Clacks family appeal over flawed stroke checks that cost 100s of lives

It comes as it emerged the rate of strokes in Scotland has reached a record high.

The European Standardised Rate for strokes in Scotland in 2022-23 year was 479.2 per 100,000 of population, the highest since the start of Public Health Scotland’s records in 2013-14, when it was 398.0.

Nearly 20,000 Scots have died from strokes over the five years to the end of 2022. There were 3874 fatalities in the last full year.

Yesterday's plea to ministers also comes in the wake of the sudden death in June, last year of Tony Bundy, from Clackmannanshire, who suffered a stroke whilst shopping at the Costco store in Glasgow.

When his stroke started, his face, arms, and speech were unaffected, meaning that his FAST (Face, Arms, Speech, Time) test was negative.

The FAST test is used to assess a patient for the most common symptoms of stroke.

However the family of the usually fit and healthy 53-year-old say he "lost his balance, his eyes were struggling to focus, and he was throwing up".

The family say while they raised concerns that it could be a stroke, because his FAST test was negative, he was left in a corridor within the Glasgow Royal A&E department 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 is now calling for changes to the stroke public health awareness campaign.

James Bundy with Alexander Stewart MSP, health secretary Neil Gray, and Selena Bundy
 

They say that whilst the FAST campaign has undoubtedly saved lives, the over-reliance on a public health campaign which does not include all symptoms has resulted in strokes, like Mr Bundy's, being "misdiagnosed and people dying prematurely".

They are calling for a review of the FAST stroke campaign to ensure that it includes all symptoms of a potential stroke including the inability to stand, cold sweats, eyes struggling to focus, slowed speech, nausea, and vomiting. They say it is intended to maximise knowledge amongst the general public and medical profession.

But the family has been told 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 “do not currently plan to deviate from supporting the use of FAST”.

She accepted that the 2023 edition of The National Clinical Guideline for Stroke states that more research is needed into improving public awareness, and the appropriate action upon suspecting a stroke, is needed.

The same guideline states that “some people with symptoms of stroke will not be identified by the FAST test and thus stroke may not be detected.”

But the minister added: "Regarding pre-hospital identification of stroke, the guideline also states that further evidence is required before a recommendation regarding the use of other screening tools that screen for non-FAST stroke symptoms could be made."

Mr Bundy's son, James, a Falkirk councillor said they were "deeply disappointed" by the response.

He said that his father's stroke could have been detected if the tests used to detect it were broader.

He said: “Why should emphasis be placed upon a test which is known not to identify all strokes? Why should the emphasis be placed upon a test that independent research shows misses 40% of ischaemic strokes? Why should emphasis be placed upon a test which academic research shows is not as effective as a BE-FAST test [which includes balance and vision issues].

"It is our belief that this proposal, if implemented, could help save lives throughout Scotland."

He said BE-FAST is used in some states in the USA, Dubai, and India, as well as individual campaign groups.

A 2021 academic systematic review of evidence found that the FAST test accurately 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 ischaemic stroke experienced by Mr Bundy.

Posterior strokes affect the blood flow at the back of the brain, and account 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 ischaemic strokes than the FAST test, and stated that it may play an important role in the diagnosis of strokes.

James and his mother, Tony's 60-year-old wife Selena met the health secretary Neil Gray yesterday to demand that changes are made.

James said that he felt that Mr Gray was listening but that his advisers were "sceptical about the adoption of BE-FAST because they were quite worried about false positives that would put pressure on the NHS".

"They were more open for medical staff to use BE-FAST than FAST," he said. "We have evidence that shows that yes it will result in an increase false positives, but because of the urgent treatment that is needed for strokes, it is worth having them.

“My mum 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 is currently behind the rest of the UK on stroke awareness, with England, Wales, and Northern Ireland having a publicly funded campaign in the past year, whilst Scotland has not had a publicly funded campaign since before the Covid pandemic.

“By undertaking a publicly funded BE-FAST campaign, Scotland wouldn’t simply be playing catch up with the rest of the UK. Scotland would be taking the lead, and that is the Scotland that I want to live in.”

Tony's 60-year-old wife Selena 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 does save a lot of lives, it is obvious that it could be so much better by simply adding two letters, BE. Yes, just two letters.

“I have no idea why the Scottish Government are so against updating FAST to BE-FAST. I cannot comprehend how the Scottish Government can sit on evidence which shows that BE-FAST is more effective than FAST and do nothing. Surely it is the job of government to be proactive and advocate change that will save lives.

“It is the time to make this simple, common-sense change.”

An NHS Greater Glasgow and Clyde spokesman said:  "When patients enter hospital, a full clinical assessment is carried out including 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 sympathy for Mr Bundy’s family and loved ones at this difficult time." 

A Scottish Government spokesman said: “We extend our deep condolences to the Bundy family.

“Mortality rates for cerebrovascular disease (including stroke) are down by one-quarter over the last 10 years and the incidence rate decreased 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 into improving public awareness of symptoms is required. This position is supported by both Chest, Heart and Stroke Scotland and Stroke Association."