2014 Stroke Report shows more are surviving, but more challenges are coming

PRESS RELEASES
June 5, 2014

New data reveal Canadians are benefitting from improvements in stroke care. But will an aging population, sicker patients, and an increase in strokes among younger Canadians overload our already stressed healthcare system?

Ottawa – According to the new Stroke Report from the Heart and Stroke Foundation (Together Against A Rising Tide: Advancing Stroke Systems Of Care) stroke care has improved and death rates from stroke are on the decline. But the report also shows that the gains we’ve seen in stroke treatment and care will soon be challenged by an aging population, more stroke patients with more complex needs, and an increase in the number of younger people having strokes.

Over the past 60 years, death rates from cardiovascular disease and stroke have declined by more than 75 per cent, with nearly 40 per cent of this decrease occurring in the last decade. While this is good news, stroke still affects thousands of Canadians and their families. There are an estimated 50,000 strokes in Canada every year, or one every 10 minutes, and 315,000 Canadians are living with its effects. Stroke currently costs the Canadian economy $3.6 billion a year in physician services, hospital costs, lost wages and decreased productivity.

Stroke can happen at any age
Although stroke is most common in people over the age of 70, new data* gathered for this report reveal an alarming escalation among those under 70. Over the past decade, strokes in people in their 50s have increased by 24 per cent and, in those in their 60s, by 13 per cent. Even more alarming, recent international studies predict that stroke rates among younger people (ages 24–64), will double in the next 15 years.

Also troubling, the profile of the typical stroke patient is changing, making treatment more complex. Two-thirds of stroke patients are living with one or more chronic conditions, such as high blood pressure, diabetes, or coronary artery disease.

“We have seen great success when looking at stroke rates declining but as physicians, we do not treat rates, we treat patients,” says Dr. Michael Hill, Director of the Stroke Unit, Calgary Stroke Program and Heart and Stroke Foundation spokesperson. “As our population gets older there will be more strokes and more patients to treat; many of these patients will be sicker, so there will be a bigger burden on the healthcare system, on society and on families.”

Chris and Chelsea Bohemier know all too well that stroke can strike at any age. Their newborn son Alex was sent to the neonatal intensive care unit after a nurse recognized he was having seizures – and he was diagnosed with stroke. Alex is now almost two and doing very well. Chris credits early diagnosis as a determining factor in his recovery.

Despite advances in stroke care and treatment there is still room for improvement
The new data reveal improvements in stroke systems of care and outcomes for patients nation-wide. These enhancements result from advances in diagnosis, procedures, treatments and drug therapies, along with efforts by the Heart and Stroke Foundation and the Canadian Stroke Network to promote coordinated stroke care and best practices for healthcare professionals.

“The data clearly show that Canadians are benefitting from improvements in stroke prevention, care and treatment,” says Ian Joiner, Director, Stroke, Heart and Stroke Foundation. “But this new information also tells us that there are opportunities for improvement at almost every point along the continuum of stroke care, from prevention through to rehabilitation.”

Where you live matters
Stroke survival rates vary across the country; there is a better chance of surviving a stroke in Quebec or Alberta. Reasons for the differences in death rates among provinces can be complex and include whether a location is more urban or rural, how well stroke services are coordinated, and the services available.

Death rate from stroke by province (per 100,000 people) from lowest to highest

 

Canada	AB	QC	BC	ON	SK	MB	Terr	PEI	NS	NB	NL
17.9	15.9	16.7	17.5	17.9	19.2	19.9	20.4	20.9	22.0	22.4	29.9

2011 – 2012 30-day stroke in-hospital mortality rates standardized per 100,000 population and for age and gender

Coordination is critical
Stroke experts stress that the key to improvement is coordination – having “the right resources, in the right place, at the right time.” Dr. Devin Harris, Medical Advisor, Stroke Services BC, and a Heart and Stroke Foundation spokesperson, says: “Stroke units, consisting of a designated ward with specially-trained physicians, nurses, and therapists, have been unequivocally shown to reduce death and disability post-stroke.” However, the new data show only one-quarter of hospitals providing stroke services have a designated stroke program and only 17 per cent have a stroke unit.

According to new data, across all hospitals, only 69 per cent of patients receive a CT scan – an important diagnostic tool – within 24 hours. Less than one-third of hospitals that provide stroke services administer clot-busting drugs which can stop or reverse the effects of a stroke.

Know the signs and take action
Stroke is a medical emergency and every minute counts. Anyone who witnesses or experiences the signs of a stroke should call 9-1-1 immediately so the person can get to a hospital that is equipped to provide emergency stroke care. The sooner someone who is experiencing stroke gets to hospital and receives appropriate treatment, the better their chances of recovery. Although 70 per cent of stroke patients arrive at hospital by ambulance, 30 per cent still do not and are putting themselves at risk. These numbers have remained unchanged since 2006, pointing to an area requiring urgent attention.

