UK Stroke Forum 2008

he UK Stroke Forum, hosted by The Stroke Association, is a coalition of over 24 organisations committed to improving stroke care in the UK.

Launched in 2006, the main activity of the UK Stroke Forum is to organise multidisciplinary educational events for healthcare professionals involved in stroke care and research, including the annual UK Stroke Forum conference.

The editor of stroke update .co.uk was at Harrogate for the stroke Forum of 2008. He is reporting from the International Harrogate Centre at the heart of the city.

It was a long journey taking me from Wales to visit Harrogate. I remember making this journey in 2006 when I attended the 1^st Stroke Forum at that time. The difference this time is that the programme is richer and there are more posters and more people at the forum. Professor Marion Walker the chairman of UK stroke Forum mentioned that conference highlights include a review of the national stroke strategy for England, one year on, with an opportunity to hear the latest news on the implementation and effect this important policy is having across all the devolved nations. There is a choice of three extended training day programmes, extra stroke nursing sessions and a range of patients and fringe sessions available throughout the event.

One of the first subjects that were discussed in the conference was Non-neurological variables and mortality of acute stroke by Dr Jagdish Sharma (Consultant Geriatrician, Sherwood Forest Hospitals NHS Trust).

He mentioned that in addition to neurological severity a number of non-neurological variables seem to influence acute stroke mortality.

Literature search was made to investigate the influence of pre-existing and non-interventional acute phase variables influencing mortality.

The results showed that the pre-stroke variables of higher age, cardiovascular factors of atrial fibrillation, myocardial infarct, left ventricular hypertrophy and more significantly cardiac failure, higher morbidity and incontinence have higher mortality. Females have a higher mortality, probably due to higher cardiovascular prevalence in older women. Pre-stroke diabetes does not seem to influence mortality but diabetics have a slower recovery. Higher prevalence of cardiac disease in patients on prior aspirin may account for their higher mortality. Prior statin therapy is associated with lower mortality. Higher body mass index and poor socio-economic status have higher mortality.
Dr. Sharma mentioned that cardiological neurohumoral changes, impairment of cardiac rate and rhythm, overt cardiac failure or occult cardiac dysfunction and ischaemic heart disease as indicated by elevated NT-proBNP or troponin lead to higher mortality. Renal failure, poor nutritional status and sleep-disordered breathing are associated with poor outcome. Higher cholesterol in acute phase seems to be beneficial for outcome. Stenosis of contralateral carotid artery is associated with higher mortality.

The speaker said that at the end of the presentation the audience should appreciate how the non-neurological (and non-interventional) variables discussed in the talk influence mortality in acute stroke. This will clarify the need for holistic care by clinicians of acute stroke patients to achieve normal physiology.