With one in four people at risk of stroke, multidisciplinary teams
at NUH work together to boost patients’ chances of recovery
and significantly lower the risk of recurrence.
Issue 7 | December 2024
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Slurred speech, weakness in the arms and facial drooping — recognising these signs of a stroke and acting quickly by calling an emergency ambulance can mean the difference between life and death.
It is estimated that one in four people will have a stroke in their lifetime. In Singapore, stroke is the fourth leading cause of death and the seventh leading cause of disability in adults, according to the World Stroke Organisation.
Age is a key risk factor, with the likelihood of stroke increasing as people get older. Against the backdrop of an ageing population, the number of stroke cases in Singapore increased by almost 58 per cent from 6,142 in 2011 to 9,680 in 2021. Furthermore, it’s not just older adults who are vulnerable — young people are increasingly affected. A study led by the National University Hospital (NUH) attributed nearly 60 per cent of ischemic stroke in patients aged 18 to 50 to atherosclerosis, often linked to hypertension, diabetes, high cholesterol, and lifestyle factors like smoking, poor diet and inactivity.
An ischemic stroke occurs when blood supply to the brain is obstructed. In ischemic stroke care, every minute counts. One key measure of response speed is the “door-to-needle” time — the interval between a patient’s arrival at the hospital and the administration of thrombolytic treatment, which dissolves the clots that cause strokes. The other is the “door-to-recanalisation” time, where the clot is retrieved through a minimally invasive operation. Reducing these time windows significantly improves a patient’s chance of recovery.
NUH has achieved a door-to-needle time of 48 minutes — below the international benchmark of 60 minutes. In recognition of these efforts, NUH’s Hyper Acute Stroke Endovascular (HASTEN-NUH) Team, led by Dr Teoh Hock Luen, Head & Senior Consultant, Division of Neurology, Department of Medicine, recently received the Angels Award (Platinum) from the World Stroke Organisation. This award recognises hospitals that have demonstrated clear commitment to quality stroke care, and have established cultures and systems to support continuous improvement.
The HASTEN-NUH Team is a collaborative initiative formed by the Emergency Medicine Department, Neurology Division, Neurology High Dependency Unit, Department of Diagnostic Imaging and Interventional Radiology to reduce both door-to-needle time and door-to-recanalisation times. The multidisciplinary team ensures patients receive timely intervention around the clock. During an acute stroke, a radiology team mobilises within 30 minutes of activation to prepare the treatment suite for clot retrieval and other stroke interventions. These hyperacute stroke services provided by the HASTEN-NUH Team are continuously reviewed and improved upon.
Leveraging artificial intelligence (AI) further bolsters the effectiveness of NUH’s stroke response. Technologies such as RapidAI, an AI-based neuroimaging software, expedites the identification of stroke patients who could potentially benefit from endovascular treatment. Other initiatives such as the Stroke Clinical Pathway ensure that best practices in stroke management are applied consistently, reducing hospital stays, complications and mortality.
These efforts have placed NUH’s stroke care programme above local and international standards, with a 70.5 per cent treatment rate in 2020 compared to the local average of 60 per cent and the U.S. average of 66.2 per cent.
Strokes can sometimes stem from silent, underlying conditions, one of which is patent foramen ovale (PFO), commonly known as a “hole in the heart”. "Individuals with a PFO may develop a stroke if small blood clots travel through this abnormal tunnel-like connection within the heart and obstruct blood flow to the brain,” says Dr Benjamin Tan, Consultant, Division of Neurology, Department of Medicine, NUH.
“PFO affects one in four people, and in most cases, it remains asymptomatic and requires no treatment throughout their lifetime. However, in rare instances, a PFO can lead to a stroke, and the patient may benefit from closure to reduce the risk of stroke recurrence. We encourage younger stroke patients with no cardiovascular risk factors to undergo a systematic evaluation to determine if a PFO might be a contributing cause.” adds Dr Tan.
A recent study led by NUH, the National University Heart Centre, Singapore (NUHCS) and the Yong Loo Lin School of Medicine, National University of Singapore (NUS Medicine) highlights this connection. It found that 40 per cent of young adults who experience ischemic strokes with no identifiable cause have an underlying PFO. Each year, NUH’s multidisciplinary heart-brain team sees around 75 young adults with unexplained strokes to assess whether a PFO may be an underlying factor.
“At NUH we want every stroke patient to have a second chance at life. We strive to deliver rapid, life-saving treatment and support, so that patients can regain their quality of life and return to the people they love. We also encourage everyone to be mindful of the underlying risks, recognise stroke symptoms and act swiftly when a stroke strikes,” says Dr Teoh.
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