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.

Picture: Bill Hearne

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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15 comments

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    • TChong says:

      06:44am | 29/05/12

      I agree with the Member for Bowman, this service ( TPA ) , with the suitably qualified staff to administer it, should be in every public hospital, and ambulance station in the country.
      Money should be no object in delivering such a proven, vital, treatment., but that is the only reason why the service isnt universal, yet.

    • Gregg says:

      07:34am | 29/05/12

      Come on Chongy, you ought to know that money is never of any concern to your beloved Labor, it just always spend, spend and spend and borrow more!
      Just a few more strokes of a pen somewhere for the future generations to handle along with more strokes.
      They could even be brought on by the thought of this Labor government continuing.
      Are you with them on stroking?

    • TChong says:

      08:04am | 29/05/12

      Gregg
      State govts, Lib or ALP do have the power and authority to prioritise service, so BOF, Ted,  Newman, Barnett can shovel more money for this program, if they choose.
      I also believe the feds should help by financing fighter jets , or submarines via raffle tickets, with hard cash poured into health.
      I reckon most of the worlds problems can be solved by money. (particularly taxes from the rich, and foreign owned mining companies.
      —QED Thats what makes me a utopian Pinko Commie wink
      As for the stroking , that sounds like a subject you have firmly in hand.
      Keep up the good work , in hilighting this lack of resources , comrade Gregg. wink

    • craig2 says:

      07:06am | 29/05/12

      Ok, i’ll say it if you won’t Andrew, Pradaxa?

    • stephen says:

      07:40am | 29/05/12

      Preventative measures are best and if the prisons are going to ban smoking indoors then we can expect an increased life-span for the criminal mind, hence, a jump in crime figures.

      These will be the stats, yet health and the measurements of the efficacy of the communities self-management will give the government more figures to play with. Does anyone really believe that, in general, the health of the majority is getting better ? Well, I hope they are right, because with our aging population, the health bill for the over 60’s will be a very serious problem, and one for the whole community.

    • Michael says:

      09:06am | 29/05/12

      I don’t think money can be the only reason services aren’t better than they are - stroke must cost the health system millions. Surely providing treatments that help people recover would save money in the long run. Maybe though it isn’t all about money - just about getting things reorganised and caring about people who have a stroke.

    • TChong says:

      09:42am | 29/05/12

      Micheal
      In NSW health
      If admitted for “stroke”, the patient recieves the care needed to stabilise their condition
      .As soon as the patient is physically able to, rehab assesments are made, and rehab starts, even in the acute wards - eg little steps like getting the sufferer to feed themselves- all part of rehab.
      Once the bed is availble, the pt is sent to “Rehab” eg Braeside Hospital in south west sydney.
      The plans and committment are there, but as I have said elsewhere it is only money that limits the total number of Rehab beds availble, not intransiance from Health practioners, or lack of knowledge on how best to treat stroke victims.
      Money, it makes the world go ‘round, and makes all the difference to Rehab services.

    • HP says:

      09:52am | 29/05/12

      the article raises very good points about the disaparity in funding between cancer and cardiovascular disease. My main concern is with the comment that heart attack is simply die or survive. If Andrew looked at the statistics for heart attack treament in Australia he would find that the number of people being treated within the 90 minute time frame is far from ideal particularly in rural and remote areas. It is naive to think that people who survive their heart attack will have no ongoing health issues. Treatment delay in heart attack will leave people with permanent heart muscle damage leading to heart failure and reduced quality of life. The good news with heart attack is more people are surviving the bad news that because of treament delay more people will be living with a disability reducing their quality of life. Clot busting drugs are equally as important for heart attack and stroke but the time to intervention for heart attack is far smaller.

    • Jay says:

      10:20am | 29/05/12

      Excellent article.
      As an ex health worker I can attest to the devastating effects a stroke can have.

      When you see the heartbreak of somebody who lose the gift of speech; the freedom of walking; suffer from incontinence and in pain, it is a wake up call not to take life for granted.
      Even after years of intensive rehab, often a major stroke victim shows little improvement.
      The aged care system is also seeing younger stroke victims who go in to full time care.
      God knows how much a stroke ultimately costs financially, but surely anything that can prevent or minimise severe damage resulting in long term health issues MUST be also considered a PRIORITY that requires urgent action.

