Our record with stroke is really just a big joke
Cancer and heart disease each claim a third of all deaths Australia-wide. Of these two, it is cancer which has a curious hold on our purse-strings, securing the lion’s share of both government and philanthropic giving. Cancer and kids are the magic words in giving. In contrast there is a real element of “your time is up” when it comes to your ticker.
On hard eligibility and based on economic return, our Pharmaceutical Benefit Scheme seems close to the mark. With 33 per cent of deaths due to heart disease, 34 per cent of our PBS funds heart, stroke and vascular disease.
But government isn’t perfect. Program funding for cardiovascular disease is just $8.6 million, compared to $2.5 billion for cancer, $1.6 billion for diabetes and $1.4 billion for mental health. Of the heart disease categories, stroke has long been the poor cousin with only a tiny fraction of Australians getting gold standard care.
In contrast to chemo- and radiation- oncology, heart transplants or carotid artery repairs, emergency stroke care relies on Australians aged under 80 getting a CT scan and possible blood thinning clot-busters (called rt-PA) within three hours of onset of symptoms.
At present just 7 per cent of Australians experiencing a stroke of any kind get that care. Of those who make it to hospital in time for treatment, evaluation delays and lack of specialist stroke units mean only 20 per cent of those who need the clot-busting treatment receive it.
Unlike a heart attack which is either massive or one recovers to live on, surviving a stroke is too often the beginning of a nightmare, for both victims and their families.
That is why this weekend’s release of the third International Stroke Trial (IST-3) published in medical journal The Lancet will transform stroke care in Australia.
Led by Professor Richard Lindley from the University of Sydney and member of the National Stroke Foundation Clinical Council, the study found that for every thousand patients given the clot-busting treatment within three hours of stroke, 80 more will survive and live without help from others than if they had not been given the drug.
More importantly, it demonstrated that clot-busting treatment works not just three hours after the fact, but up to six and possibly 7.5 hours. That is big news particularly for the third of Australians who don’t reside in our capital cities.
These increased odds of being alive and independent after treatment also apply to treatment at any age, not just those under 80 years of age and even those experiencing a severe stroke.
This international study pretty much grabs the goal posts of stroke care and pulls them apart. Of the 120,000 Australians now living after a stroke, many would have arrived at hospital between three and six hours after onset of symptoms. Until now, they were shown little more than the rehab ward.
Worse, a number of our mid-to-large public hospitals lack specialist stroke units. So do most country cities and towns. Our dispersed population (second only to Mongolia) means significant travel time challenges to make the three hour deadline. Shifting it to six hours means virtually no Australian should miss the new time cut-off for care.
As the Stroke Foundation points out, one in six people will suffer a stroke in their lifetime. Of those who survive, many will be left with a wide range of disabilities. The quality of their recovery depends on prompt assessment, treatment and care.
Stroke is treatable. A combination of public sentiment, a Claytons national priority strategy and delays in updating clinical guidelines mean hundreds more Australians die each year when world-standard treatments are sitting in our emergency rooms around the nation.
Australia has been part of a global alliance in determining best practice in stroke. Now our health systems need to play catch up to ensure that health dollars follow the evidence in order to reduce stroke death and disability.
Providing clot-busting treatment to the right kinds of stroke and doing it early makes the difference between severe disability or going home to resume life with capabilities which might otherwise have been lost.
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