Stroke pathway — An evidence base for commissioning — An evidence review for NHS England and NHS Improvement

Abstract

Background: Stroke is a leading cause of death and disability in the UK with around 90,000 new stroke patients each year. The NHS England (NHSE) Long Term Plan is committed to saving 150,000 lives from cardiovascular disease over the next 10 years and improving the quality of care available for patients who have a stroke. Methods: This overview was commissioned by NHSE to summarise what we currently know and don’t know across the breadth of the care pathway. We conducted a series of evidence reviews to inform NHSE and its providers (commissioners, primary and secondary care teams, networks) of what needs to be achieved to deliver world class services equitably across England. Here, we present a concise summary of this work. Results: Our report summarised the findings of 539 research articles, which we organised into ten sections relating to different stages of the stroke care pathway, from prevention in the community, to acute pre-hospital and hospital care, and on to rehabilitation and longer-term care in the community. Priorities include better prevention (with 90% of stroke attributable to modifiable risk factors), and improving awareness to maximise the chances that people experiencing an ischaemic stroke will reach hospital in time to be eligible for acute treatments. We describe the effects of reorganising hospital care into a smaller number of 'hyperacute' centres, and early supported discharge. In the longer term after stroke, the needs of stroke survivors and their families are not being met, but we found little evidence about what works to improve the situation. Conclusions: We present in this ‘concise’ version, an overview of the evidence to support the delivery of world class stroke care in England. We conclude with an overview of gaps in the evidence base for each area, set out as research questions to be prioritised and addressed.