Ministers have sanctioned a review over the education surrounding the detection of strokes in Scotland following concerns that flaws are costing hundreds of lives.
The move has come in the wake of a meeting with the health secretary Neil Gray by the Bundy family who lost a loved one to a stroke and believe 'flawed' assessments for strokes are costing lives.
It comes as 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 five years to the end of 2022. There were 3874 fatalities in the last full year.
Calls for action have surfaced after 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.
The family are now calling for an update to the stroke public health awareness campaign.
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 called for 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.
The family had previously 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 guidleine 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."
Now after Mr Bundy's son, James, a Falkirk councillor, and his mother Selena met with Mr Gray, it has been confirmed a review will be conducted.
A Scottish Government spokesman said: "The Cabinet Secretary for NHS Recovery, Health and Social Care met with the Bundy family to hear their experience and has asked the advisor to the Chief Medical Officer to conduct a review of education around stroke symptoms for clinical staff.”
Mr Bundy, who said that his father's stroke could have been detected if the tests used to detect it were broader, welcomed the development.
“It’s a step forward but this cannot be the final outcome," he said.
“Increasing knowledge of stroke symptoms amongst medical staff is a welcome step. The more knowledge that is held, the more lives that will be saved due to people getting access to fast treatment.
“Yet, the question I ask myself is this: Why will the public health campaign not be updated to incorporate more symptoms of stroke? Medical staff having more information about stroke is not useful if patients suffering stroke don’t turn up to A&E.
“Let’s trust the people of Scotland with information that could save their lives.
“When people in Scotland, or their loved ones, suffer a stroke, all of us should be in a position that we know the correct response is to 'BE FAST' [which includes being alert to balance and vision issues] and seek emergency treatment.”
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.
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