Getting the priorities right for stroke care

BMJ 2009; 338 doi: (Published 04 June 2009) Cite this as: BMJ 2009;338:b2083
  1. Cathie Sudlow, clinical senior lecturer,
  2. Charles Warlow, emeritus professor of medical neurology
  1. 1Division of Clinical Neurosciences, University of Edinburgh, Western General Hospital, Edinburgh EH4 2XU
  1. Correspondence to: C Sudlow cathie.sudlow{at}

    Cathie Sudlow and Charles Warlow question whether the current emphasis on hyperacute stroke care to improve access to thrombolysis may distract attention and resources from a truly comprehensive stroke service

    Stroke services in the UK are currently being overhauled in response to the UK government’s 2007 national stroke strategy.1 The strategy was developed after the National Audit Office (NAO) report on stroke services laid out the features of a first rate service and how improvements in the service could reduce death, disability, and recurrent stroke along with costs.2 The strategy highlights markers of a quality service (box) that are entirely appropriate. However, possibly inaccurate estimates of clinical benefits and cost savings in the NAO report may have influenced subsequent plans for stroke services.3 4 These have a strong emphasis on hyperacute stroke care (the first 72 hours) and on greatly increasing the proportion of patients being given intravenous thrombolysis, but with the risk that the many other effective components of a comprehensive stroke service might not receive as much attention. The stroke strategy for London is a good example.5

    Markers of quality stroke service from UK stroke strategy1

    • Awareness raising—Educating the public and health and care staff

    • Managing risk—Assessment and management of vascular risk factors

    • Information and advice—For people with stroke

    • Involving patients with stroke and their carers in service development

    • Prompt assessment and follow-up of transient ischaemic attack and minor stroke

    • Acute stroke urgent response, assessment, and treatment—Immediate transfer to a hospital with 24 hour hyperacute services for expert triage, clinical assessment, urgent brain imaging, intravenous thrombolysis if appropriate, prompt access to an acute stroke unit, and early multidisciplinary assessment

    • High quality specialist rehabilitation in hospital and following discharge

    • Seamless transfer of care from hospital to community

    • Long term care and support—Local services to support people with stroke and …

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