Campaigners have hit out at "horrifying and unacceptable" new statistics which reveal that only half of stroke patients in Scotland are receiving the care needed to maximise their chances of survival and recovery.
It comes as the number of strokes recorded rose to 11,257 last year, an increase of 202 compared to 2021, although Public Health Scotland (PHS) said this is probably down to better diagnosis rather than "a genuine increase in stroke numbers".
An audit by PHS found that just 50% of patients received the 'stroke care bundle' - a series of tests and interventions designed to speed up diagnosis and effective treatment.
This was down from 57% in 2021.
READ MORE: World-first stroke study into long-term impact of Covid on recovery
The bundle is made up of four key targets: a swallow screen within four hours; brain imaging within 12 hours; aspirin within 24 hours; and admission to a stroke unit within one day.
Performance on three out of the four measures - excluding aspirin - had deteriorated year-on-year, with the steepest fall from 70% to 63% for timely admission into a specialist stroke unit.
PHS said this was seen "predominantly in larger city centre or general hospitals" due to Covid-related disruption, noting that "anecdotally we have seen stroke unit closures during outbreaks at various times during 2022".
It adds that "it will only be through fixing whole hospital problems that we have a hope of returning to pre-pandemic performance levels".
This requires improvements in "social care systems, as well as within internal hospital systems, such as protecting stroke unit beds".
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PHS also warns that the decline in performance against the stroke bundle "will inevitably have led to longer lengths of stay and worse outcomes for those patients affected".
The "door-to-needle" (DTN) time - the period between a stroke patient arriving at hospital and receiving thrombolysis, an injection to dissolve a stroke-causing blood clot - also increased from 52 to 55 minutes, although more patients received the procedure last year: 1,059, compared to 977 in 2021.
The report notes that worse DTN times may be linked to factors such as the "tremendous pressure" facing emergency departments as well as an increased use of advanced imaging which "can provide valuable additional information but can slow down the process".
The report also highlights the limited availability of thrombectomy - a procedure where clots can be manually removed.
It is estimated that it could help avoid or reduce disability for 800 patients a year once centres are fully operational, but only 112 stroke patients underwent a thrombectomy last year.
While the goal is to create a 24/7 thrombectomy service available to patients throughout Scotland via three hubs, it is currently limited by a shortage of specialist doctors and support staff.
READ MORE: Anger as Scot Govt slashes planned stroke thrombectomy funding
The number of hours thrombectomy is available expanded during 2022, but remains particularly scarce in the west where it is available for only a "limited number of hours per week" for patients presenting at the Queen Elizabeth University Hospital in Glasgow.
In the East it is available six days a week from 8am-8pm for patients presenting at the Royal Infirmary of Edinburgh or St John's in Livingston, and for five days a week from 8am-5pm at Ninewells in Dundee, which also takes transfers from Aberdeen Royal Infirmary or the Victoria hospital in Kirkcaldy.
Jane-Claire Judson, chief executive of Chest, Heart and Stroke Scotland (CHSS), said: “It is horrifying and unacceptable that only half of patients got the full stroke care bundle last year – these are essential measures that greatly improve people’s chances of survival and recovery.
“We all know that stroke is one of Scotland’s biggest health challenges, so it’s devastating to see in black and white that patients are not getting the emergency stroke care they need to recover."
John Watson, associate director for the Stroke Association in Scotland said the figures were "alarming".
He added: "Stroke patients and their families pay the price in lives lost, or profound and avoidable disabilities.”
A Scottish Government spokeswoman said: “We are focused on ensuring that people who have had a stroke receive the best possible care as quickly as possible to enable them to live longer, healthier and independent lives.
“That is why, this month we have published our new Stroke Improvement Plan, which sets out our vision for minimising preventable strokes and ensuring timely and equitable access to life-saving treatment.
“We continue to expect health boards to identify aspects of their stroke services which do not meet the Scottish Standards and to work with their stroke MCNs to improve their standards of care locally.”
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