A pathway created to help deliver better care to patients after haemorrhagic stroke is being proven to save lives, with a ten per cent increase in survival rates at the 30-day mark. The ABC Bundle is a research-led intervention which improves on the delivery of existing treatments for patients after intracerebral haemorrhage (ICH).
Statistics show that around 30 to 40 per cent of people typically do not survive to one month after ICH – but through the introduction of the ABC Bundle, lives are being saved through the new approach, which was initially introduced at Salford Royal Hospital but has now been adopted at 28 stroke sites across the North of England.
Created through research from Dr Adrian Parry-Jones of the University of Manchester, the ABC Bundle is now looking to advance further still to secure the funding for national roll-out, as well as to assess its efficacy in reducing long-term disability after stroke.
ABC stands for:
A – Rapid Anticoagulant reversing
B – Intensive Blood pressure lowering
C – Care pathway for prompt neurosurgical referral
Here, we learn more about the pioneering work of Dr Parry-Jones – who won the award for Research Project of the Year at the inaugural NR Times Awards – its impact and huge potential across the UK and beyond.
A life-saving new approach
While stroke rehabilitation has advanced greatly over the recent past, and survivors benefitting from new innovations and techniques in neuro-rehab, sadly the same progress has not been seen in survivorship after stroke, and particularly ICH.
Survival rates have barely changed in 30 years, and although research into life-changing and potentially life-saving treatments is advancing – with the University of Manchester being an eminent name internationally – still ICH remains a condition with high levels of mortality.
Dr Parry-Jones began his research into this in 2015 while based at Salford Royal Hospital, having secured funding to explore new treatments.
“But while I was doing the research, I became very apparent that we weren’t really all that good at doing the things we should know already,” he said.
“So we came up with an idea that, through putting certain bits together as a care pathway, we could try and make sure they were delivered as well as possible for every patient.”
Using research from Dr Parry-Jones – the largest study of its kind – which demonstrated that clotting factor replacement reduced death rates after ICH, along with the INTERACT2 phase III trial, also led by Dr Parry-Jones – which showed that a strategy of intensive blood pressure lowering in acute ICH reduced disability at 90 days – the ABC Bundle was born.
The need for prompt referral to neurosurgery was also included, with retrospective research showing that transfer to neurosurgical care was associated with lower risk of death compared to care under stroke medicine.
Initially trialled at Salford Royal Hospital, its results were hugely significant, with a ten per cent reduction in mortality at the 30-day point.
“It was quite a big surprise, considering the outcomes for patients had barely changed in 30-plus years,” says Dr Parry-Jones.
“At the outset, I wasn’t particularly optimistic it would make that much difference. I hoped it would be ambitious enough to inspire people, for staff to really get behind it.
“And I must admit it started very pleasingly.”
Ongoing roll-out and development
Having delivered such life-saving outcomes in its first centre, the ABC Bundle secured the funding to be rolled out across Greater Manchester, into hyper acute stroke units in Stockport and Bury.
Adoption across the North of England was the next step, although one which was delayed by COVID-19, but did take effect from August 2021. The process of roll-out is still ongoing, and is currently in use at 28 stroke units.
“It has been a very instructive process. I think it’s one thing to drive your ideas forward in your own hospital, but to take it elsewhere and try and get everyone behind you is a different challenge, but one we have learned a great deal from,” says Dr Parry-Jones.
“There has been a lot of enthusiasm, and while the NHS is struggling with a number of challenges, we have been very pleased at the willingness to do this.”
National roll-out is the next step, with Dr Parry-Jones now looking to secure the funding to support this. In addition to the impressive outcomes secured at sites in the North, evidence continues to support the impact and potential of the use of a bundle.
A recent clinical trial across 144 hospitals in ten non-UK countries demonstrated the ability to reduce death and disability with a structured care pathway in place.
Further evidence is also being collected through data from the SSNAP National Audit Programme, which records stroke numbers, and the modified Rankin Scale Score, which measures disability after stroke at six months.
“This is something we are keen to measure as part of the scale up, because it’s equally important for people to survive and recover better as well,” says Dr Parry-Jones.
“On that back of that (the recent non-UK study) we have additional strength of evidence behind us. It’s now just dependent on the funding.”
Funding the life-saving research
Among the key funders of the stroke research team at the University of Manchester – of which Dr Parry-Jones is part – is the Natalie Kate Moss Trust.
NKMT was established in 2012 after the sudden death of Natalie from brain haemorrhage aged only 26. Led by Natalie’s family and ever-growing numbers of volunteers and supporters, it is committed to educating and empowering society in understanding how lifestyle can help prevent brain haemorrhage.
The charity also raises money to directly fund research by the University of Manchester – of which, coincidentally, Natalie was an alumnus – into treatments for haemorrhagic stroke.
Fiona Moss, director of NKMT, said the role of fundraising and donations is vital in helping to change the future.
“Fundraising genuinely does underpin life-changing research. Probably because we’re a small charity, you can see directly where it goes, that the funds were generate are being passed to research,” says Fiona, who nominated Dr Parry-Jones for his NR Times Award.
“And in the case of research like this, you can put numbers on it, you can put figures on it in terms of lives being saved. And that is really incredible.
“We work so closely with the team at Manchester and regularly sit down with them and look at how we can generate the funds to support them in their vision.
“Since 2012, in what is a relatively short timeframe, so much has been achieved and so much progress has been made. The success of research like Adrian’s is really exciting for us and gives us the momentum to keep moving forward.”
On a personal level, for Fiona and the Moss family, the advances being made as a result of their fundraising is particularly poignant.
“There’s a huge purpose behind this for us, and of course this is very important for us as a family.,” says Fiona.
“But looking beyond that, and seeing the numbers of people who can potentially be affected by this research, is amazing.
“If we look at what has been achieved since we started working with the team in 2012, and we continue over the next 20, 30, 40 years and continue to increase the funds, we could make a real dent in these statistics.
“The results are giving us a lot of encouragement – and absolutely every donation makes a difference to our ability to do this.”
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Your NR Headlines: Thursday 15th February