FIRST the good news: major improvements in NHS acute stroke care in Scotland over the past decade mean that stroke deaths are falling.
Today there are around 110,000 stroke survivors. Now the bad news: of the two-thirds who survive, around half have to live with a disability that seriously affects their quality of life.
A significant cause of strokes is a condition known as AF (atrial fibrillation), a complication of various diseases that causes a fast and irregular heartbeat. It is extremely common. One in four of us will develop it over our lifetimes and around 6% of over-65s live with the condition. It gives them a five-fold increased risk of having a stroke. Strokes are the leading cause of disability in Scotland.
It follows that if AF was better controlled in the general population, fewer people would have strokes. Just as prevention is better than cure, preventing strokes is better than surviving with distressing and debilitating physical and psychological symptoms.
The rise in obesity and diabetes, together with Scotland's aging population, mean this problem is going to get much worse, unless urgent steps are taken to address it. That is why UK stroke experts meeting in Edinburgh at the weekend are calling on the Scottish and UK governments to introduce a screening programme for older patients to detect and treat AF.
With more and more treatments juggling for a virtually static NHS budget, inevitably there is much jockeying for position from different medical specialisms. What distinguishes this voice from the general clamour are the numbers of patients involved and the relative simplicity of the solution. Screening would consist of merely checking the pulse of everyone over the age of 65 and referring those with suspected AF to a cardiologist. If an ECG indicates that they have the condition, it can be treated with anti-coagulant drugs such as warfarin. (The hope a few years ago that a daily aspirin could perform the same function now appears to have been dashed.)
Treating AF currently costs the NHS in Scotland around £40m. Though a screening programme would inevitably increase that figure, that should be offset against the current costs of caring for stroke survivors with severe medical problems and the distress to patients and their families of premature death or reduced quality of life.
If the Westminster Government is too distracted by its major overhaul of the NHS in England to introduce a national screening programme there, this is surely an area where Scotland could lead the way?
The symptoms of AF – feeling dizzy and breathless or simply below par – are hard to spot and easy to dismiss as "part of the aging process". For too many patients living with this condition, it has come to stand for "alone and frustrated".
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