patients23" 25 . Although stroke care usually involves hospitalisation, wide variations have been reported between English districts in the proportion of stroke cases that is admitted to in-patient care (55-90%)3 . It is estimated that, in terms of acute stroke services, patients consume the following resources: 20% of acute beds, and 25% of all long-term beds, including nursing home places3 . In a Stroke Association survey in the UK in 1998, consultants responsible for care of stroke patients were questioned. The findings are summarised to illustrate the inequity in impact on health services in the UK of stroke patients24: over three-quarters of consultants had access to organised stroke services, yet only half of stroke patients go to them; there was geographical inequity in the provision of organised stroke services; social work support was inadequate; access to neuroradiology remained difficult; stroke consultants are rare; better information and management tools are required. In a sentinal audit of stroke care m the UK in 1999, Rudd and colleagues re-inforced the survey findings of the Stroke Association but actual practice appeared even more sub-optimal than the consultant survey25 . Only 18% of patients spent over half their stay in a stroke unit. If care is to be more effective, the changes in stroke service provision will have to be considerable, which will impact on the health services but to the advantage of the patient and their families. 284 British Medical Bulletin 2000,56 (No 2) Downloaded from https://academic.oup.com/bmb/article/56/2/275/303250 by guest on 17 April 2022 The impact of stroke Key points for clinical practice Table 3 outlines some of the relevant data presented in this chapter that are considered useful information for both patients, families and health care professionals. Stroke has a significant impact on our society and we are only just beginning to be able to quantify it. With increasing opportunities to reduce this impact, it is important that there are reliable baseline figures on the needs of stroke patients and robust tools for monitoring improvements in outcome. Table 3 Key points for clinical practice Incidence 1 in 4 men and 1 in 5 women will have a stroke if they live to 85 years Incidence rate of cerebral infarction 1 2-2 per 1000 Incidence rate of subarachnoid haemorrhage 9-33 per 100,000 Recurrence 20-40% 30% increase in acute strokes between 1983 and 2023 Prevalence 9 million stroke patients world-wide Prevalence rate 5 per 1000 Survival/mortality 4 5 million deaths a year world-wide Third most common cause of death 28 day case fatality 20-28% 1 year case fatality 34-41 % Health service provision 4-6% health service budget 9% primary care consultations are for 'circulatory" disorders 55-90% admission rates to hospital 20% acute beds, 25% long-term beds used for stroke Inequity in provision of effective stroke services References 1 Department of Health. Our Healthier Nation; Saving Lives. London HMSO, 1999 2 Abodenn I, Venebles G Stroke management in Europe: Pan European Consensus meeting on stroke management J Intern Med 1996: 240: 173-80 3 Wade D. Stroke (acute cerebrovascular disease). In: Stevens A, Raftery J. (eds) Health Care Needs Assessments, vol 1 Oxford Radcliffe Medical Press, 1994; 111-255 4 Intercollegiate Working Party for Stroke. National Clinical Guidelines for Stroke. London: Royal College of Physicians of England, 2000 5. Office of National Statistics. Mortality Statistics Causes. England and Wales 1997. Series DH 2 no. 24. London: HMSO, 1998 6 Bamford J, Sandercock P, Dennis M, Warlow C. Classification and natural history of clinically identifiable subtypes of cerebral infarction. Lancet 1991, 337 1521-6 7. Murray CJL, Lopez AD. (eds) The Global Burden of Disease: a comprehensive assessment of mortality and disability from disease, injuries, and risk factors in 1990 and projected to 2020 Boston, MA: Harvard University Press, 1996 8 Department of Health Public Health Common Data Set 1995. Guildford: Institute of Public Health University of Surrey, 1996 British Medical Bulletin 2000,56 (No 2) 285 Downloaded from https://academic.oup.com/bmb/article/56/2/275/303250 by guest on 17 April 2022 Stroke 9. Kunst AE, del Rios M, Groenhof F, Mackenbach for the European Union Working Group on Socioeconomic Inequalities in Health. Socioeconomic inequalities in stroke mortality among middle-aged men. An international overview. Stroke 1998; 29: 2285-91 10 Bonita R Epidemiology of stroke Lancet 1992; 339: 342^t 11 Wolfe CDA. The effectiveness of public health and individual measures in reducing the incidence of stroke. In: Wolfe C, Rudd A, Beech R. (eds) Stroke Services and Research. London: Stroke Association, 1996, 40-87 12 Sudlow CLM, Warlow CP. Comparable studies of the incidence of stroke and its pathological types. Stroke 1997: 28: 491-9 13 Stewart JA, Dundas R, Howard RS, Rudd AG, Wolfe CDA Ethnic differences in stroke incidence: prospective study using stroke register. BMJ 1999; 318: 967-71 14 Hankey G, Jamrozik K, Broadhurst R et al. Long-term risk of first recurrent stroke in the Perth community stroke study Stroke 1998; 29: 2491-500 15 Thorvaldsen P, Asplund K, Kuutasmaa K, Rajaknagas AM, Schroll M, for WHO MONICA Project. Stroke incidence, case fatality and mortality in the WHO MONICA project Stroke 1995; 26: 361-7 16