Abstract
Introduction: The risk of stroke after a transient ischaemic attack (TIA) is greatest within the first few days of the TIA and then tapers over time. It is known that early initiation of best medical therapy significantly reduces this risk. Hypothesis: To test whether a TIA/Stroke Electronic Decision Support (EDS) tool in primary care promotes faster access to optimal TIA management and reduces the risk of recurrent stroke and vascular events. Methods: A cluster randomized controlled trial (FASTEST Trial ACTRN12611000792921) with general practitioner (GP) practices randomized to use an EDS tool versus usual care. Results: The study period was 28 February 2012 to 15 May 2013 and 46 GP practices (145 GPs) registered 373 patients. Eligibility criteria were met by 291/373 (78%) patients of whom 178 received GP care using the EDS and 113 usual care. Ninety day follow up was completed on 13 August 2013. Stroke occurred in 2/178 (1.1%) of the intervention group and 5/113 (4.4%) in the usual care group; odds ratio (95% CI), unadjusted for cluster randomization, 0.25 (0.05 to 1.29), p=0.073. Any vascular event or death occurred in 7/178 (3.9%) of the EDS group and 14/113 (12.4%) of the control group, unadjusted OR (95% CI) 0.29 (0.11 to 0.74), p=0.007. The time to starting anti-platelet medication, in those not previously using these, was similar in the two groups, median (inter-quartile range) of 0 days (0 to 0) and 0 days (0 to 1) in the EDS and usual care groups. Statin and anti-hypertensive prescription, in those not previously using these, occurred more quickly in the EDS group compared to usual care; median (inter-quartile range) 2 days (0 to 7) versus 3 days (0 to7) for statin and 3 days (0 to 7) versus 5 days (1.5 to 37) for anti-hypertensive prescription. Conclusion: The preliminary analysis of this trial supports improved outcomes and process of care with EDS versus usual care for TIA management in primary care. The full analysis, adjusted for the cluster randomization, will be presented at the meeting.
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