Stroke in the West Midlands

Stacey Croft, WMPHO

Kristina Routh, DH (WM)

Helen Carter, NHS WM

What is covered in the KHD chapter?

• What is stroke?• Mortality• Morbidity

– Hospital Admissions– Prevalence

• Quality of care markers – Primary Care• Quality of care markers – Secondary Care

What is stroke?Disruption of blood supply to brain – ‘brain attack’.• Two main types

– ischaemic (80%), haemorrhagic (15%)

• Sudden onset– e.g. weakness of limbs, loss of speech, unconsciousness

• Transient ischaemic attack (TIA) lasts <24 hrs• 110,000 people a year in UK have a stroke• Around 30% die within a year• Single largest cause of disability in the UK• Risk factors include

– age, raised bp, smoking, alcohol, lack of exercise, atrial fibrillation, obesity, previous TIA.

Mortality

• Age profile

• PCTs map mortality

• Association with deprivation

0

1000

2000

3000

4000

50000-

4

5-9

10-1

4

15-1

9

20-2

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25-2

9

30-3

4

35-3

9

40-4

4

45-4

9

50-5

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55-5

9

60-6

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65-6

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70-7

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75-7

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80-8

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85+

Age

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0

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Ag

e Sp

ecific Rate

(per 100,000)

Count Males Count Females Rate Males Rate Females

Data Source: ONSAnalysis: WMPHO

Age Profile of Stroke (ICD10 I60-I69) Mortality in the West Midlands, deaths registered 2004-06

Under 75’s Stroke (ICD10 I60-I69) Mortality Rates in the West Midlands by Primary Care Organisation, deaths registered 2004-06

Mortality

95% Confidence Interval Persons Linear (Persons)

Under 75s

R2 = 0.97

0

5

10

15

20

25

30

35

1 (most

deprived)

2 3 4 5 (least

deprived)IMD 2007(England Rank Quintiles)

Dir

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ate

(per

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)

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200

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2 3 4 5 (least

deprived)IMD 2007(England Rank Quintiles)

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dis

ed R

ate

(per

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,000

)

Data Source:ONS, DCLGAnalysis:WMPHO

Stroke (ICD10 I60-I69) Mortality Rates in the West Midlands by Deprivation, deaths registered 2004-06

Morbidity

• Hospital admissions– Emergency admissions by PCT

• Prevalence– Quality Outcomes Framework (QOF)

Under 75’s Stroke (ICD10 I60-I69) Emergency Admission Rates in the West Midlands by Primary Care Organisation, financial year 2006/07

Morbidity Emergency Admissions

Unadjusted Prevalence Rates of Stroke and TIA (STR1), in the West Midlands by Primary Care Trust, Financial Year 2007/08

MorbidityQOF Prevalence

Quality of care markers

• Primary care – QOF

• Secondary care– Sentinel Audit

Primary care quality markers

• Further investigations (Stroke 11)

• Blood pressure (Stroke 6)

• Cholesterol (Stroke 8)

• Anti-coagulation (Stroke 12)

70%

75%

80%

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90%

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Primary Care Organisation

95% Confidence Interval % West Midlands

Data Source: QOF STROKE11Analysis: WMPHO

QoF Stroke 11: Referral for further investigations 2007/08 financial year by PCT

Secondary care quality markers

Sentinel Audit: Royal College of Physicians

• Phase 1– organisation of care. 10 domains

• Phase 2– process of care. 12 Key Standards

Conclusions

• Higher than national mortality– More stroke?– More likely to die?

• Quality indicators vary

• Expect changes following introduction of National Stroke Strategy