Improving Stroke Care Pathways
Source: Medscape
مدت زمان تمرین این بخش: 45 دقیقه
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Stroke is a leading cause of death and disability in the UK, responsible for approximately 38,000 deaths each year (National Institute for Health and Care Excellence (NICE), 2023), and its burden on individuals, families, and the NHS will only increase as the population ages with co-morbidities (NICE, 2019). One in four stroke survivors will experience another stroke (secondary stroke) within five years (NICE, 2019). Based on 1.3 million stroke survivors in the UK alone, this is a staggering 325,000 people who have been, or will be, affected by a stroke yet again (Public Health Scotland, 2023; Department of Health Northern Ireland, 2021). This has led to an increase in the number of stroke-related readmissions to hospitals across the UK (King et al, 2020). This article will explore how nurse practitioners transformed the stroke arrhythmia pathway by improving the remote cardiac monitoring process and creating a nurse-led stroke service.
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Stroke is a major cause of death and disability in the UK, causing about 38,000 deaths each year (NICE, 2023). As the population ages and more people have other health problems, the impact of strokes on individuals, families, and the NHS will increase (NICE, 2019). One in four stroke survivors will have another stroke within five years (NICE, 2019). With 1.3 million stroke survivors in the UK, this means 325,000 people will experience a second stroke (Public Health Scotland, 2023; Department of Health Northern Ireland, 2021). This has led to more stroke-related hospital readmissions across the UK (King et al., 2020). This article will discuss how nurse practitioners have improved the stroke care pathway by enhancing remote heart monitoring and establishing a nurse-led stroke service.
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Of the more than one million stroke survivors living in the UK, a disproportionate number are living with atrial fibrillation (AF) (Stroke Association, no date). People with AF have a risk of stroke that is around five times higher than those without the condition (Stroke Association, no date). It is now well known that AF-related strokes are often more severe, with higher mortality and greater disability rates than strokes with other causes (Stroke Association, no date). Additionally, effective anticoagulation therapy can decrease the rate of stroke by at least two-thirds in people with AF, this is of course only possible in cases where AF has been identified (Lowres et al, 2019).
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Remote patient cardiac monitoring and programming, which are available with some insertable cardiac monitoring systems, allow healthcare teams to remotely monitor patients and remotely reprogram devices, capturing medical data from patients without needing to arrange an in-clinic visit, and transmitting this data electronically to consultants for clinical assessment. Remote patient monitoring technology can identify several cardiac conditions, including AF, by regularly monitoring cardiac changes such as heart rhythm and heart rate. This helped consultants at University College Hospitals NHS Foundation Trust (UCLH) to reduce emergency hospital visits for stroke patients, lessening the pressure on its healthcare systems.
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Remote patient cardiac monitoring and programming, available with some insertable cardiac monitoring systems, let healthcare teams check patients’ heart data and adjust devices remotely. This means patients don’t need to visit the clinic as often. The data is sent electronically to doctors for review. This technology can identify several heart conditions, including atrial fibrillation (AF), by continuously tracking heart rhythm and heart rate. At University College Hospitals NHS Foundation Trust (UCLH), this technology has helped reduce emergency hospital visits for stroke patients, easing the burden on the healthcare system.
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Insertable loop recorders or insertable cardiac monitors (ICMs) – also known as implantable cardiac monitors – are chosen for patients who are suspected to be suffering from arrhythmias or have had a cryptogenic stroke (stroke of an unknown source), including transient ischaemic attack (TIA). The use of long-term cardiac monitoring to support the detection of AF in cryptogenic stroke and TIA patients is now also recommended by both NICE and the European Stroke Association (NICE, 2020; Rubiera et al, 2022; National Clinical Guideline for Stroke for the United Kingdom and Ireland, 2023).
Simplified:
Insertable loop recorders, also known as insertable cardiac monitors (ICMs) or implantable cardiac monitors, are used for patients suspected of having arrhythmias or who have had a cryptogenic stroke (a stroke with an unknown cause), including transient ischemic attacks (TIAs). Long-term cardiac monitoring with these devices helps detect atrial fibrillation (AF) in patients with cryptogenic stroke and TIA. This practice is now recommended by both NICE and the European Stroke Association (NICE, 2020; Rubiera et al., 2022; National Clinical Guideline for Stroke for the United Kingdom and Ireland, 2023).
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Consequently, ICMs with remote monitoring and programming can help to improve the quality of life for patients recovering from a stroke, while reducing the risk of secondary stroke and minimizing unnecessary healthcare costs for the NHS (National Clinical Guideline for Stroke for the United Kingdom and Ireland, 2023).
