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Clinical Articles, Lead Article


While care for patients with stroke has improved over the past 12 years, key areas of concern remain, according to the final report of a national audit published recently by the Royal College of Physicians.1

The audit found that improvements in stroke care are ongoing – in 2008 74% of patients went to a specialised stroke unit at some stage during their hospital admission, a figure which has since increased to 88%.  5% of all patients in the audit sample were found to have received thrombolysis, a considerable increase from 1.8% in 2008.

However, the authors also highlight areas still in need of improvement, including the management of cardiovascular risk factors.  They note that only 27% of patients who were recorded as having atrial fibrillation (AF) prior to stroke were taking warfarin, asserting that “Patients are dying and having disabling strokes because of our failure to anticoagulate people appropriately”.

Heading their list of the top ten recommendations for change is that “All patients with ischaemic stroke in AF should be considered for anticoagulation and a clear reason documented where a decision is made not to treat”.

The authors also claim that too many patients (57%) spend the majority of their time on a general assessment unit, waiting too long for stroke specialist care.  Patients are not receiving enough face to face therapy, they say, advising a major review of therapy working practices and staffing levels.

Professor Tony Rudd, Chair of the Intercollegiate Stroke Network, said: “Stroke care has dramatically improved since we first started measuring the quality of care 13 years ago. In many areas of management we perform as well or better than other countries in Europe and America. The National Stroke Strategy and the subsequent work undertaken by the Stroke and Cardiac Networks have been the most important factors leading to this improvement”.

Professor Rudd continued: “However, there are still many aspects of care, particularly in rehabilitation and longer term management, that need to be developed.  It is vital that we continue to develop national policies to encourage these changes to occur and that we also continue to monitor both processes of care and patient outcomes”.


1 Intercollegiate Stroke Working Party. National Sentinel Stroke Clinical Audit 2010 – Round 7.  Royal College of Physicians 2011

Full report available from:

Published on: June 8, 2011

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  • ArrhythmiaAlliance
  • Stars
  • Anticoagulation Europe
  • Atrial Fibrillation Association

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