22 May 2016

Positive results for NZ stroke patients

3:45 pm on 22 May 2016

The speed at which stroke patients are treated in Dunedin may mean patients are more likely to do better over time than overseas, a study suggests.

Wellington Free Ambulance.

Photo: RNZ / Alexander Robertson

That was despite New Zealand patients of the study, which was trialling special skin patches, being older and more at risk of cardiovascular and related diseases.

A medical specialist at Dunedin Hospital said the result came as a surprise but was probably because of more rapid access to hospital treatment, combined with access to a special skin patch.

Stroke is the third most prevalent cause of death in New Zealand, with about 2500 deaths a year. It is also the major cause of serious adult disability.

Blood pressure plays a crucial role, as a key trigger for strokes, while also being associated with poor outcomes after stroke.

The study, known as ENOS, involved 23 countries and ran from 2001 to 2013.

It was looking at the use of nitric oxide skin patches to help reduce blood pressure, at a time when swallowing can be dangerous.

The 71 New Zealanders, mostly from Dunedin, took part from 2006.

Internal medicine specialist Michael Furlong told a meeting of doctors in Australia this week the patches were safe for both thrombotic and haemorrhagic strokes.

He also said that in comparison to 3940 patients from the rest of the world, the 71 New Zealanders were older and sicker - but they did better overall.

"The key local finding was that 16 percent of [the] New Zealand sub-group were less likely to suffer severe disability within 90 days of their strokes than patients in the rest of the world.

"This was despite New Zealand patients being over four years older (74.5 versus 70.2 years) and having higher rates of cardiovascular and other related diseases than others in the study."

Michael Furlong

Internal medicine specialist Michael Furlong Photo: Supplied

Dr Furlong said the New Zealanders also had better 90-day outcomes than patients recruited from other countries when it came to verbal fluency and acute hospitals stays (six days rather than 11).

He said 19 New Zealand patients were enrolled in the trial less than six hours after a stroke, and 52 between six and 48 hours.

The very small number (19) getting either the patch or a placebo meant making firm conclusions about its actual effectiveness would be unwise, and further analysis was needed, he said.

That is under way in the United Kingdom in a follow-up trial, however Dr Furlong confirmed to RNZ News the nitric oxide patch was well tolerated.

He also said that during the trial Dunedin Hospital had developed a Stroke Unit to standardise and improve co-ordination of patient care.

"It included a system where the Emergency Department could send urgent tracer calls to members of the stroke team.

"This helped the team see patients immediately, and [to] consider thrombolysis treatment and enrolment in the trial."

Dr Furlong said the Dunedin patients' outcomes were probably down to both the rapid access to treatment, notably medication to help dissolve blood clots, or thrombolysis, and the patches.

"It could be that they were admitted to a stroke unit; it could be that the patches are indeed truly beneficial to patients in the first six hours, or it could be both."

Dr Furlong said rapid access to care following a stroke was important.

"Certainly if you're having an acute stroke it would be to your advantage to get to the hospital sooner rather than later, and by sooner I'm talking within an hour of the onset of symptoms because that would allow you to be more likely to receive the treatments that would help limit the damage."

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