SOURCE: Heart and Stroke Foundation

Heart and Stroke Foundation

June 04, 2015 00:01 ET

Stroke Report 2015: Canadians Are Not Getting the Care They Need Fast Enough in the Critical First Hours After Stroke

Gaps in the Healthcare System and Canadians' Inability to Recognize Stroke Put Them at Risk of Death or Disability

OTTAWA, ON--(Marketwired - June 04, 2015) - The Heart and Stroke Foundation's Stroke Report 2015 highlights challenges in the vital first hours after stroke that are preventing too many Canadians from getting the best care. These challenges start with Canadians' lack of knowledge around stroke and include delays in important steps in diagnosis and treatment.

Stroke is a medical emergency that requires immediate action and medical attention. The faster someone experiencing a stroke gets to a hospital that provides acute stroke care services, the better their chances of survival and recovery with little or no disability. But this is not happening to the extent it should.

"Canadians, paramedics, emergency department staff and other medical professionals all play a vital role in early stroke management," says Dr. Michael Hill, Director of the Stroke Unit, Calgary Stroke Program, and Heart and Stroke Foundation spokesperson. "Rapid treatment is life- and disability-saving. Speed requires teamwork. How quickly and how well everyone works together within the stroke system of care, can dramatically influence stroke patients' outcomes."

Canadians' stroke awareness is low

According to a new Heart and Stroke Foundation poll cited in the report, Canadians' understanding of stroke is poor, with only one-third able to describe what a stroke is. Understanding of stroke risk factors is also lacking. Only one-fifth of those polled identified high blood pressure as a main risk factor for stroke, when in fact it is the number one risk factor. Most Canadians also do not know that smoking, poor diet, physical inactivity and obesity are risk factors for stroke.

Too few Canadians recognize the signs of stroke and know what to do

The Foundation recently launched a campaign promoting the acronym FAST as a simple way to help Canadians recognize the signs of stroke and take immediate and life-saving action:

FACE -- is it drooping?
ARMS -- can you raise both?
SPEECH -- is it slurred or jumbled?
TIME -- to call 9-1-1 right away.

The first critical steps in early stroke management are recognizing the signs of stroke and taking immediate action. Unfortunately the poll revealed that too few Canadians recognize the signs of stroke and know what to do: almost half did not know any of the three FAST signs of stroke; only one-fifth could name two or three signs. Although three-quarters (77 per cent) of respondents said they would call 9-1-1 if someone is having a stroke, the reality is different. According to data from the Canadian Institute for Health Information (CIHI), only 59 per cent of people who have a stroke arrive at the emergency department by ambulance.

Awareness of the three FAST signs of stroke varies by province

 
Individual FAST Signs*  CAN  BC  AB  SK  MB  ON**  QC  NB  NS  PEI  NL
FACE (Drooping face)  21%  19%  23%  27%  15%  26%  14%  11%  15%  16%  19%
ARMS (Cannot raise arms)  13%  9%  8%  10%  11%  19%  11%  7%  6%  13%  7%
SPEECH (Slurred or jumbled speech)  47%  46%  42%  48%  48%  61%  26%  49%  52%  58%  42%
Notes: * Respondents may have provided more than one sign, therefore these numbers reflect responses, not people. **The poll was carried out two months after the FAST campaign was launched in Ontario.

In May 2012 Dr. David Butler-Jones, Canada's first chief public health officer, experienced a stroke. Even as Canada's head doctor, he had trouble recognizing what was happening. Although he has made tremendous progress in his recovery, he still made the difficult decision to step down as head of the Public Health Agency of Canada, as he felt he no longer possessed the stamina required by the demanding role.

"Having experienced a stroke, I know the impact it can have," Dr. Butler-Jones says. "Recognizing the common symptoms of stroke and being able to respond appropriately can mean the difference between successful recovery or permanent disability or death. Rapid response matters. Those experiencing a stroke may often not realize what is happening to them and so depend on others to act."

Paramedics are fundamental in the critical first hours

As the initial point of contact, paramedics play a key role in early stroke management -- although this is not widely understood. They are trained to "recognize and mobilize" by first recognizing the event as a stroke and addressing immediate health needs such as blood pressure and heart rate. They gather important information about existing medical conditions and most importantly, try to establish stroke onset time.

Ambulances not only get stroke patients to hospital more safely and efficiently, they can get them to one that provides specialized stroke care, including the ability to administer clot-busting therapy such as tPA, a drug administered intravenously. However, an agreement must be in place to allow ambulances to bypass a smaller, closer hospital and go to a stroke hospital. Unfortunately bypass agreements are not in place in all regions across the country.

When paramedics let an emergency department know they are on their way with a suspected stroke patient, this ensures the team is prepared to start diagnosis and treatment as soon as the patient arrives. Yet only half of hospitals in the country have such a pre-notification system in place.

Canadians do not understand paramedics' important role

Too few Canadians understand why it is important to call 9-1-1 when they experience or witness stroke. According to our poll:

  • Only one-third stated it is important to call an ambulance because stroke is an urgent condition that requires immediate action.
  • Only one-quarter know that paramedics can start clinical assessment, treatment and care as soon as they arrive at the scene.
  • Only five per cent understand that paramedics know which hospitals are best equipped to provide stroke care.

Further, just one-third of Canadians are aware that only some hospitals are designated stroke centres that are equipped to provide the best stroke care possible.

Rapid diagnosis and treatment save lives and promote recovery

Suspected stroke patients should be taken directly to a CT scanner when they arrive at hospital to determine the type of stroke, which dictates treatment options. Ischemic strokes, which are more common, are caused by a clot; hemorrhagic strokes are the result of a bleed. Clot-busting drugs such as intravenous tPA must be administered as soon as possible, within 4½ hours of onset. Yet less than 40 per cent of patients arrive within the 4½ hour treatment window and young stroke patients in their 20s and 30s take the longest to get to hospital. A target has been set for patients receiving tPA to do so within 30 - 60 minutes of arriving at hospital, but new data show that the median "door-to-needle" time is too long at 104 minutes.

Patients experiencing severe strokes caused by larger clots may be eligible for new endovascular treatments, which physically remove the clot using a tiny device inserted via the blood vessels. This treatment must take place within six hours for most patients. The recent Heart and Stroke Foundation co-funded ESCAPE trial revealed endovascular treatment cut by half the death rate from major ischemic strokes, and increased positive outcomes by 30 per cent.

What can we do to ensure Canadians get the best stroke care in the critical first hours?

  • Canadians should learn the signs and know to act FAST by calling 9-1-1 or local emergency medical services if they witness or experience stroke.
  • Governments can promote the use of FAST to raise awareness of stroke signs and support integrated stroke care systems.
  • Healthcare providers can train all paramedics and healthcare team members to learn the signs of stroke and carry out stroke protocols, and implement the Heart and Stroke Foundation's Canadian Stroke Best Practice Recommendations.

Stroke facts

  • A stroke is a sudden loss of brain function.
  • 62,000 strokes occur in Canada each year -- that is one stroke every nine minutes.
  • 83 per cent of those who have a stroke and make it to hospital will now survive.
  • Brain cells die at a rate of 1.9 million per minute after stroke.
  • Hundreds of thousands of Canadians are living with the effects of stroke.
  • Stroke among people under 65 is increasing and stroke risk factors are increasing for young adults.

Visit heartandstroke.ca/strokereport for the full report

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) hospitalization and emergency department data, paramedic services data, and Environics Research Group poll.

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Contact Information

  • For more information or interviews, please contact:
    Jane-Diane Fraser
    jfraser@hsf.ca
    613-691-4020