A stroke is when blood stops flowing to a part of the brain, due to a blood clot forming or blood vessel leaking. A stroke is always an emergency; it is important to restore blood flow to the brain quickly and safely, to save lives and prevent long-term disability.
Some hospitals have dedicated stroke wards to offer specialist care to stroke patients, often including both immediate emergency treatment and post-stroke rehabilitation services. However, not every hospital has the resources or expertise to offer these services.
In the 1990s there was lively debate between medical professionals about the best way to help stroke patients: should they be cared for in general wards or in dedicated stroke units staffed by a stroke-skilled multidisciplinary team? Following conventional wisdom, many medics and patients had a preference for the former approach, but there was no clear consensus.
To provide an evidence-based answer, a review team led by Professor Peter Langhorne at the University of Glasgow set out to address this question. They meticulously examined data from clinical trials comparing the odds of death or disability after stroke, and found that patients treated in dedicated stroke wards were significantly more likely to be alive, independent and living at home following a stroke.
Their findings were published as a full Cochrane review in 2001, with earlier iterations published in other medical journals. As the evidence and consensus around stroke units settled, more recent updates of the review have focused on how to organize stroke units to achieve the best outcomes for patients.
“The surprising feature of the initial review was the consistent message from clinical trials of an important improvement in patient recovery,” says Professor Langhorne.
Accelerating implementation
Following the publication of the 2001 Cochrane review, hospitals and guideline developers across the world began to update their guidelines and policies to recommend the use of specialist stroke wards and units. The UK was an early adopter, accelerated by the National Health Service (NHS)’s ability to plan and organise care nationally. Stroke survival and rehabilitation rates have increased worldwide, and evaluations in the UK have quantified the impact locally.
Reflecting on the impact of his review, Professor Langhorne notes that “there is no doubt that the stroke unit review gave stroke clinicians the evidence to push for service improvement”
Between 2001 and 2010, the chances of dying within 30 days of a stroke fell by 40% in the UK, largely attributed to improvements in stroke care. The implementation of stroke units also allowed services to embrace the opportunities provided by new specialist stroke treatments. Specific studies looking at the impact of further stroke service centralization in London and Manchester found that it saved over 150 lives per year across the two cities, reduced the time people need to spend in hospital and improved quality of care for many thousands of patients.
Improving stroke care for everyone
Cochrane’s contributions to stroke care do not end there. Cochrane reviews help medical professionals to offer the best care to every patient, including quantifying the benefits and risks of giving clot-busting drugs and identifying the crucial time window when they are most effective. Our reviews have also helped to guide rehabilitation of stroke survivors, covering interventions to improve both physical and mental recovery.
“A challenge for future services is to ensure that patients who can benefit from the new hyperacute clot-busting treatments can access them, while also ensuring all stroke patients can access care in a stroke unit,” says Professor Langhorne.
In the 1990s, approximately a quarter of UK stroke patients died within 30 days; today, that figure is around 13%. Thanks to the work of diligent medical professionals and clinical service planners, guided by evidence from Cochrane reviews, there are now millions of stroke survivors living independently who may otherwise have died or required lifelong care.
