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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


References

1. Intercollegiate Stroke Working Party. National clinical guideline for stroke, 5th edition.

London: Royal College of Physicians 2016.

2. Bhalla A, Wang Y, Rudd A, Wofle CD (2013). Differences in outcome and predictors between

ischemic and intracerebral hemorrhage: the South London Stroke Register. Stroke 44:

2174-2181.

3. Chandratheva A, Mehta Z, Geraghty OC, Marquardt L, Rothwell PM (2009). Population-based

study of risk and predictors of stroke in the first few hours after a TIA. Neurology 72: 1941-1947.

4. Coull AJ, Lovett JK, Rothwell PM (2004). Population based study of early risk of stroke after

transient ischaemic attack or minor stroke: implications for public education and organisation

of services. BMJ 2004; 328:326.

5. Johnston SC, Gress DR, Browner WS, Sidney S (2000). Short-term prognosis after emergency

department diagnosis of TIA. JAMA;284:2901-2906.

6. Neuropathology Group of the Medical Research Council Cognitive Function and Aging Study

(2001). Pathological correlates of late-onset dementia in a multicentre, community-based

population in England and Wales. Lancet 357: 169-175.

7. Schmidt R, Fazekas F, Kapeller P, Schmidt H, Hartung HP (1999). MRI white matter

hyperintensities: three-year follow-up of the Austrian Stroke Prevention Study. Neurology 53:

132-139.

8. Garde E, Mortensen EL, Krabbe K, Rostrup E, Larsson HB (2000). Relation between age-related

decline in intelligence and cerebral white-matter hyperintensities in healthy octogenarians: a

longitudinal study. Lancet 356: 628-634.

9. Iadecola C (2013). The pathology of vascular dementia. Neuron 80: 844-866.

10. Wardlaw JM, et al. (2013). Neuroimaging standards for research into small vessel disease and

its contribution to ageing and neurodegeneration. Lancet Neurology 12: 822-838.

11. Royal College of Physicians Sentinel Stroke National Audit Programme (SSNAP). Is stroke care

improving? Second SSNAP Annual Report prepared on behalf of the Intercollegiate Stroke

Working Party November 2015.

12. Royal College of Physicians Sentinel Stroke National Audit Programme (SSNAP). National

clinical audit annual results portfolio March 2015-April 2016. Available: http://bit.ly/1M5R3Op

Last accessed 26 October 2016.

13. ISD Scotland. (2016). Scottish Stroke Care Audit, Scottish Stroke Improvement Programme

Report-2016. Available: http://bit.ly/29uWaYZ Last accessed 26October 2016.

14. Feigin VL, et al. (2013). Global and regional burden of stroke during 1990-2010: findings from

the Global Burden of Disease Study 2010. Lancet 383: 245-255.

15. Mohan KM, Wolfe CD, Rudd AG, Heuschmann PU, Kolominsky-Rabas PL, Grieve AP (2011).

Risk and Cumulative Risk of Stroke Recurrence: A Systematic Review and Meta-Analysis.

Stroke 42:1489-1494.

16. NHS Digital. (2015). Bespoke requested data.

17. Wang Y, Rudd AG, Wolfe CD (2013). Age and ethnic disparities in incidence of stroke over time:

the South London Stroke Register. Stroke 44:3298-3304.

18. Warren, L (2011). Childhood Hemorrhagic Stroke: An Important but Understudied Problem.

Journal of Child Neurology 26: 1174-1185.

19. Fullerton HJ, Wu YW, Zhao S, Johnston SC (2003). Risk of stroke in children: ethnic and gender

disparities. Neurology 61: 189-194.

20. Roach ES, et al (2008). Management of Stroke in Infants and Children: A Scientific Statement

From a Special Writing Group of the American Heart Association Stroke Council and the

Council on Cardiovascular Disease in the Young. Stroke 39: 2644-2691.

21. Fullerton HJ, et al (2015). Infection, vaccination, and childhood arterial ischemic stroke:

Results of the VIPS study. Neurology 85: 1459-1466.

