Abstract W P282: Delays in Presentation to Stroke Prevention Clinic after TIA or Minor Stroke are Associated with Increased Recurrent Events, Hospitalization and Mortality

Abstract

Background: Prompt assessment in a stroke prevention clinic (SPC) reduces the risk of recurrent stroke after transient ischemic attack (TIA) or minor stroke. However, not all patients are seen rapidly, even in high-risk TIAs with speech deficits or unilateral weakness. The effects of delays on patient outcomes are not clear. We examined the records of patients referred after TIA/minor stroke to determine frequency, degree and reasons for delays in evaluation and carotid revascularization, as well as the effect of delays on patient outcomes. Methods: Records were obtained for all referrals to a regional SPC over 3 years. Target times were based upon triage symptoms, with highest-risk patients (unilateral weakness/speech deficits) being seen 2 days from receipt of referral, moderate-to-high risk within 7 days, and others within 30 days. Data regarding presentation, triage/referral, appointment, investigations and carotid revascularization were obtained. Delays between time points were calculated, and delay reasons were adjudicated. 90-day outcomes including death, recurrent stroke/TIA, and hospital readmission were determined, and comparisons made between patients with and without assessment delays. Results: Between 2009-11, 3492 patients were referred. 1420 (35.8%) were seen beyond suggested dates; the most common reason was scheduling issues (74.2%) followed by patient cancellation (7.9%) and hospitalization (6.0%). The average delay was 2.63 days (SD 7.48), increasing to 3.75 days (SD 5.35) in highest-risk patients. 79 (2.26%) patients had carotid revascularization; of these, 71 (90%) had surgery more than two weeks after onset. Delays were most often due to logistical issues (42.3%). Overall, assessment delays were associated with an absolute increase of 3.7% in 90-day hospitalization (p=0.001), 2.0% in recurrent stroke/TIA (p=0.013) and 0.8% in mortality (p=0.013). Conclusions: Delays in assessment after TIA/minor stroke are common and often due to potentially preventable system factors. These delays are associated with an increased absolute risk of recurrent stroke/TIA, hospitalization, and death. Avoiding delays between referral and assessment may provide opportunities to reduce adverse outcomes in this population.