‘Focus on Stroke’ Ross Evans

because Stroke is one of the top clinical conditions demanding attention. It can cause great physical, cognitive, sensory, social and financial damage

Stroke is cruel it can hit you out of nowhere and rob you of your speech, your ability to walk, your memory, your independence and your dignity it can kill you in an instant and it’s more common than you might think. Stroke is the UK’s fourth biggest killer. “It was a difficult time for me both physically and emotionally. I was 26 years old and my whole life changed in a matter of months. My studies had to be put on hold so I could have my treatments but I managed to return over half a year later to finish my dissertation.”

Wales/UK 1 in 5 strokes are fatal within the first 30 days[1][2] 1 in 3 strokes are fatal within the first year[3] Stroke will take a life every 13 minutes in the UK Stroke is the 4th SINGLE leading cause of mortality in the UK Almost 1 in 10 (9%) of all deaths in the UK is caused by stroke[5] The latest figures show 49,682 people died of stroke in 2010; 19,171 men and 30,511 women[3] The burden of disease (disability, illness and premature deaths) caused by stroke is set to DOUBLE worldwide by 2030[6] Stroke is sometimes quoted as the 4th largest cause of mortality in the U.K. This is because respiratory diseases (pneumonia, asthma, flu, lung disease, etc) is bunched into one umbrella term “respiratory diseases”. However when respiratory diseases are separated stroke is the 3rd SINGLE cause of mortality. Although mortality percentage was remained the same, the number of deaths have increased. This is primarily due to the increasingly aging population.

Wales/UK There are roughly 65,000 Stroke Survivors across Wales Every year there are roughly 7,000 Strokes across Wales There are roughly 65,000 Stroke Survivors across Wales Stroke kills twice as many women as breast cancer… and more than 1.5 times as many men as prostate and testicular cancer combined. Thanks to improvements to stroke care; you are twice as likely to survive a stroke, compared to 20 years ago. Stroke is sometimes quoted as the 4th largest cause of mortality in the U.K. This is because respiratory diseases (pneumonia, asthma, flu, lung disease, etc) is bunched into one umbrella term “respiratory diseases”. However when respiratory diseases are separated stroke is the 3rd SINGLE cause of mortality. Although mortality percentage was remained the same, the number of deaths have increased. This is primarily due to the increasingly aging population.

Stroke is the number one cause of long-term adult disability. Stroke is second biggest killer in the world.

Stroke is a Brain Attack What is a stroke? Stroke is a Brain Attack  

A stroke happens when the blood supply to the brain is cut off causing brain damage; it can be fatal. There are two causes of strokes; a brain haemorrhage, when a blood vessel bursts also known as haemorrhagic stroke. The other cause is a blockage (or clot) in the artery that carries blood to the brain, known as ischaemic stroke, accounting for 85% of all stroke.

Transient Ischaemic Attack (TIA) stroke symptoms resolved within 24 hours.

TIA- Long Term Impact It is often assumed that TIA has no long-lasting effects, yet people tell us that they experienced problems ranging from muscle weakness, poor memory and fatigue to anxiety and panic attacks. “It has affected me mentally. Shock to everyone because I look so healthy. Years later, still feel anxious it might happen again.” “Overall this has had a huge impact as it has affected my work, confidence and mentality.” “I began to feel suicidal and my GP referred me for counselling.”

MUST be treated as a medical EMERGENCY A stroke, even a suspected one MUST be treated as a medical EMERGENCY to ensure brain function is preserved and to save lives. Thrombolysis within 4.5hrs

The impact of stroke can be devastating, with far reaching consequences for patients, families and their carers.   … For many patients, the full impact of a stroke is only realised following discharge from hospital when survivors are left to adjust suddenly and unaided to the full impact of the stroke on their life at home.   It is at this stage that many report a sense of ‘abandonment’ and have difficulty accessing the services they need.

The most common include: The effects of stroke are too numerous to list; they are cognitive, physical and emotional. The most common include: weakness or paralysis on one side of the body; chronic pain and / or chronic fatigue; depression, loss of confidence and of self-identity; visual and perceptual difficulties; communication difficulties, including severe ones such as Aphasia stroke survivors also face the barriers of negative public attitudes and of poor service provision.

stroke causes a greater range of impairments than any other condition

Vision and Stroke Central vision loss – partial or complete loss of vision in one or both eyes Visual field loss – most common is losing the right or left side of vision out of each eye – known as homonymous hemianopia Problems with the nerves controlling eye movement – this can include nystagmus, a condition that causes the eyes to move continually Visual processing problems – ie affecting the ability to receive visual information that is then processed by the brain to find out what it means, such as colours or familiar objects or people However, visual problems still not widely recognised as a symptom of stroke or as an issue that affects stroke survivors

Impact of visual impariment Limits quality of life (Tsai et al, 2004) Increased depression (Tsai et al, 2003) Poor functional ability (McKenna, 2006; Park et al, 2005) Increased risk of falls (Overstall, 1995) Jones (2006) states that neglect negatively affects rehabilitation Increased dependence on others (Jones, 2006; Jacobs et al, 2004) Emotional impact of sight loss and self esteem Recovery is usually seen within the first 3-6 months if it is going to occur British and Irish Orthoptic society, Jones 2006, Shen et al 2006

‘We were not told about Aphasia for about six weeks by any medical staff – we thought he understood but could not speak.’ ‘I’ve battled with depression and fatigue, but I no longer consider suicide on a daily basis…’ ‘It’s a journey that feels like it will never end… two and a half years after, I suffer from cognitive and emotional issues, I feel I’m not there for my family anymore…’

: the single most important risk factor by the age of 75, 1 in 5 women and 1 in 6 men 1 in 4 (26%) of strokes in people aged under 65 around 1 in 150 strokes in the UK in people aged under 20 around 400 childhood strokes a year in the UK 1 in 4,000 babies have a stroke at birth worldwide – around 200 strokes in babies a year in the UK

The three main risk factors Hypertension- Contributing factor in 54% of Stroke Atrial Fibrillation (AF)- Increases your risk of stroke by 5 times TIA Up to 80% of all strokes are preventable by living a healthy lifestyle

public awareness campaign National public awareness campaign January – March 2015

Infographic English

mainstream media and social media posters and leaflets in all in main hospitals and across all primary care settings, including the 714 community pharmacies across Wales awareness talks and events with c 500 blood pressure readings bus advertising, over 600 busses targeted pharmacy work (quiz, promotion of MUR and DMR)

What do we Offer?? Life After Stroke services across all Health Boards These include 22 IAS and CS services LAS Grants; Means tested recovery and activity grants up to £300 and Hardship Grants up to £100 Voluntary Peer Support Groups Campaigns; FAST, TIA, Action on Stroke Month Fundraising events; Step Out For Stroke New online self management platforms; My Stroke Guide Stroke Training Research; New Wales Research Strategy 2015-2020

What can we achieve Together? Greater awareness of Stroke and an understanding of the long term impacts Many Strokes are avoidable; if mini-stroke symptoms were recognised, diagnosed and promptly treated, a person’s risk of stroke could be reduced by as much as 80% An understanding of the number of people who experience visual problems following a stroke with an aim of providing a greater quality of care post stroke Better Support when Stroke Survivors leave hospital; People need appropriate therapies, rehabilitation, coordinated health and social care services, access to ophthalmology appointments plus access to the right information and advice. Work to make sure appointments are timely, prioritised and not delayed.

We’re for Life After Stroke