Stroke Can Double Risk of Dementia

People who have had a stroke are twice as likely to develop dementia, according to a new study. Click here to read PsychCentral article

Emotional Support Is Vital for Stroke Patients and Families

A new Scottish study suggests that physicians of severe stroke patients need to take into account their patients’ mental health needs and better prepare their families for the possibility that their loved one may not recover. Click here for PsychCentral article

NIHR Signal Direct acting oral anticoagulants likely to be better than warfarin for people taking them for atrial fibrillation

In people with atrial fibrillation needing anticoagulant treatment, deaths were fewer in those who had direct acting oral anticoagulants compared with warfarin. The picture is less clear for the risk of stroke and complications such as bleeding in the brain or gut. Apixaban had the best efficacy and safety profile and was cost-effective compared with warfarin.




From the NIHR Dissemination Centre

First stroke estimates in England: 2007 to 2016

These reports from Public Health England use general practice data to estimate the incidence of first-ever strokes in England.

While the majority (59%) of strokes occur in the older generation, PHE’s figures also found that over a third (38%) of first time strokes happen in middle-aged adults (between the ages of 40 to 69). More first-time strokes are now occurring at an earlier age compared to a decade ago. The average age for males having a stroke fell from 71 to 68 years and for females, 75 to 73 years between 2007 and 2016.

Interventional radiology leaders release guidance to help speed up rollout of vital life-changing stroke treatment

The Supplementary Guidance to Facilitate the Training of Interventional Radiology Consultants to Undertake Stroke Thrombectomy has been produced by The Royal College of Radiologists, the British Society of Interventional Radiology, the British Society of Neuroradiologists and the UK Neurointerventional Group, to help hospitals train more specialist radiologists to perform life-changing stroke thrombectomy treatment.

Giving oxygen routinely after a stroke does not improve outcomes

There was no benefit to routinely giving oxygen to people who have had a stroke. Oxygen given continuously, or just overnight, did not reduce disability or death and it did not improve people’s ability to do everyday tasks or live independently. There were no oxygen-related adverse events reported.
Strokes occur when the blood supply to the brain is disrupted by either a blocked or burst blood vessel. They can lead to death or disability as parts of the brain are deprived of blood. Therefore, giving oxygen to reduce the potential damage may appear to make sense.
Guidelines from NICE and the British Thoracic Society recommend that people are not routinely given oxygen after a stroke unless their oxygen levels drop. This large NIHR funded trial provides evidence to support these recommendations and reinforces the need to monitor oxygen levels to guide the appropriate use of oxygen therapy on an individual basis. Given the size and quality of this UK-based trial, it is unlikely that future research would change these recommendations.
From the NIHR Dissemination Centre

4th SSNAP Annual Report for 2016/2017 “Rising to the Challenge”

The fourth annual SSNAP report states that patients are getting much quicker access to the vital tests and treatment they need when they have a stroke, greatly improving their chances of recovery.

On the key indicators for stroke care, significant quality improvements have been made including on waiting times and specialist care. Improvements highlighted in the report since the first report four years ago include:

• Brain scanning times have improved with the numbers of patients scanned within 12 hours with more than 9 out of 10 (93.5 per cent) scanned within 12 hours, up from 84.6 per cent.
• Four out of five patients are assessed by a stroke specialised consultant physician within 24 hours.
• Almost nine out of 10 of eligible patients are receiving a clot busting drug thrombolysis, up from around seven in 10 two years ago. The numbers treated within one hour have risen from 53.2 per cent to 62.3 per cent.
• Nine out of 10 patients received a joint health and social care plan on discharge in 2016/17, compared to only seven out of 10 in 2013/14.

UCLH robots help stroke patients regain upper limb movement

Staff at UCLH’s stroke rehabilitation unit have become the first in the NHS to use robotic devices in conjunction with more traditional therapies to help patients regain arm and hand movement.

The robots, which help patients practise exercises to build up strength and dexterity, can be supervised by a physiotherapy assistant and were introduced as part of UCLH’s intensive three-week upper limb neuro rehabilitation programme.

New Getting It Right First Time leads announced

Clinical leads for three areas of the Getting It Right First Time programme have been announced.

The £60m clinical efficiency and safety programme is run by NHS Improvement and sees clinician led teams look at service lines in every trust in England to determine whether they are operating at sufficient scale, among other factors.

Some trusts change their practices or stop providing some services as a result of the subject area GIRFT reports published so far on orthopaedics and general surgery.

The programme announced clinical leads for endocrinology, rheumatology and stroke medicine last week.

To obtain this article copy and past it into an email and send to: librasryw@uhcw.nhs.uk

NIHR Signal Older people with acute coronary syndromes may benefit from routine invasive therapy

Routine invasive therapy for people aged over 75 with non-ST-elevation acute coronary syndromes reduced the risk of dying, having a heart attack or stroke, and need for further intervention. However, there was a higher risk of major bleeding compared to treating people with medication.


