Patients who had a transient ischaemic attack (TIA), sometimes referred to as a "mini stroke," were much less likely to experience further vascular events in the first year if their care was co-ordinated by a special hospital team. That is the key finding from a study published in the November issue of the European Journal of Neurology.
Researchers from the Department of Neurology at Aarhus University Hospital in Denmark studied 306 patients admitted to the hospital with a TIA. They found that when the patients were treated by an acute TIA team their cumulated risk of having a stroke in the first seven days was 65% lower than expected. The cumulated risk in the first 90 days fell by 74%.
"The aim of our study was to see if patients had better clinical outcomes if they were under the care of a special team, which integrated outpatient care and stroke unit facilities and provided on-going nurse-led counselling" says lead author Dr Paul von Weitzel-Mudersbach.
"TIA, which is caused by a temporary lack of blood to part of the brain, is a serious condition associated with a high short-term risk of ischaemic stroke. Previous research has shown that the cumulated stroke risk in the first three months after a TIA is ten to 12% in unselected patients and more than 30% in patients with carotid stenosis, a dangerous narrowing of the largest blood vessels that deliver blood to the brain.
"Although urgent intervention has been shown to reduce the risk of stroke, a number of previous studies have shown poor long-term drug compliance in many patients."
The patients were referred directly to the acute TIA team by their family doctor or ambulance, bypassing the emergency department. Patients who had suffered a TIA in the last 48 hours, and those with multiple TIA, faced a high risk of stroke and were admitted to the stroke unit. This offered the option for immediate preventative action, including thrombolysis drugs, to break up blood clots in the case of recurrent stroke. The other patients were seen in the outpatients department within three days of referral.
All the patients seen by the team received acute treatment with antithrombotic and cholesterol lowering drugs and were offered fast-track surgery if they had carotid stenosis. Follow-up included nurse-conducted health counselling after seven, 90 and 365 days. Each contact included the importance of secondary prevention, such as drug compliance and stopping smoking.
Key findings of the study included:
"Our study shows that urgent treatment of patients with TIA is feasible and associated with a substantial reduction in stroke risk during the first three months, which is consistent with previous studies from the UK and France" says Dr von Weitzel-Mudersbach.
"We believe that early and aggressive antithrombotic treatment may play a major role in the reduction of short-term stroke risk in most patients. Meanwhile, the combination of secondary prevention efforts with a relatively high compliance rate -- including the essential telephone follow-up provided by a specially trained nurse in the first three months -- was probably responsible for the low long-term risk of adverse clinical outcome.
"Treating TIA by deploying a specialist team that can admit patients when the risk of recurrent symptoms is highest and prompt thrombolysis can be used, combined with nurse-conducted health counselling, seems to be effective."
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