22. Fox CK, Sidney S, Fullerton HJ (2015). Community-based case-control study of childhood

stroke risk associated with congenital heart disease. Stroke 46: 336-340.

23. Office for National Statistics. (2016). Deaths registered in England and Wales: 2015. http://

bit. ly/2h7Om7P Last accessed 20 December 2016.

24. National Records of Scotland. (2016). Deaths by sex, age and cause, Scotland, 2015. http://bit.

ly/2h671Pu Last accessed 20 December 2016.

25. Northern Ireland Statistics and Research Agency (NISRA). (2016). Deaths, by sex, age and

cause, 2015. http://bit.ly/29ffuON Last accessed 20 December 2016.

26. Wang Y, Rudd AG, Wolfe CD (2013). Age and ethnic disparities in incidence of stroke over time:

the South London Stroke Register. Stroke 44: 3298-3304.

27. Ohene-Frempong K, et al (1998). Cerebrovascular accidents in sickle cell disease: rates and

risk factors. Blood 91: 288-294.

28. Banerjee S, Biram R, Chataway J, Ames D (2009). South Asian strokes: lessons from the St

Mary’s stroke database. Q J Med 2010 103: 17-21.

29. Marshall IJ, et al (2015). The effects of socioeconomic status on stroke risk and outcomes.

Lancet Neurology 14: 1206-1218.

30. NHS Digital. (2016). Quality Outcomes Framework (QOF) – 2015-16. Available http://bit.

ly/2gC6LWb Last accessed 20 December 2016.

31. Welsh Government. (2016). General Medical Services Quality and Outcomes Framework

Statistics for Wales 2015-16. Available http://bit.ly/2hQzI46 Last accessed 20 December

2016.

32. ISD Scotland. (2016). Quality and Outcomes Framework 2015-16. Available http://bit.

ly/2hPEpZv Last accessed 20 December 2016.

33. Department of Health. (2016). Quality and outcomes framework (QOF) achievement data

2015/16. Available http://bit.ly/2hQNsMB Last accessed 20 December 2016.

34. Bray BD, et al (2016). Weekly variation in health-care quality by day and time of admission: a

nationwide, registry-based, prospective cohort study of acute stroke care. Lancet 388:170-177.

35. World Health Organisation. (2014). The top 10 causes of death. Available http://bit.

ly/1c9a3vO Last accessed 20 December 2016.

36. Adamson J, Beswick A, Ebrahim S (2004). Is stroke the most common cause of disability?

Journal of Stroke and Cerebrovascular Diseases 13:171-177.

37. Stroke Association: A New Era for Stroke, our campaign for a new national stroke strategy.

(2016).

38. Rowe F (2013). Care provision and unmet need for post stroke visual impairment. Available:

http://bit.ly/2iMfarz. Last accessed 06 January 2017.

39. Engelter ST, et al (2006). Epidemiology of Aphasia Attributable to First Ischemic Stroke.

Stroke 37:1379-1384.

40. Berthier ML (2005). Poststroke aphasia : epidemiology, pathophysiology and treatment. Drugs

Aging 22:163-82.

41. Dickey L, et al (2010). Incidence and profile of inpatient stroke-induced aphasia in Ontario,

Canada. Archives of Physical Medicine and Rehabilitation. 91:196-202.

42. Lawrence ES, et al (2001). Estimates of the Prevalence of Acute Stroke Impairments and

Disability in a Multiethnic Population. Stroke 32:1279-1284.

43. Bray BD, et al (2016). The association between delays in screening for and assessing

dysphagia after acute stroke, and the risk of stroke-associated pneumonia. Published Online

First. Accessed: 06 January 2017. doi:10.1136/jnnp-2016-313356.

44. Hackett ML, Yapa C, Parag V, Anderson CS (2005). Frequency of Depression After Stroke A

Systematic Review of Observational Studies. Stroke 36:1330-1340.

