by a team of therapists, nurses and
a doctor. Rehabilitation is then provided in the patient’s own
home instead of in hospital.
31 State of the Nation Stroke statistics - January 2017
Rehabilitation and life after stroke support
Life after stroke support
• Only 3 out of 10 stroke survivors who need a six month
assessment receive one. 12 A six month review monitors how
well stroke survivors are recovering and identifies additional,
tailored support that may be needed to prevent unnecessary
readmissions to hospital and care homes.
• 20% of stroke survivors who have a psychological assessment
at their six month review in England, Wales and Northern Ireland
need support. 12 However, stroke survivors wait an average of 10
weeks after referral to receive psychological treatment. 80
• In 2015, only 15% of post-acute services in England, Wales and
Northern Ireland were commissioned to help people return to
work after their stroke. 80
• In 2015, 1 in 3 commissioning areas in England, Wales and
Northern Ireland did not commission family and carer support
services. 80
• In 2015, 1 in 5 commissioning areas in the England, Wales and
Northern Ireland did not offer access to speech and language
therapy for stroke survivors. 80
Guideline for six month reviews
A new National Clinical Guideline for Stroke was published
in 2016. The fifth edition of the guideline on how stroke care
should be provided in the UK recommends that stroke survivors,
including those living in a care home, should be offered a
structured health and social care review at six months and 1 year
after the stroke, and then annually. The review should consider
whether further interventions are needed, and the person
should be referred for further specialist assessment if:
••
new problems are present;
••
the person’s physical or psychological condition, or social
environment has changed. 1
Life After Stroke Services
The Stroke Association is UK’s leading stroke service provider,
working with stroke survivors and their families to help them to
make the best possible recovery by:
••
Giving 80,000 people the information they need through
the Stroke Association website, our helpline and stroke
information resources.
••
Offering vital support to around 60,000 people after a stroke
through our Life After Stroke services.
••
Making support available for recovery in the long-term
through our ~457 stroke clubs and groups.
32 State of the Nation Stroke statistics - January 2017
Economic impact
of stroke
33 State of the Nation Stroke statistics - January 2017
The cost of stroke to health and social care
••
The NHS and social care costs of stroke are around £1.7 billion
a year in England. 81
••
The average NHS and social care cost for each person that
has a stroke is about £22,000 a year, and around £45,000 over
five years. 81
••
The older you are when you have a stroke, the more
expensive the care. 81
Costs broken down:
••
one day on a hyper-acute stroke unit (HASU): £583
••
one month of ESD service: £213-£535
••
a single treatment of thrombolysis: £480
••
a week in a care home: £523.
••
The NHS could save £4,100 over five years for each stroke
patient given thrombolysis, and £1,600 over five years for each
patient discharged with Early Supported Discharge, because of
better health-related outcomes. 81
••
Previous research has estimated that stroke costs the UK
around £9 billion a year as a society. This includes £2.4 billion
a year in informal care costs, £1.3 billion in lost income due
to care, disability and death, and over £800 million in benefit
payments. 82
34 State of the Nation Stroke statistics - January 2017
Research spend in the UK
Total government and charity research funding
••
In 2012, £56 million was spent on stroke research in the UK.
This figure is dwarfed by the comparable spend on cancer
research (£544 million). Stroke also receives considerably
less funding than coronary heart disease (£166 million) and
dementia research (£90 million). 83
Total spend on research for each person with the disease
••
For every cancer patient living in the UK, £241 is spent each
year on medical research, compared with just £48 a year for
every stroke patient. That’s about a fifth of the comparable
spend on cancer and less than half of the comparable spend on
dementia research (£118). 83
Cancer
544
Cancer
241
Coronary
heart disease
Dementia
90
166
Dementia
Coronary
heart disease
73
118
Stroke
56
Stroke
48
0 100 200 300 400 500 600 700
0 50 100 150 200 250
300
Spend in millions (£)
Spend (£)
Research into the psychological consequences of stroke
As part of our five-year research strategy we made a commitment to work with others to achieve a clear vision about the future
priorities for stroke research. We want to ensure that these priorities reflect expert opinion as well as the views of stroke survivors
and their families. One of these priorities is research into the psychological consequences of stroke.
While physical impairment after a stroke may be easily seen and diagnosed, the psychological effects of stroke often remain hidden,
may go unrecognised by some healthcare professionals, with the true impact remaining unknown. The Priority Programme for the
psychological consequences of stroke research aims to fund research that will address these issues.
35 State of the Nation Stroke statistics - January 2017
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37 State of the Nation Stroke statistics - January 2017
We are the Stroke Association
We believe in life after stroke. That’s why we support
stroke survivors to make the best recovery they can.
It’s why we campaign for better stroke care. And it’s
why we fund research to develop new treatments
and ways of preventing stroke.
We’re here for you. Together we can conquer stroke.
If you’d like to know more please get in touch.
Stroke Helpline: 0303 3033 100
Website: stroke.org.uk
Email: info@stroke.org.uk
From a textphone: 18001 0303 3033 100
We are a charity and we rely on your support to
change the lives of people affected by stroke and
reduce the number of people who are struck down
by this devastating condition.
Please help us to make a difference today.
© Stroke Association, 2017
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Twitter @TheStrokeAssoc
Stroke Association is a Company Limited by Guarantee, registered in England and Wales (No 61274). Registered office: Stroke Association House, 240 City Road, London EC1V 2PR.
Registered as a Charity in England and Wales (No 211015) and in Scotland (SC037789). Also registered in Northern Ireland (XT33805) Isle of Man (No 945) and Jersey (NPO 369).
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