Abstract TP386: Prompt Preventive Treatment of TIA Could Reduce the Need for Weekend Service
Background: There is 10% risk of stroke in the week after transient ischaemic attack (TIA). Urgent evaluation and early preventive treatment can reduce recurrence after a TIA by 80% at 90 days. Specialist assessment of high risk TIA patients within 24 hours and low risk within a week is recommended. Many centers struggle to provide a 7 day service. In our center, specialist assessment is available on weekdays only but the referrer is asked to initiate preventive treatment (anti-platelets, statins) followed by rapid referral for vascular imaging and TIA clinic.
Hypothesis: Prompt treatment started by the referring physician is effective and safe in reducing recurrent cerebrovascular events.
Methods: Planned service evaluation of patients referred to TIA service between December 2009 - September 2011 (21 months). Data was collected at 1st presentation to TIA clinic and at 90 day follow up.
Results: The TIA service received 537 patients (median age 67 years [range 19 - 96years], 42% over 70 years, 48% females). 60% referrals were from emergency department (rest from primary care). 47 patients did not attend, hence 490 included in final analyses. Referrers started preventive treatment in 436(89%) patients. 12% (54/436) of these patients had side effects [SE] (headaches, GI upset) from early treatment (none required hospitalisation). 62% (303/490) referrals were truly TIA’s on specialist assessment. Recurrent events occurred in 8/303(2.6%) TIA patients. 6 of 8 of these patients did not receive treatment; mean delay of 4.8 days before specialist review. Recurrences were lower in treated patients (2/279 [0.7%] vs.6/24 [25%] in the non-treated group; p<0.0001). Weekend referrals constituted 33% (161/490) vs. 67% (329/490) weekday patients; 110 weekend vs. 193 weekday confirmed TIA’s. 90% weekend referrals had early treatment (16% had SE) vs. 88% weekday referrals (10% had SE). Weekend recurrence rate was 1.8% (2/110) vs. 3% weekday recurrences (6/193) (p=0.7). Median TIA clinic review delay was 1 day in both groups (IQR 0-2days).
Conclusion: Weekend TIA service would be desirable. However, prompt treatment before specialist assessment appears to be equally effective and safe in reducing recurrent cerebrovascular events.
- © 2012 by American Heart Association, Inc.