This is the largest review to date to gather the evidence on treatments for older people with smaller heart attacks or severe angina (chest pain). NICE recommend treating these “non-ST-elevation acute coronary syndromes” either with stents, to open narrowed arteries, or with medication depending on the person’s risk. These treatments are quite commonly used in younger people, but older people are less likely to receive them and these researchers wanted to see if there was evidence that they are missing out on the benefits.


The findings suggest that age is not a barrier to invasive therapy, but greater clarity is needed around the balance of risks and benefits for this group of people.


From NIHR Dissemination Centre

NIHR Signal Early discharge ‘hospital-at-home’ gives similar outcomes to in-patient care

Supported early discharge, where patients receive on-going hospital-level treatment in their own home, had no effect on mortality compared with standard in-patient care. Patients had shorter hospital stays, were more likely to be satisfied and less likely to end up in residential care.


This updated Cochrane review identified 32 international trials comparing early discharge hospital-at-home with hospital in-patient care. Most evidence related to people recovering from a stroke, where NICE already recommends supported discharge if this is appropriate. Other patient groups included those recovering from orthopaedic surgery and older people with various conditions. Trials were relatively small and the overall evidence quality was moderate to low.


The review aimed to see whether early discharge has an effect on NHS costs, but found insufficient evidence. Training, staffing and equipment costs need to be measured against patient outcomes in different therapy areas. Early supported discharge needs to be driven in areas where it can make the most difference and give the greatest benefit.


From NIHR Dissemination Centre

NIHR Signal Head position after acute stroke does not affect disability outcomes

Lying flat for 24 hours after a stroke is no better than sitting up at an angle of at least 30 degrees. These differences in early head position did not affect people’s levels of disability or survival to 90 days, which was more than 92% in both groups. It had been thought that the head down position might increase the chance of pneumonia, but in this trial, the rates were also similar for people cared for in either position.


The results of this large international randomised controlled trial are likely to be applicable to adults with different types of stroke in varied settings. As lying position did not affect outcomes, this suggests that clinicians can be guided by patients’ clinical condition, preferences and levels of comfort during the initial management of care.


The current NICE guideline on diagnosis and initial management of stroke suggests that people with acute stroke should be helped to sit up as soon as possible (when their clinical condition permits).


From NIHR Dissemination Centre

Current, future and avoidable costs of stroke in the UK

Briefing from the Stroke Association about the societal costs of stroke in the next 20 years andpotential returns from increased spending on research.

Rehab Matters - film

Rehab Matters, is a short film, commissioned by the CSP, and made by Oscar-shortlisted UK director Chris Jones, looking at the difference community rehabilitation makes to the life of a woman who has just left hospital following a stroke.

Preventing and managing stroke: NHS RightCare Pathway

As part of the ongoing commitment by NHS England to prevent stroke and improve treatment and outcomes, NHS RightCare has published the latest Pathway for Stroke. 

Developed with the Stroke Association, the pathway details interlocking components for an optimal system for prevention and management of stroke and the priority higher value interventions that local health economies should focus on to address variation, improve outcomes, reduce cost and contribute toward a sustainable NHS.      

New rehab garden helps hospital patients return home with confidence

Leamington Spa Hospital has opened a garden to rehabilitate patients who have experienced brain injuries, strokes and amputations.

Lead physiotherapist Lucy Gwynne described the garden as ‘unique’ and said its design aims to improve the balance, mobility and confidence of patients in dealing with everyday hazards on foot and in wheelchairs.

The features of the garden are a slalom course, stepping stone path, uneven surface, bridge, activity board, wire loop challenge and cognitive therapy facilities.

NHS England funding restrictions under fire after patient's death

A 74-year-old man died of a bleed on his brain after he was refused treatment aimed at preventing strokes. NHS England is assessing the treatment as part of Commissioning Through Evaluation
Charity claims it warned NHS England of potential deaths for more than a year.

To obtain this article please copy and paste the post into an email and send it to libraryw@uhcw.nhs.uk with the subject line, Please obtain this article.

NIHR Signal Group rehabilitation activities improve walking after stroke

Group-based circuit class therapy (CCT) focused on repetitive mobility, and functional tasks improved walking ability in people after stroke. People walked on average 61m further during six minutes than those receiving comparison interventions. CCT involves stroke survivors practising different activities at workstations in sight of each other.

Seven day stroke service wins Welsh national award

Twenty physiotherapists were part of an award-winning therapy team whose seven-day pilot service improved the care of stroke patients at the University Hospital of Wales.

The project involved 54 volunteer therapists and aimed to provide earlier therapy assessments in the hospital’s acute stroke unit.

Mechanical clot removal for stroke reduces disability at two years

Timely mechanical removal of the blood clots from inside vessels in the brain after a stroke reduces disability and improves quality of life at two years compared with usual care.

Over a third of those in the thrombectomy group had good functional outcome compared with less than a quarter of the standard care group who received clot busting drugs. This was similar to the results at 90 days and was associated with improved quality of life in terms of self-care and mobility. Findings came from a trial of almost 400 people followed up over two years in the Netherlands.

From the NIHR Dissemination Centre