South London Stroke Register celebrates 20 years of improving stroke survival and care
On the 22nd of July, the South London Stroke Register (SLSR) is celebrating its 20th year. Data and trials from the SLSR have underpinned improvements in acute stroke care and rehabilitation in the UK, which have led to reduced stroke death and disability, better long-term health outcomes, and cost savings for the NHS. It is the world’s longest running, population-based stroke register with long term follow up.
Get involved with the SLSR 20th anniversary
- Attend the Symposium: '20 years of the South London Stroke Register' on the 22nd of July - bookings required.
- Visit the blog: SLSR20 Blog
- Visual arts project: We are excited to be working with talented young photographers who are studying for a BA in Photography at Camberwell College of Arts (UAL), to create a visual arts exhibition inspired by and featuring members of the King’s College London Stroke Research Patients & Family Group. The art will be exhibited from 4-6pm on the 22nd of July.
Photo: Pauline By Hedvig Larsson
The SLSR was set up by Professor Charles Wolfe to provide reliable information about the numbers of strokes occurring and the immediate and long term consequences of the disease, to assess the quality of stroke care, and to test new ways of providing care.
Since 1995, the SLSR has been recording and following up all first-ever strokes in people of all ages living in Lambeth and Southwark, inner city South London, a well-defined multi-ethnic population. Information has been collected on over 5,900 patients who are followed up at three months and annually after stroke, for life. Highlights of the study and its impact over the last 20 years are outlined below:
Stroke data helping to save lives
SLSR information was used by the National Audit Office in its damning 2005 report criticising the poor state of stroke care in England. The Department of Health then devised the National Strategy for Stroke, setting out how to improve the coordination and provision of care for people with stroke. As a result, stroke became a national health priority and the treatment and services for stroke patients began to improve.
SLSR data underpinned the highly successful 2010 reconfiguration of stroke services in London. This introduced a new system of directing patients in the first 72 hours after stroke to eight high quality Hyper-Acute Stroke Units, rather than to one of 30 hospitals in the capital. SLSR data was used to estimate of the number of people who can be expected to have a stroke and to model the most cost-effective way of delivering stroke treatment services, i.e. the number and allocation of Hyper-Acute and Acute Stroke Unit beds in London.
An evaluation of the effectiveness of this new system found an estimated 12% reduction in deaths of stroke patients at 90 days after a stroke – there were an estimated 168 fewer deaths from stroke in the first 21 months after the service was introduced. The evaluation also found that there was a reduction in median length of hospital stay, saving the NHS an estimated £811 per patient.
Successful trial of early supported discharge
The SLSR conducted the first and largest randomised trial of the effectiveness of early supported discharge. This aimed to reduce the length of hospital stay in costly acute beds and to determine if rehabilitation could be provided at home. This programme resulted in equivalent health outcomes, whilst significantly reducing the length of hospital stays and improving community treatment of impairments from stroke. This evidence has contributed to national policies and clinical guidelines, leading to early supported discharge being implemented in two-thirds of English hospitals and being adopted internationally.
Stroke Research Patients and Family Group
The Stroke Research Patients and Family Group, established in 2005, brings together stroke researchers from KCL and people who have had a stroke and their family members who take part in the research. The group of over 20 people meet every six weeks to help identify research priorities and refine research methods. This is changing the way stroke research is being prioritised, conducted and disseminated.
Ethnic differences affect stroke prevention
SLSR data has provided the good news that the rate of people having strokes decreased by nearly 40% between 1995 and 2010. However, these improvements in stroke prevention have not been seen in those of black Caribbean and African origin.
The higher rate of deaths from stroke in black than white ethnic groups is likely to be driven by more black people having strokes and at younger ages. The rate of strokes in black people was more than twice the rate in white people – 2.6 strokes per 1,000 in black people compared with 1.1 strokes per 1,000 in white – according to an SLSR analysis of early data from 1995 to 1996. The average age of black people having a stroke was also 10 years younger than in the overall population of the study.
The reason for this increased risk in black people is not yet fully understood – a SLSR study found that the differences weren’t explained by social class, age, or sex. There was a higher prevalence of high blood pressure and diabetes among the black population and a longer delay in attending hospital when they had stroke symptoms.
SLSR’s future research
Register data showed that 20 to 30% of stroke survivors had poor functional outcomes (such as walking ability) up to 10 years after stroke, over half of survivors had depression, and 22% had long-term cognitive impairment. Therefore, we need to further improve long-term stroke care, including better management of multiple morbidities and support for carers.
The SLSR will continue to investigate stroke risks, develop and test novel methods of care, and document experiences of stroke survivors and their families. It will draw on new technologies to link data on genomics, patient experience, service delivery and the environment to develop innovative approaches to personalised stroke care.
We have found that a large proportion of strokes occur in people with untreated risk factors, including high blood pressure. While the proportion of people being treated for these risk factors is getting better, there is still room for improvement in our stroke prevention strategies, especially with an ageing population.
The long-term investment in the stroke register has and will continue to enable us to gather high-quality longitudinal and population-representative data and conduct trials that reduce death and disability from stroke, whilst producing cost-savings for the NHS.
Publications: Evidence from the SLSR has contributed to 230 papers, policy documents and clinical guidelines. For a list of publications download this pdf or view more recent papers in the King’s publications database.
Funders: More than £150 million in funding has been received from numerous funding sources, including: National Institute of Health Research (NIHR), Medical Research Council (MRC), Stroke Association, Royal College of Physicians (RCP), European Commission FP7, Guy's and St Thomas' Charity, EU BIOMED 1 & 2, UK Department of Health, Wellcome Trust, Health Foundation, Dunhill Medical Trust, and Stanley Thomas Johnson Foundation.