Abstract W P331: Management of TIA Patients Referred to Ontario Secondary Stroke Prevention Clinics From the Emergency Department

Abstract

Background: Previous studies have found that patients with TIA discharged from the emergency department (ED) have low rates of testing and treatment for secondary stroke prevention. Secondary Stroke Prevention Clinics (SPCs) were established in Ontario to increase access to diagnostics, treatment, and risk factor education programs for patients at risk of stroke. We aimed to characterize the management of patients with transient ischemic attack (TIA) and ischemic stroke referred to the SPCs following discharge from the ED. Method: The Ontario Stroke Registry performed a chart audit of 40 of 41 operational SPCs between April 1, 2011 and March 31, 2012. We included patients discharged from the ED and referred to a SPC with a diagnosis of probable stroke or TIA, and evaluated processes of best practice care. Using encrypted health card numbers, we linked to administrative databases to identify 7, 30 and 90 day outcomes after the index event. Results: Our study sample included 8,501 patients discharged from the ED and referred to a SPC with probable stroke/TIA. After evaluation in the SPC, 1,902 were given a final diagnosis of TIA and 1,126 ischemic stroke. The median age was 72 years and 46.6% were female. The median time from ED discharge to clinic visit was 8 days for TIA patients and 7 days for ischemic stroke patients. The majority of patients (>92%) received neuroimaging, carotid imaging and antithrombotic therapy, and rates of treatment were similar in those with TIA and stroke. The rate of death or recurrent stroke admission at 30 days was 3.6% among patients with confirmed ischemic stroke, and 0.4% in those with TIA. Conclusion: Ontario patients with TIA and ischemic stroke discharged from the ED with stroke secondary prevention clinic follow up receive high quality best practice secondary stroke prevention care. Further work will examine whether TIA patients discharged from EDs without SPC follow up have similar care and outcomes.