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

2. 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

3. 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.

4. Mortality Age profile PCTs map mortality Association with deprivation

5. Age Profile of Stroke (ICD10 I60-I69) Mortality in the West Midlands, deaths registered 2004-06

6. Under 75’s Stroke (ICD10 I60-I69) Mortality Rates in the West Midlands by Primary Care Organisation, deaths registered 2004-06 Mortality

7. Stroke (ICD10 I60-I69) Mortality Rates in the West Midlands by Deprivation, deaths registered 2004-06

8. Morbidity Hospital admissions –Emergency admissions by PCT Prevalence –Quality Outcomes Framework (QOF)

9. 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

10. Unadjusted Prevalence Rates of Stroke and TIA (STR1), in the West Midlands by Primary Care Trust, Financial Year 2007/08 Morbidity QOF Prevalence

11. Quality of care markers Primary care –QOF Secondary care –Sentinel Audit

12. Primary care quality markers Further investigations (Stroke 11) Blood pressure (Stroke 6) Cholesterol (Stroke 8) Anti-coagulation (Stroke 12)

13. QoF Stroke 11: Referral for further investigations 2007/08 financial year by PCT

14. 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

15. Conclusions Higher than national mortality –More stroke? –More likely to die? Quality indicators vary Expect changes following introduction of National Stroke Strategy