    • fairsfair says:

      12:21pm | 29/05/12

      My father’s stroke was handled poorly at the time of his admission. In fact we think that he may have suffered a second and more severe stroke overnight in the hospital as the major response to the CVA was to pump fluids into him as they thought he was simply dehydrated (perhaps understandable as in the first instance people thought he was drunk but then realised it was more sinister when he became extremely disoriented).

      I am happy to hear that there is a clot busting type drug available. If this had have been provided to my father after he was delivered to the hospital within hours of what now seems like a minor stroke, he may still be as proud of himself as he once was. Couple that with the fact he could have received treatment for the underlying caise he would have happily got on with his life. People need to be aware that there are underlying causes that have nothing to do with your lifestyle and general health - it can literally happen to anyone at anytime.

      After the dust settled he was returned to our regional hospital, discharged and told to go home and come to terms with his new lifestyle. The services were available, but he had to travel and pay for them himself. He has used every cent of his insurance payout on treatment and I don’t hold that against the government - that is what it is for. He has never given up, he will never give up and even though his right arm still hangs lifeless and after nine years of rigorous physio he can now twitch his little finger, he will not stop walking 10km a day and undertaking major projects in his shed. I have no doubt that if he gave up in his mind his body would soon follow suit.

      There is no daughter on earth that could possibly be prouder and have more respect for their father and I would do anything to stop another person having to go through what he has (yes it has been hard on us too, but we are still able bodied). In fact this has inspired me. I am going to look into what I can do locally to get people talking about it.

      Andrew, I may be in touch. Thankyou for a great article.

    • TChong says:

      01:01pm | 29/05/12

      ff
      your dads seems very determined, that’ll be his greatest resourcl, and with a you as family, things shouldnt be too bad.
      adaptation, and realism is the unchangable future life for cva pts, great family suppport, and determinatiion helps to make the necessary changes bearable.
      “It can literally happen to anyone , at any time “
      Yep
      I know it sounds trite to say, but after witnesssing the affect stroke has on the person, and their people- , enjoy every day while you can.
      It makes bearing and pursuing grudges, hatreds, feuds etc appear as the waste of life that those things are.

    • fairsfair says:

      03:57pm | 29/05/12

      Agreed TC - all the things that used to annoy me about him are what has kept him alive. He is stubborn, determined, too strong etc.

      LOL “Shouldn’t be too bad” yes differing opinions on that one wink

      Agreed TC - I do have bad days and then often look at my dad limping up from the shed and think snap out of it. It certainly puts things into perspective, but then human nature, it is very easy to get used to what confronts you and still sweat the small stuff.

      Poor dad - I’d give anything to make him better but we know that it won’t ever happen and I think he came to terms with that on his most recent anniversary. Life is never the same and it affects every relationship he has in life.

      Given that this is something that often can’t be prevented or predicted and it is happening to more and more of us - this article is very pertinent. Why isn’t a proven effective treatment available, particularly when in the long run not only will its successful use save the patient, but also save the tax payer in not removing an individual capable of contributing to the economy plus treatment and rehab costs?

    • Karen Bayly says:

      03:29pm | 29/05/12

      It is morally criminal that people are dying or living with a dependent disability because such a simple and effective treatment for stroke is not more widely available. We need more accute stroke care units within our public hospitals and we need them now.

    • Elaine Bromilow says:

      04:27pm | 29/05/12

      Our daughter had a major stoke when she was 35 lost all feeling in the left side her speech was also effected.We owe so much to the quick thinking ambo that invaded our house and got the ball rolling we were at Redlands Hospital within 30 minutes then onto the PA they were also terrific 6 weeks of hard slog and determination won through.We had to get used to this new person but love her just as much. our lives changed forever that day but are so greatful to everyone for their assistance,

    • A.Bakker says:

      09:30am | 05/06/12

      A stroke unit saved my life, what more can I say. Every Australian should be given the same opportunity.

 

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