Two multicentre clinical trials conducted by Professor Potter have
contributed to revised
international guidelines for the management of hypertension following
acute stroke, the single
largest cause of adult disability worldwide. Before these trials, there
was little evidence on the
effects of using antihypertensive drugs immediately after stroke and there
was concern that use of
these drugs could extend the stroke. The trials found no serious adverse
effects of using
antihypertensive drugs immediately after stroke whilst mortality after 3
months was halved. The
American Heart Association, the European Societies of Hypertension and of
Cardiology, and the
Royal College of Physicians all reference these trials in support of their
recent Guidelines, thereby
promoting better patient care and improved outcomes.
Worldwide, around 5 million stroke-related deaths occur annually, while
another 5 million people
are left with chronic disabilities following strokes. University of
Glasgow research demonstrated
that admission to a specialist stroke unit significantly improves
patients' chances of survival and
recovery. This discovery transformed the culture of stroke service
delivery in the UK. These studies
drove the development of new advice in national and international clinical
practice guidelines and
promoted the implementation of NHS healthcare targets and audit activities
to standardise and
evaluate the quality of stroke care. In the UK, the early death rate after
stroke has fallen from over
45% to under 30% in the past 20 years; at least one-fifth of that decline
is attributed to the
introduction of stroke units.
Forster, House and Young have played a leading role in establishing the
importance of long-term psychological and social distress after stroke,
shifting the clinical emphasis (and evidence base) in stroke care from a
limited focus on physical recovery to acceptance of the importance of
psychological and social factors. Evidence we have generated has informed
the stroke care pathway in national and international clinical guidelines
that influence stroke service delivery, by providing guidance to clinical
teams on psychological treatments after stroke and information provision.
In tandem we have developed the methodology of stroke rehabilitation
research, involving clinical staff in delivery of multi-site studies and
thereby enhancing evidenced-based stroke care.
Stroke is a major health burden to patients, carers and the NHS, with UK
costs estimated at £15.5bn annually. Clot-busting agents (thrombolytics)
can substantially improve the consequences of ischaemic stroke, but only
if administered rapidly. Newcastle research that recognised the importance
of rapid referral to a stroke unit allowed reconfiguration of ambulance
services for direct transport of victims to a specialised centre.
Newcastle work also validated a test developed for paramedics to recognise
the signs of stroke, which was developed as the nationwide
Face-Arms-Speech-Time (Act FAST) campaign. Use of thrombolytics has
increased eightfold between 2005 and 2012, and there has been a
considerable increase in public awareness of FAST.
Impact: Health and welfare; saving lives by determining that
aspirin is an effective treatment for
acute stroke and that heparin anticoagulation is ineffective.
Significance: In the UK, treating all acute stroke patients with
aspirin and avoiding heparin means
1800 people avoid death or disability each year; aspirin is also highly
Beneficiaries: Stroke patients, the NHS, the economy.
Attribution: Sandercock, UoE, designed, led and reported the
International Stroke Trial, and was
on the steering committee of the Chinese Acute Stroke Trial.
Reach: Up to 15M stroke patients annually affected by guideline
encompassing Europe, North America and Australasia; educational events by
the World Stroke
Academy promote aspirin use.
Stroke is the leading cause of disability and a major cause of death in
the developed world. Hypertension (high blood pressure) is the single most
important modifiable risk factor for stroke, contributing to around 50% of
all events. University of Glasgow researchers have played lead roles in
the design, conduct and analysis of pivotal clinical trials on treatment
regimens for hypertension. These research findings have informed European
and UK hypertension and stroke guidelines, advancing treatment strategies,
and contributed to the observed ~25% reduction in the incidence of primary
(first) and secondary (recurrent) stroke.
Research in Oxford by Rothwell and colleagues since 2000 has radically
changed how minor strokes and transient ischaemic attacks (TIAs) are
managed. First, the risk of a major stroke in days after a minor
stroke/TIA was found to be much higher than thought. In consequence, these
`warning' events were rebranded as a medical emergency in clinical
guidelines. Second, Rothwell showed that a delay in treating individuals
at high risk of major stroke substantially reduced the benefits. Third,
the Rothwell group developed a simple risk score (`ABCD system') to triage
high-risk individuals, showing that more urgent treatment reduced the
90-day risk of major stroke by 80%. This strategy has been implemented in
the National Stroke Strategy and NICE and international guidelines. In the
UK it is estimated to prevent 10,000 strokes per year, and to save the NHS
£200 million in acute care costs alone.
Impact: Health and welfare: reducing morbidity; providing evidence
to disinvest in an ineffective
and damaging treatment; policy change.
Significance: Since 2009, applied clinical trial findings have
resulted in approximately 6000 fewer
complications (e.g., skin breaks) in the UK. Stocking use has decreased by
95%, which has saved
the NHS in excess of £20M per annum.
Beneficiaries: Stroke patients worldwide, the NHS and healthcare
delivery organisations, the
Attribution: Trials were designed and led by Professor M Dennis,
Reach: Changed national guidelines in at least seven countries
worldwide (Europe, N America,
South Africa, Singapore).
Impact: Health and welfare; Wardlaw's work on diagnostic imaging
in stroke prevention and treatment has effected changes to clinical
guidelines worldwide, prevented thousands of strokes and decreased
Significance: In the UK, changes in stroke treatment consequent
upon effective imaging result in 6000 more quality-adjusted life-years and
save ~£300M per year. Improved stroke prevention averts 1760 strokes and
saves the NHS £30M per year.
Beneficiaries: Stroke patients, the NHS and healthcare providers
in other countries
Attribution: The research took place entirely at UoE.
Reach: UK, Europe, N. America, Australasia.
Dysphagia affects >50% of stroke patients with increased risk of aspiration and pneumonia,
costing the NHS approximately £400m pa. Until recently there has been no effective treatment.
Over the last 15 years, Hamdy has identified the mechanisms underlying dysphagia after stroke
and demonstrated that electrostimulation delivered to the pharynx dramatically alters brain regions
controlling swallowing beneficially. This work has gone through extensive clinical evaluation and
forms the basis of a company, Phagenesis Ltd (~£10m VC funding), which has now commenced
implementation of the technology (PhagenyxTM), gained CE marking and has sold >£2.0m of
product in the UK, Europe and the Middle East.