Lee Cayer was fortunate that her family recognized the signs of stroke from a Heart and Stroke Foundation awareness campaign. “If my family and I had not seen those ads, not known the signs – if we had just waited a few more hours before calling 9-1-1 – my outcome could have been vastly different.” For Lee, getting to the hospital in time was the difference between a lengthy hospital stay with months of physical rehabilitation and walking out of the hospital on her own two feet, two days later.

Telestroke has great potential but is underutilized
Telestroke uses various types of technology to link healthcare sites, providing diagnosis and treatment recommendations, and services to stroke patients regardless of their location. This technology has been shown to support better outcomes in patients, address regional inequities in access to and standards of care, and reduce costs for health care and long-term social support. However, telestroke is not being used to its full potential. While the technology infrastructure is in place in more than 80 per cent of hospitals, only 44 per cent are using it to care for stroke patients.

Measurable improvements in stroke care over the past five years
The Stroke Services Inventory carried out by the Foundation reveals that 303 hospitals improved their stroke services between 2009 and 2013, including:

• 51 more hospitals are designated as stroke centres
• 70 more hospitals have identified stroke teams
• 31 more hospitals have designated stroke units
• 12 more hospitals provide clot-busting drugs (tPA)
• 48 more hospitals have telestroke capacity.

Quick access to rehabilitation has a significant impact on stroke recovery
Rehabilitation is critical to a stroke survivor’s recovery but not enough have access to the services they need to make the best recovery possible. Half of stroke patients are not receiving in-patient services until 13 or more days after their stroke; the ideal is closer to five to seven days. And only 16 per cent of all stroke patients even receive in-patient rehabilitation when this number should be closer to 40 per cent, based on those who need it. Information around stroke rehabilitation is also lacking, making it a challenge to identify new therapies for survivors.

Early supported discharge allows patients to go home sooner, and results in a better quality of life as well as less burden on the healthcare system. However only 60 per cent of stroke patients who leave hospital return home and of those, only 11 per cent have home support services in place.

Prevention every step of the way
Up to 80 per cent of premature heart disease and stroke is preventable. It is never too late to adopt healthy behaviours that will decrease your risk factors for stroke, even after a stroke has occurred.

Healthy behaviours all Canadians can adopt to make health last

• Eat a healthy diet. Follow the recommendations in Canada’s Food Guide.
• Be physically active. Accumulate at least 150 minutes of moderate- to vigorous-intensity aerobic physical activity per week, in bouts of 10 minutes or more.
• Be smoke free.
• Know and control your blood pressure.
• Manage diabetes.
• Limit alcohol. Women should limit themselves to no more than two drinks a day, to a weekly maximum of 10; and men to three drinks a day to a weekly maximum of 15.
• Manage stress. Identify the source of your stress, talk to friends, family, and your healthcare provider. Be sure to take time for yourself.
• Take the Heart&Stroke Risk Assessment at heartandstroke.ca.

What can governments and healthcare system decision makers do?

• Take a leadership role in stroke care and continue to fund and support provincial stroke strategies where they exist and support the development of strategies in provinces where they do not.
• Support the development of coordinated systems of stroke care including stroke units and stroke care teams.
• Implement and support 9-1-1 systems across each province to ensure access to timely life-saving services for all residents.
• Develop coordinated regional bypass systems so emergency medical services get stroke patients to the hospitals equipped to provide emergency stroke care.
• Expand telestroke infrastructure and services.
• Create more secondary prevention clinics.
• Expand rehabilitation services for stroke patients both in hospital and in the community.
• Develop detailed and coordinated provincial surveillance systems and other data and information infrastructure.

What can healthcare providers do?

• Train all emergency medical staff to recognize the signs of stroke.
• Implement the Canadian Best Practice Recommendations for Stroke Care.
• Promote and implement coordinated systems of stroke care working across interdisciplinary teams.
• Put patients and families at the centre of stroke care.
• Take a leadership role and advocate for stroke systems improvement.

Read the complete report at heartandstroke.ca/strokereport.

The Heart and Stroke Foundation’s mission is to prevent disease, save lives and promote recovery. A volunteer-based health charity, we strive to tangibly improve the health of every Canadian family, every day. Healthy lives free of heart disease and stroke. Together we will make it happen. heartandstroke.ca

* Data sources include Canadian Institute for Health Information (CIHI) Discharge Abstract Database (2003–13), CIHI Stroke Quality Special Project 340, CIHI National Rehabilitation Reporting System (NRS) and Heart and Stroke Foundation Stroke Services Inventory (SSI) of 612 Canadian hospitals.

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