Abstract
Background: Transient ischemic attack (TIA) and minor stroke (TIAMS) are risk factors for stroke recurrence. Some TIAMS may be preventable by appropriate primary prevention. We aimed to recruit “possible-TIAMS” patients in the INternational comparison of Systems of care and patient outcomes In minor Stroke and TIA (INSIST) study.Methods: A prospective inception cohort study performed across 16 Hunter–Manning region, Australia, general practices in the catchment of one secondary-care acute neurovascular clinic. Possible-TIAMS patients were recruited from August 2012 to August 2016. We describe the baseline demographics, risk factors and pre-event medications of participating patients.Results: There were 613 participants (mean age; 69 ± 12 years, 335 women), and 604 (99%) were Caucasian. Hypertension was the most common risk factor (69%) followed by hyperlipidemia (52%), diabetes mellitus (17%), atrial fibrillation (AF) (17%), prior TIA (13%) or stroke (10%). Eighty-nine (36%) of the 249 participants taking antiplatelet therapy had no known history of cardiovascular morbidity. Of 102 participants with known AF, 91 (89%) had a CHA2DS2-VASc score ≥ 2 but only 47 (46%) were taking anticoagulation therapy. Among 304 participants taking an antiplatelet or anticoagulant agent, 30 (10%) had stopped taking these in the month prior to the index event.Conclusion: This study provides the first contemporary data on TIAMS or TIAMS-mimics in Australia. Community and health provider education is required to address the under-use of anticoagulation therapy in patients with known AF, possibly inappropriate use of antiplatelet therapy and possibly inappropriate discontinuation of antiplatelet or anticoagulation therapy.
Highlights
Transient ischemic attack and minor stroke (TIAMS) account for ∼40% of all cerebral ischemic events [1, 2] and can precede a disabling or fatal stroke [3] and major cardiovascular events [4, 5]
Clinical diagnosis of TIAMS is often challenging and it can be difficult to distinguish TIAMS from benign, low risk “stroke-mimic” syndromes [10, 11]. It is uncertain how compliant primary health care practitioners are with guidelines directed at the management of TIAMS and how applicable the guidelines are in primary care settings
Episodes with symptoms lasting 24 h) episodes with National Institute of Health Stroke Scale < 5 at presentation were classified as minor strokes
Summary
Transient ischemic attack and minor stroke (TIAMS) account for ∼40% of all cerebral ischemic events [1, 2] and can precede a disabling or fatal stroke [3] and major cardiovascular events [4, 5]. Recurrent stroke usually occurs very early after TIAMS [6] and rapid specialist assessment and intervention has been shown to reduce this risk [7, 8]. Clinical diagnosis of TIAMS is often challenging and it can be difficult to distinguish TIAMS from benign, low risk “stroke-mimic” syndromes [10, 11]. It is uncertain how compliant primary health care practitioners are with guidelines directed at the management of TIAMS and how applicable the guidelines are in primary care settings. Transient ischemic attack (TIA) and minor stroke (TIAMS) are risk factors for stroke recurrence. We aimed to recruit “possible-TIAMS” patients in the INternational comparison of Systems of care and patient outcomes In minor Stroke and TIA (INSIST) study
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