Irish National Audit of Stroke organisational audit report 2021

This is the third national audit of the organisation of acute hospital stroke services in Ireland and the first under the governance of the National Office of Clinical Audit. The first audit examining the organisation of stroke care took place in 2006 and it found that only one hospital had a stroke unit, that access to acute treatments such as thrombolysis  was very limited, and that the patient journey was fragmented and poorly organised.</p

The association between increasing oral anticoagulant prescribing and atrial fibrillation related stroke in Ireland

Aims: Recent increases in the number of patients with atrial fibrillation (AF) prescribed oral anticoagulants (OAC) are evident in Ireland and internationally, largely due to the availability of direct oral anticoagulants (DOACs). This study aimed to determine the rate of stroke in the context of increasing anticoagulation utilisation, with a focus on AF-related ischaemic stroke (IS).Methods: Dispensing data for OACs were identified for the period 2010-2018 as well as hospital discharges for IS (2005-2018). Irish National Stroke Register data were used to elucidate the characteristics of patients with acute ischaemic stroke.Results: The number of patients prescribed OACs increased by 94% from 2010-2018 with a significant change from 2013 (β = 2.57, P = .038), associated with a large increase in the number of patients on DOACs. There was 3.3-fold increase in expenditure on OACs nationally from 2013 to 2018, of which 94% was DOAC related. Using the 2013 timepoint, ischaemic stroke rates until 2018 did not show a significant deviation from the previous trend (β = 0.00, P = .898). The percentage of AF-related ischaemic stroke was stable from 2013 to 2017 with a 4.5% decrease in 2018. The percentage of ischaemic stroke patients with previously diagnosed AF decreased from 2013 to 2018; however, there was an increase in the percentage of ischaemic strokes while on OAC in this cohort.Conclusion: Large increases in OAC utilisation have not resulted in changes in ischaemic stroke rates at a national level. The percentage of ischaemic strokes with a previous diagnosis of AF has decreased indicating a possible benefit from greater OAC utilisation. However, the percentage presenting with an ischaemic stroke while on OAC treatment is increasing. The increase in patients presenting with stroke while treated with OAC may largely reflect the national increase in patients prescribed DOACs but the findings raise concerns about treatment failures. The real-world effectiveness of DOACs requires further examination.</div

Irish National Audit of Stroke: a critical review of national stroke data for Ireland from 2013 to 2021

In the European Union (EU) stroke is the second most common  cause of death and a leading cause of adult disability. As populations continue to grow and live to an older age, stroke and the long-term sequelae, along with the corresponding costs, are expected to increase dramatically (The Stroke Alliance for Europe, 2020; Bennett et al., 2014). Treatment for stroke has advanced greatly since the 1990s, and there is strong evidence that stroke unit care with multidisciplinary team input will reduce disability and mortality and will benefit all patients with a stroke. Patients with ischaemic stroke who present early after symptom  onset will benefit from emergency  treatments such as thrombolysis and thrombectomy (Organisation for Economic Co-operation and Development, 2015). </p

Irish National Audit of Stroke National Report 2020

Stroke remains the third leading cause of death in Ireland and Western Europe, and the leading cause of severe, adult-onset physical disability. We report on patients aged 17 years and over who were treated in the 24 public hospitals that provide acute stroke care in Ireland and that admit more than 25 stroke cases annually. Data are typically collected by stroke services on behalf of the participating hospitals. In order to be included in the audit report, hospitals must have collected data on more than 80% of patients with a stroke. This year’s report incorporates data from the 23 participating hospitals that met the mandatory 80% coverage threshold; overall, despite the effects of the coronavirus disease 2019 (COVID-19) pandemic, coverage improved from 83% to 93% across the hospital system for patients with a stroke identified through the Hospital In-Patient Enquiry (HIPE) system as having been admitted with acute stroke, either ischaemic or haemorrhagic. The audit does not currently collect data on subarachnoid haemorrhage; however, we are exploring how these data may be effectively incorporated in future years’ audits. Because of the increased coverage, the number of individuals on whom data have been collected increased by more than 20% in 2020 from 2019. This important increase in coverage does appear to have led to substantial changes in proportional outcomes for most variables, but caution should be exercised in interpretation of minor changes from previous years.</div

Irish National Audit of Stroke National Report 2019

INTRODUCTION Stroke is the third leading cause of death in Western Europe and is the leading cause of severe long-term adult disability (The Stroke Alliance for Europe, 2020). Stroke is an important health issue for people in Ireland, with approximately 5,500 adults admitted to hospitals with a stroke in 2019. Stroke can affect people physically, emotionally and socially. It has a significant impact on Health Service Executive (HSE) resources, accounting for up to 4% of total health expenditure annually (Health Information and Quality Authority, 2017a). Although the economic costs of stroke in terms of lost employment and the cost of support in the community are significant, the impact on family members or friends who care for stroke survivors is massive. It is therefore important that all hospitals providing acute stroke services deliver high-quality and equitable stroke care. </p