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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
4
25-2
9
30-3
4
35-3
9
40-4
4
45-4
9
50-5
4
55-5
9
60-6
4
65-6
9
70-7
4
75-7
9
80-8
4
85+
Age
Nu
mb
er o
f D
eath
s
0
500
1000
1500
2000
2500
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
ectl
y A
ge
& S
ex S
tan
dar
dis
ed R
ate
(per
100
,000
)
75+
0
200
400
600
800
1000
1200
1 (most
deprived)
2 3 4 5 (least
deprived)IMD 2007(England Rank Quintiles)
Dir
ectl
y A
ge
& S
ex S
tan
dar
dis
ed R
ate
(per
100
,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%
85%
90%
95%
100%N
orth
Sta
fford
shire
Wol
verh
am
pto
nC
ity
Her
efor
dsh
ire
Sto
ke-o
n-T
rent
Dud
ley
Cov
entr
y
Tel
ford
& W
reki
n
Shr
ops
hire
Cou
nty
Sou
thB
irmin
gham
Wal
sall
Sou
thS
taffo
rdsh
ire
San
dwe
ll
Birm
ingh
am E
ast
& N
ort
h
Hea
rt o
fB
irmin
gham
Wor
cest
ers
hire
War
wic
kshi
re
Sol
ihul
l
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