The National Stroke Strategy - is it achievable?
BACKGROUND
Timing of intervention in symptomatic carotid disease is critical. The UK Department of Health's National Stroke Strategy published in December 2007 recommends urgent carotid intervention within 48 h, in appropriate patients, who have suffered a transient ischaemic attack (TIA), amaurosis fugax or minor stroke. Despite the running of a rapid-access clinic for patients with symptoms of TIA, the time from symptom to surgery is rarely less than 2 weeks. To date, there has been little published research on the UK public response to the symptoms of TIA, and no study at all of the response of primary care to such patients. The aim of this study was to ascertain both these responses to see whether a 48-h target is achievable.


METHODS
A total of 402 men attending our aortic aneurysm screening sessions were asked to complete a questionnaire requesting their most likely response to an episode of amaurosis fugax or TIA. All 45 GP practices in the hospital catchment area were asked how they would respond to patients requesting to be seen with the symptoms used in the questionnaire.


RESULTS
Nearly one in six patients would ignore the symptom unless it recurred, approximately half would request a GP appointment and a third would see an optician if they had amaurosis fugax. The mean waiting time to see a GP was 2 days for a routine appointment and within 24 h for an emergency appointment.


CONCLUSIONS
It is clear that a significant number of people would ignore the first symptom of carotid ischaemia; for those with amaurosis fugax, nearly a third would initially seek help from their optician. Those given a routine GP appointment would have to wait a minimum of 2 days. If the Department of Health is serious about reducing the incidence of stroke and introducing a target of 48 h from symptom to treatment, then there needs to be a wide-spread public and healthcare education programme, in particular alerting opticians and GP receptionists that these symptoms constitute a medical emergency.
Reid
T D
TD
Department of General Surgery, Princess of Wales Hospital, Coity Road, Bridgend CF31 1RQ, UK. tomreid74@gmail.com
Finney
L J
LJ
Hedges
A R
AR
D000368:Aged; D004630:Emergencies; D016894:Endarterectomy, Carotid; D005194:Family Practice / Q000458:organization & administration / Q000706:statistics & numerical data; D019983:Guideline Adherence / Q000592:standards*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D002546:Ischemic Attack, Transient / Q000150:complications / Q000601:surgery*; D008297:Male; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology / Q000517:prevention & control*; D011795:Surveys and Questionnaires; D013997:Time Factors; D006113:United Kingdom / Q000453:epidemiology
Eur J Vasc Endovasc Surg. 2003 Aug;26(2):115-29
12917824
N Engl J Med. 1991 Aug 15;325(7):445-53
1852179
Lancet. 1991 May 25;337(8752):1235-43
1674060
Neurology. 2005 Mar 8;64(5):817-20
15753415
Cerebrovasc Dis. 2007;23(5-6):435-40
17406114
Stroke. 1989 Mar;20(3):333-9
2922771
Lancet Neurol. 2007 Dec;6(12):1063-72
17993293
Neurology. 2003 May 13;60(9):1429-34
12743226
J Neurol. 2007 Feb;254(2):179-84
17334952
Eur J Vasc Endovasc Surg. 2008 Apr;35(4):383-91
18261942
Stroke. 2006 May;37(5):1254-60
16574923
Surgeon. 2007 Feb;5(1):23-30
17313125
BMJ. 1989 Mar 11;298(6674):656-60
2523745