Death-rate halved

By Noralv Pedersen
Photo: Noralv Pedersen

A new form of treatment can halve the number of acute fatalities among stroke patients. Society can save NOK 500 million a year by making use of the treatment, which has been developed at NTNU/RiT.

Every year about 14 000 Norwegians have strokes. Of these, 3 000 die during of the first month. Strokes are the third most frequent cause of death, and a significant cause of serious functional disability.

50 countries have shown an interest in Doctor Bent Indredavik's (right) pioneering methods for the treatment of stroke patients. Nurse Lise Helle Berg (left) is helping to get Martha Esbensen (81) back to her daily routine.

Up to now it has been difficult to find effective treatment for acute strokes. However, Senior Physician Bent Indredavik and his colleagues in the Department of Medicine at Trondheim Regional Hospital (RiT) have developed a new course of treatment which halves the number of dacute deaths among stroke patients. The number of stroke patients who die following a stroke has been reduced by a third.

Saves NOK 50 000 a patient
In 1987, Bent Indredavik and a team of specially trained nurses and physiotherapists started to experiment with two groups of acute stroke patients. The first group received regular treatment, which included rest in bed and a small fluid intake for the patient. The other group received a course of treatment involving systematic supervision, early mobilization and retraining, intravenous fluid intake and antipyretic medication if the patient had fever. The treatment was organized in a dedicated unit - a stroke unit. In addition to the reduction in the death rate, it became apparent that the patients' life quality was improved by this new method, and that the need for institutionalization was reduced.

Indredavik recently defended his medical doctorate at NTNU, with a thesis on the short-term and long-term effects of treatment at this stroke unit. In addition to the fact that the number of fatalities was halved, about twice as many patients became self-sufficient, compared to patients in conventional wards.

- The treatment is most efficient when these measures are instituted during the first 24 hours, says Indredavik. The head doctor at the Stroke Unit explains that this treatment does not in any way require high-cost technology, but that it contains many small measures organized in a system put together by a trained staff. Financial analyses indicate that the treatment will reduce the cost to the public health system by NOK 50 000 per patient. This means that the Norwegian State can save NOK 500 million a year by making use of this treatment for all stroke patients in Norway.

Encouraging follow-up
Indredavik has also been in charge of the work to develop a treatment model which can be used in the follow-up of stroke patients after their two weeks of intensive care in hospital. The final results of the research project inve- stigating this model will shortly be published. So far the results have been very positive, and they come in addition to the encouraging results from the stroke unit study about the effects of the initial two-week acute course of treatment. This new research project shows that the home, rather than rehabilitation institution, is the best place for retraining.

International praise
Today Indredavik's treatment method is regarded as the best documented course of treatment for acute apoplectic strokes. 20 investigations carried out in ten different countries demonstrate that there are obvious benefits to be gained from the use of models similar to the one at RiT. The Stroke Unit has had phone calls from physicians in 50 countries, and representatives from 20 countries have visited the Stroke Unit at RiT to study the method. The Trondheim results have contributed to the decision by the World Health Organization (WHO) European Region that all acute stroke patients should be offered treatment in a stroke unit. Many Norwegian hospitals have, or are about to have, such units.

* Contact at NTNU: Bent Indredavik
Tel: + 47 73 86 88 55
E-mail: inbe@online.no