Achi news desk-
The European Standard Rate for stroke in Scotland in the year 2022-23 was 479.2 per 100,000 of the population, the highest since Public Health Scotland records began in 2013-14, when it was 398.0.
Almost 20,000 Scots have died from a stroke over the five years to the end of 2022. There were 3874 deaths in the last full year.
The plea to ministers yesterday also comes in the wake of the sudden death of Tony Bundy from Clackmannanshire in June last year, who suffered a stroke while shopping at a Costco store in Glasgow.
When his stroke started, his face, arms and speech were unaffected, meaning his FAST (Face, Arms, Speech, Time) test was negative.
The FAST test is used to assess a patient for the most common symptoms of a stroke.
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However, the family of the 53-year-old man who is usually fit and healthy say that he “lost his balance, his eyes had trouble focusing, and he was throwing up”.
The family say that although they raised concerns that it could be a stroke, because his FAST test was negative, he was left in a corridor at Glasgow Royal A&E for over five hours before his fatal stroke struck.
NHS Greater Glasgow and Clyde has confirmed that it is currently carrying out a review of the care provided to Mr Bundy, and his family will be informed of the outcome.
The family are now calling for changes to the stroke public health awareness campaign.
They say that while the FAST campaign has undoubtedly saved lives, the overreliance on a public health campaign that doesn’t include all the symptoms has led to strokes, like Mr Bundy being “misdiagnosed and people dying premature”.
They are calling for a review of the FAST stroke campaign to ensure it covers all possible stroke symptoms including the inability to stand, cold sweats, eyes having trouble focusing, slow speech, nausea, and vomiting. They say the intention is to maximize knowledge among the public and the medical profession.
But the family have been informed by the Scottish Government that there would be no update to the stroke public health awareness campaign.
Jean Minto, minister for public health and women’s health said in response to a family plea that the Scottish Government “does not currently intend to deviate from supporting the use of FAST”.
He accepted that the 2023 edition of the National Clinical Guideline for Stroke states that more research is needed to improve public awareness, and the appropriate steps for suspected stroke.
The same guideline states that “some people with stroke symptoms will not be identified by the FAST test and therefore a stroke may not be detected.”
Mr Bundy’s son, James, who is a councilor in Falkirk, said they were “very disappointed” with the response.
He said his father’s stroke could have been detected if the tests used to detect it were more widespread.
He said: “Why should emphasis be placed on a test that is known not to identify all strokes? Why should the emphasis be placed on a test that independent research shows misses 40% of ischemic strokes? Why emphasis should be placed on a test that academic research shows is not as effective as the BE-FAST test [which includes balance and vision issues].
“We believe that this proposal, if implemented, could help save lives across Scotland.”
He said BE-FAST is being used in some states in the USA, Dubai and India, as well as individual campaign groups.
An academic systematic review of evidence in 2021 found that the FAST test correctly detected 69-90% of strokes. However, the review noted that the FAST test missed up to 40% of posterior circulation strokes, such as the basilar artery ischemic stroke experienced by Mr Bundy.
Posterior stroke affects the blood flow at the back of the brain, and accounts for 20-25% of all acute strokes.
They can cause different symptoms than those assessed by the FAST test, including vertigo, vision problems, and nausea and vomiting.
The review noted that the less commonly used BE-FAST (Balance, Eyes, Face, Arms, Speech, Time) test identified more ischemic strokes than the FAST test, and noted that it may play an important role in diagnosing a stroke.
Yesterday James and his mother, Tony’s wife, Selena, who is 60 years old, met the health secretary Neil Gray to demand that changes be made.
James said he felt Mr Gray was listening but his councilors were “skeptical about adopting BE-FAST because they are quite concerned about false positives which would put pressure on the NHS”.
“They were more open to medical staff using BE-FAST than FAST,” he said. “We have evidence to show that it will lead to an increase in false positives, but because of the urgent treatment required for stroke, it is worth having them.
“My mother and I told him of our belief that by adding balance and eyes to FAST – updating it to BE-FAST – many lives will be saved in Scotland.
“We also highlighted how Scotland currently lags behind the rest of the UK on stroke awareness, with England, Wales and Northern Ireland having had a publicly funded campaign in the last year, while not Scotland has had a publicly funded campaign since before the Covid pandemic. .
“By running a publicly funded BE-FAST campaign, Scotland would not be playing catch-up with the rest of the UK. Scotland would take the lead, and that’s the Scotland I want to live in.”
Tony’s wife Selena, 60, said: “How many more lives need to be lost before common sense kicks in? How many more families need to be left devastated?
“Although the FAST campaign saves many lives, it is clear that it could be so much better by adding two letters, BE. Yes, just two letters.
“I have no idea why the Scottish Government is so against updating FAST to BE-FAST. I cannot understand how the Scottish Government can sit on evidence that shows BE-FAST is more effective than FAST and do nothing. Surely it is the government’s job to be proactive and promote change that will save lives.
“Now is the time to make this simple, common sense change.”
A spokesman for NHS Greater Glasgow and Clyde said: “When patients go to hospital, a full clinical assessment is carried out including a detailed history and physical examination, this also includes a full range of investigations which may include imaging as clinically required.
“While NHS Greater Glasgow and Clyde cannot discuss individual patient cases publicly, we would like to express our deepest sympathies to Mr Bundy’s family and loved ones at this difficult time.”
A spokesman for the Scottish Government said: “We extend our deepest condolences to the Bundy family.
“Death rates for cerebrovascular disease (including stroke) have fallen by a quarter over the last 10 years and the incidence rate has fallen by 6% over the same period.
“The Scottish Government is guided by the 2023 National Clinical Guideline for Stroke, which is clear that more evidence is needed before a recommendation can be made on screening for non-FAST stroke symptoms and that more research is needed to improve public awareness of symptoms. This post is supported by Chest, Heart and Stroke Scotland and the Stroke Association.”
