Stroke in the West Midlands Stacey Croft, WMPHO Kristina Routh, DH (WM) Helen Carter, NHS WM.

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