Description of specialty
Stroke is the most common cause of severe disability and the fourth most common cause of death in the UK. It costs the economy £9 billion a year (£4.38 billion in health and social care costs; over 5% of NHS resources). Twenty-five per cent of patients are under 65, and people from certain ethnic minorities are at a higher risk. (Source: State of the Nation: Stroke statistics).
Stroke medicine is a sub-specialty that attracts physicians from different specialty training pathways, most commonly geriatric medicine or neurology. Other potential parent specialties include rehabilitation medicine, cardiology, general internal medicine, and clinical pharmacology and therapeutics. Stroke physicians may care exclusively for stroke patients or may have clinical responsibilities within their parent specialty and/or general medicine. Stroke physicians are represented by the British Association of Stroke Physicians (BASP).
Rapid access transient ischaemic attack (neurovascular) clinics enable accurate diagnosis and aim to optimise secondary prevention. Stroke physicians contribute to neurovascular clinics, acute stroke care and rehabilitation services. All acute hospitals in the UK now either have a stroke unit on site or have rapid access to this service (usually by redirection of ambulances when patients are suspected of having had a stroke or urgent transfer) National Clinical Guideline for Stroke.
Hyperacute stroke units offer rapid specialist and multidisciplinary assessment of patients with suspected stroke. Up to 25% of patients have a stroke mimic condition. Hyperacute stroke units offer 24/7 thrombolysis for patients with acute ischaemic stroke. Recent advances in the evidence base in support of thrombectomy mean that services will need to develop further to ensure equitable access of eligible patients to such therapies.
Once stable, stroke patients are transferred to either an acute stroke unit or stroke rehabilitation unit where they receive specialist multidisciplinary care. Stroke patients need specialist rehabilitation either in hospital or at home, and to access further rehabilitation and support, often for many years.
Improvements in acute care remain unmatched by progress in delivering more effective post-hospital support, in particular comprehensive access to early supported discharge (ESD) services and specialised community stroke rehabilitation.