More than 1 million people in the European Union have a stroke each year, and this number is rising. In the UK there are over 100 000 strokes per annum — perhaps three for each GP — and although stroke incidence in this country is falling slightly, and mortality improving, strokes still account for approaching 10% of all deaths.1,2 This is a major public health concern, and often an individual tragedy. Every Sunday morning the wonderful Andrew Marr is a reminder of our vulnerability to cerebrovascular accidents, his lifeless left arm a powerful image of the struggles faced by stroke survivors. Who can complain about his occasional impatience with the slippery responses of some of his dissembling interviewees? Key weapons in the fight against stroke include detection and control of the risk factors, public awareness of early symptoms, prompt reporting, and swift and appropriate intervention. The Stroke Association launched its new Act FAST campaign in February, taken up by bodies such as NHS Direct and NHS 111: be aware of changes in the Face, weakness in the Arms, changes in Speech, and the importance of not wasting Time in getting help. In this issue of the BJGP we have articles on important aspects of the prevention and recognition of stroke.
The editorial by Richard Hobbs sets the scene, contextualising some of the research in the Journal. Until recently, most guidance on stroke prevention has been contained in specialist guidelines, in which scoring systems and methods of estimating risk have not always been easy to follow, and not been entirely applicable to general practice. The European Primary Care Cardiovascular Society has produced a set of guidelines aimed at giving GPs practical advice on the management of atrial fibrillation and the prevention of stroke (www.epccs.eu).
General practice receptionists are at the front line of disease recognition. Patients who think they may be having a stroke may telephone the practice or even present themselves at the front desk, so receptionists need to be part of the Act FAST awareness campaign. The study by Ruth Mellor et al is valuable in highlighting this important role. They found that receptionists were able to recognise over two-thirds of simulated ‘stroke’ telephone calls, and that recognition was less good when callers had only one or two of the FAST symptoms. Further implications of this study for ‘triage’ and early recognition of other serious problems, such as heart disease, obstetric complications, sepsis, and trauma are not difficult to see.
Stroke prevention is an area in which patients themselves play a key role and the articles from researchers in Oxford, Birmingham, and Cambridge on self-monitoring of oral anticoagulation to prevent embolic stroke provide comprehensive information on the means of optimising this important extension of hospital-based care. More controversially, acceptability of the polypill — a fixed-dose combination of antihypertensive agents and a statin — was examined by Sheila Greenfield et al who found a good deal of scepticism among patients, particularly those at lower risk of vascular events, and concerns about side effects. There is, however, accumulating evidence of the potential value of this population preventive approach, and its acceptability and high rates of adherence to therapy. The Polypill Prevention Programme website (www.polypill.com) will provide a 3-month supply of polypills, following an online medical consultation, for £88.
Our Out of Hours section this month is full of literary interest. We had a fantastic response to our Student Writing Competition, in which we invited short essays on the theme of The GP in the Digital Age and we are publishing the winning entry and two of the best of the rest. You can also read reviews of new novels by two of Britain’s best contemporary writers — Martin Amis’s Zone of Interest, set in Auschwitz, and Ian McEwan’s The Children Act, a cool, ironic dissection of a legal conundrum and a legal marriage. Please think about contributing to this section of the BJGP — we know there is a wealth of talent out there!
- © British Journal of General Practice 2015
REFERENCES
- 1.↵
Epidemiology, Stroke Forum.
- 2.↵