36 State of the Nation Stroke statistics - January 2017


45. Ayerbe L, et al (2015). Explanatory factors for the association between depression and longterm

physical disability after stroke. Age Ageing 44:1054-1058.

46. Ayerbe L, et al (2014). Natural history, predictors and associated outcomes of anxiety up to 10

years after stroke: the South London Stroke Register. Age Ageing 43:542-547.

47. McKevitt C, et al (2011). Self-Reported Long-Term Needs After Stroke. Stroke 42:1398-1403.

48. Maaijwee NA, et al (2014). Long-term increased risk of unemployment after young stroke: a

long-term follow-up study. Neurology 83:1132-1138.

49. British Heart Foundation, Public Health England, Stroke Association, Royal College of General

Practitioners, Primary Care Leadership Forum, Blood Pressure UK and British and Irish

Hypertension Society (2016). High blood pressure: How can we do better? Data collated

and visualised by the National Cardiovascular Intelligence Network (NCVIN) in Public Health

England. Available: http://bit.ly/2ju4O31 Last accessed 09 January 2017.

50. Department of Health. Cardiovascular Disease Outcomes Strategy (2013). Improving

outcomes for people with or at risk of cardiovascular disease. Available: http://bit.ly/1aN51FO

Last accessed 09 January 2017.

51. NHS choices. Diabates. Available: http://bit.ly/1fTlDYZ last accessed 09 January 2017.

52. Greater Manchester Academic Health Science Network (2017). UK atrial fibrillation audit.

Unpublished dataset, cited with permission.

53. Savelieva I, Bajpai A, Camm AJ (2007). Stroke in atrial fibrillation: Update on pathophysiology,

new antithrombotic therapies, and evolution of procedures and devices. Annals of Medicine

39: 371-391.

54. National cardiovascular intelligence network. Cardiovascular (CVD) intelligence packs.

Available: http://www.yhpho.org.uk/ncvinintellpacks/Default.aspx. Last accessed 22

December 2015.

55. NHS choices. High cholesterol. Available: http://bit.ly/2i6aWOs Last accessed 09 January 2017.

56. MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20536 highrisk

individuals: a randomised placebo-controlled trial. Heart Protection Study Collaborative

Group, ROYAUME-UNI (2002). Lancet 360: 2-3, 7-22 [18 page(s) (article)] (66 ref.)

57. Amarenco P, Labreuche J (2009). Lipid management in the prevention of stroke: review and

updated meta-analysis of statins for stroke prevention. Lancet Neurology 8:453–63.

58. NHS choices. Sickle cell disease. Available: http://bit.ly/2i92Lwd Last accessed 09 January

2017.

59. Verduzco LA, Nathan DG (2009). Sickle Cell Disease and Stroke. Blood 114: 5117-5125.

60. Guiraud V, Amor MB, Mas JL, Touze E (2010). Triggers of Ischemic Stroke. Stroke. 41: 2669-2677.

61. NHS Digital (2016). Health Survey for England, 2015. Available http://bit.ly/2iVUnnL Last

accessed 09 January 2017.

62. Thun MJ, et al (2013). 50-Year Trends in Smoking-Related Mortality in the United States.

N Engl J Med 368:351-64.

63. NHS Digital (2016). Statistics on Smoking, England 2016. Available: http://content.digital.nhs.

uk/catalogue/PUB20781 Last accessed 09 January 2017.

64. Scottish Government. Health of Scotland’s population – smoking. Available: http://bit.

ly/2iLcZUy Last accessed 12 January 2017.

65. Welsh Government (2012). Tobacco and Health in Wales, 2012. Available: http://bit.ly/2jnu3jV

Last accessed 12 January 2017.

66. Public Health Agency (2015). Tobacco Control Northern Ireland. Available: http://bit.

ly/28KwlV8 Last accessed 12 January 2017.

67. de los Rios F, et al. (2012). Trends in Substance Abuse Preceding Stroke Among Young Adults.

Stroke. 43:3179-3183.

