Preparing for increased stroke volumes in New Zealand

Although the incidence of stroke and mortality are declining due to better management strategies, stroke volumes are going up in New Zealand due to a growing and ageing population.

New research from Associate Professor Anna Ranta, Head of the Department of Medicine at the University of Otago, Wellington, has found that stroke volumes will grow by around 40 per cent over the next 10 years.

The research, published in the New Zealand Medical Journal, describes realistic projections of the number of people likely to require stroke treatment in New Zealand.

“We knew it would go up but didn’t expect the increase to be quite this high,” says Associate Professor Ranta.

“The large increase emphasises that our New Zealand health sector needs to implement effective stroke prevention programmes and stroke intervention strategies to minimise the impact on both human suffering and healthcare expenditure,” she says.

Stroke is a leading cause of death and disability worldwide. In New Zealand it has been estimated that around 8-9000 people have a stroke each year and that 50,000 people live with the consequences of stroke. The annual cost has been estimated to be at $NZ 700 million.

“The study aimed to project stroke volumes over the next 10 years to help with health sector planning,” she says

“Because these figures are growing due to our population growing, it is imperative that the health sector plans ahead and implements effective and appropriate prevention and post-stroke intervention strategies to manage the rise in stroke burden,” says Associate Professor Ranta.

One effective way of managing stroke in an emergency in regional hospitals is by ‘telestroke’ a technique that helps improve out-of-hour patient access to IV thrombolysis in provincial hospitals through remote expert support using videoconferencing.

Clot busting medication can help reverse stroke symptoms if given rapidly and to carefully selected patients, but stroke experts are often unavailable especially out-of-hours at smaller provincial hospitals

Telestroke helps link tertiary hospital experts via videoconferencing to patients in provincial emergency department when a local expert is unavailable.

An evaluation co-authored by Associate Professor Ranta with Suzanne Busch about telestroke was also published in today’s NZ Medical Journal. This was a case study in Nelson auditing the impact of discontinuation of telestroke.

“Some felt that a limited period of expert telestroke support may suffice to help upskill local staff,” says Associate Prof Ranta.

Based on this assertion, telestroke was discontinued at Nelson Hospital after a six-month pilot. However, the study evaluation found that after discontinuing, the treatment rates dropped to pre-telestroke rates.

“This shows that although telestroke is a very useful technique, it does not result in sufficient local staff upskilling to retain improved treatment rates once remote expert support is withdrawn,” she says.

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