Mater Dei Hospital is only serviced by four neurologists. Photo: Matthew MirabelliMater Dei Hospital is only serviced by four neurologists. Photo: Matthew Mirabelli

Almost one-fifth of Maltese die within one month of being admitted to hospital after suffering a stroke, according to a report, which is the second highest rate in Europe.

Only Latvia ranks lower – 19 per cent compared with Malta’s 18.8 per cent – while in Denmark the rate is just 4.1 per cent.

The mortality rates serve as an indicator of the quality of acute care received by patients.

Drafted by the European Commission and the Organisation for Economic Co-operation and Development (OECD), Health at a Glance: Europe 2014 looks at mortality following a stroke.

According to a neurologist who preferred to remain anonymous, the negative rating could stem from the fact that many patients with hypertension and diabetes do not bother visiting doctors and many diabetics are only diagnosed after being admitted to hospital with a stroke.

There no programmes to identify people at risk and due to a number of constraints, including lack of manpower, people over 70 are not admitted to neurology wards – which are the next best thing to a dedicated stroke unit – but to a general ward.

Mater Dei Hospital is only serviced by four neurologists. Some 400 people a year are admitted with a stroke. “The level of specialisation in general wards is not as focused as that of neurologists. Also, people who suffer a heart attack at age 70 and survive it are much more likely to die if they suffer a major stroke at 80.”

There are no programmes to identify people at risk

There is also no dedicated rehabilitation unit which specialises in looking after stroke patients, the neurologist pointed out.

Cerebrovascular disease was the underlying cause for about 11 per cent of all deaths in EU countries, according to the report.

Ischemic stroke represents around 85 per cent of all cerebrovascular disease cases. This occurs when an artery to the brain is blocked, leading to dead cells of the affected part. Immediate medical treatment is critical.

The report notes that treatment for ischemic stroke has advanced dramatically over the last decade.

Clinical trials have demonstrated clear benefits of thrombolytic treatment (used to break up dangerous clots inside blood vessels) for ischemic stroke as well as receiving care in dedicated stroke units to facilitate timely and aggressive diagnosis and therapy for stroke victims.

Based on the measure of deaths within a hospital, the standardised case-fatality rate for ischemic stroke was 9.6 per cent on average across EU member states.

There is almost a five-fold cross-country difference between the highest and lowest percentage of in-hospital case-fatality for ischemic stroke, the report notes.

System-based factors play a significant role in explaining these differences.

“Denmark for example has been at the forefront of establishing dedicated stroke units in hospitals, contributing to the lowest case-fatality rates for ischemic stroke.

“Patterns of hospital transfers, average length of stay, emergency retrieval time and average severity of stroke constitute other factors influencing these rates.”

Between 2001 and 2011, case-fatality rates for ischemic stroke declined by over 20 per cent across EU member states.

These reductions, the report continues, suggest overall improvements in the quality of care for stroke patients, with gains made in most countries.

However, improvements were not uniform across countries. Improvements in Belgium and Luxembourg were below the EU average, while the Czech Republic, the Netherlands and Norway were able to reduce their case fatality rates by more than 40 per cent between 2001 and 2011.

As in Denmark, the improvements in case-fatality rates can at least be partially attributed to the high level of access to dedicated stroke units in these countries.

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