Stroke Facts a devastating and chronic disease

  • Stroke is the number one cause of acquired long-term disability in adults in British Columbia.
  • There are two kinds of stroke:
    • Hemorrhagic stroke is bleeding into the brain due to a ruptured blood vessel
    • Ischemic stroke is a disruption in the blood supply to the brain
  • A transient ischemic attack (TIA) is a short term disruption in the blood supply to the brain
    • Most TIAs last less than 10 minutes, but they can last as long as 24 hours
    • Most TIAs do not cause permanent brain damage, and the symptoms may last only a short time
    • A person who has experienced a TIA is at increased risk of having another TIA or a severe stroke requiring hospitalization
    • In 2008-09, more than 6,000 people in British Columbia were diagnosed with a TIA or a stroke that was not severe enough to require hospitalization, but that placed them at higher risk for a severe stroke
    • Many of these patients did not receive preventative care.

In 2008-09:

  • More than 4,500 people in British Columbia were diagnosed with a first-ever stroke severe enough to be hospitalized.
  • Of these patients, 1,610 (36%) died within a year following their stroke making stroke the third leading cause of death in the province.
  • While the majority of stroke victims survive their attack, most remain affected by neurological disabilities over the long term.

The BC Stroke Strategy identified the following existing gaps in stroke care in BC:

  • There is less than 50% of needed visit capacity to access TIA rapid assessment services
  • Only 20% of TIA patients are currently seen within the 48 hours needed to significantly reduce their risk of having a subsequent full blown stroke
  • Only 4% of hospitalized ischemic stroke patients receive the clot-busting drug tPA. This drug has been shown to reduce the impact of stroke
  • Only 26% of beds (in five BC hospitals) occupied by stroke patients are clustered (co-horted) in a designated geographic area within an acute care facility for improved coordination and quality of care
  • Early acute rehabilitation resources and protocols are under-developed and inconsistently implemented across the province There is a shortage of neurologists and internal medicine specialists willing to provide stroke care and work in a coordinated “on- call pool”
  • There are limited resources to provide coordinated and consistent stroke education to nurses and allied health professionals working in acute care centers across BC.

The Provincial Stroke Action Plan:

  • It will cost an estimated $34 million over three years to implement the BC Stroke Action Plan.
  • However, direct acute and residential care costs avoided seven years after full implementation are anticipated to exceed $42,000 million annually.

Key outcomes of the BC Stroke Action Plan include:

  • 250 fewer early deaths in the province each year
  • Optimal care will help save about 3,300 life years, by reducing early deaths and extending life expectancy for people who have had a stroke.
  • The volume of TIA/non-hospitalized strokes processed in TIA Rapid Assessment Services should increase by 50%
  • The number of ischemic stroke patients appropriately receiving tPA will increase from 5% to 10%
  • The age-standardized incidence rate of both ischemic and hemorrhagic stroke will be reduced by 10%
  • The proportion of patients who die in hospital or are discharged to long-term care after being admitted/discharged for ischemic stroke will be reduced
  • 10% reduction for acute admissions in which an ischemic stroke is the principal diagnosis

Published evidence also indicates that health and economic benefits of an adequately-resourced and system-wide approach to stroke care in British Columbia can result in:

  • 80% reduction in the risk of a major stroke developing in those who present with a TIA or minor stroke;
  • 9% reduction in admissions to residential care for those treated with the clot-busting drug tPA;
  • A 20% reduction in acute care hospital days following stroke and a 5% reduction in admissions to residential care (stroke unit impact);
  • A further 27% reduction in acute care hospital days following stroke and a 16% reduction in admissions to residential care for patients eligible for early home-supported discharge.

Approximately 37,000 fewer acute care days, 56,000 fewer residential care days with an estimated current annual direct care cost avoidance of approximately $42 million can be achieved through the Stroke Action Plan. This $42 million will increase to $52 million by year seven, due to a 3% per year inflation adjustment

We can also expect reductions in vascular dementia, cardiovascular disease, diabetes, and renal failure as spin-off benefits.

Note: All numbers are based on data from the BC Stroke Registry, a new evaluation tool that merges stroke data from hospitals and physicians. It provides detailed and up to date information about the incidences and outcomes of stroke in British Columbia.

Take Note