68. Cheng YC, et al. (2016). Cocaine Use and Risk of Ischemic Stroke in Young Adults. Stroke

47:918-922.

69. O’Donnell MJ, et al (2016). Global and regional effects of potentially modifiable risk factors

associated with acute stroke in 32 countries (INTERSTROKE): a case-control study. Lancet

388:761-775.

70. Royal College of Physicians Sentinel Stroke National Audit Programme (SSNAP). Mind the gap!

Third SSNAP Annual Report prepared on behalf of the Intercollegiate Stroke Working Party

November 2016.

71. Stroke Unit Trialists’ Collaboration (2007). Organised inpatient (stroke unit) care for stroke.

The Cochrane Database of Systematic Reviews. 2007 Oct 17;(4):CD000197.

72. Royal College of Physicians Sentinel Stroke National Audit Programme (SSNAP). Acute

organisational audit 2016 prepared on behalf of the Intercollegiate Stroke Working Party.

Available http://bit.ly/2ivXRdv Last accessed 09 January 2017.

73. National Institute for Health and Care Excellence (2012). Alteplase for treating acute

ischaemic stroke. Available: http://www.nice.org.uk/guidance/ta264/chapter/4-

consideration-of-the-evidence. Last accessed 09 January 2015.

74. Scottish Intercollegiate Guidelines Network. (2008). Management of patients with stroke

or TIA: assessment, investigation, immediate management and secondary prevention. A

national clinical guideline. Available: http://www.sign.ac.uk/pdf/sign108.pdf. Last accessed

09 January 2015.

75. Saver JL (2005). Time Is Brain – Quantified. Stroke. 37:263-266.

76. The IST-3 collaborative group. (2012). The benefits and harms of intravenous thrombolysis

with recombinant tissue plasminogen activator within 6 h of acute ischaemic stroke (the third

international stroke trial [IST-3]): a randomised controlled trial. The Lancet 379;9834: 2352-2363.

77. McMeekin P, White P, James M, Price C, FlynnD and Ford G. Estimating the number of

stroke patients in the UK that could be treated with Mechanical Thrombectomy (MT). Paper

presented at: UK Stroke Forum, 2016. 28-30 November, 2016; Liverpool, UK.

78. National Institute for Health and Care Excellence (2016). Mechanical clot retrieval for treating

acute ischaemic stroke. Available: https://www.nice.org.uk/guidance/ipg548 Last accessed

09 January 2017.

79. Wolf SL, et al (2008). The EXCITE Trial: Retention of Improved Upper Extremity Function

Among Stroke Survivors Receiving CI Movement Therapy. Lancet Neurol. 7: 33-40.

80. Royal College of Physicians Sentinel Stroke National Audit Programme (SSNAP). Post-acute

audit 2015 prepared on behalf of the Intercollegiate Stroke Working Party. Available http://bit.

ly/2j0gWI4 Last accessed 09 January 2017.

81. Royal College of Physicians Sentinel Stroke National Audit Programme (SSNAP). Stroke health

economics: Cost and Cost-effectiveness analysis 2016. Last accessed 09 January 2017.

82. Saka O, McGuire A, Wolfe C. (2009). Cost of stroke in the United Kingdom. Age and Ageing 38:

27-32.

83. Stroke Association (2014). Research Spend in the UK: Comparing stroke, cancer, coronary

heart disease and dementia. Available: http://www.stroke.org.uk/research-spend-uk. Last

accessed 09 January 2015.

84. World Health Organisation. Risk factor: physical inactivity. Available: http://www.who.int/

cardiovascular_diseases/en/cvd_atlas_08_physical_inactivity.pdf. Last accessed 09 January 2015.

85. Strazzullo P, et al. (2010). Excess body weight and incidence of stroke: Meta-analysis of

prospective studies with 2 million participants. Stroke 2010; 41 e418-e426.

86. Lee CD, Folsom AR, Blair SN. (2003). Physical Activity and Stroke Risk. Stroke. 2003; 34: 2475-

2481.

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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