1. Home>
2. Specialties>
3. Neurology>
4. Summary and Comment

Prompt TIA and Minor Stroke Management

Urgent referral to and treatment in a specialized clinic boosts clinical outcomes and saves costs.

An unacceptably high proportion of patients with transient ischemic attack (TIA) or minor stroke are underinvestigated and undertreated, especially during the period of highest risk for recurrent stroke (the 7 days after the event). Investigators for the Early use of eXisting PREventive Strategies for Stroke (EXPRESS) study previously reported that relatively rapid management of TIA and minor stroke was effective in reducing 90-day recurrent-stroke risk among patients referred to a specialized clinic (JW Neurol Jan 15 2008). The authors now report further analysis of the study data for the effects of prompt management on 90-day hospital admissions, hospital bed-days, and costs, and new disability at 6 months.

For phase one of EXPRESS, patients with TIA or minor stroke received assessment in an appointment-based clinic and then were sent back to their primary care physicians to implement treatment recommendations. For phase two, primary care physicians sent patients to the clinic immediately after presentation (without an appointment), and treatment was initiated promptly in the clinic after the diagnosis was confirmed. As previously reported, the 90-day recurrent-stroke risk dropped significantly (by 80%) from phase one to phase two.

The new analysis shows that, compared with phase one, phase two patients had significantly fewer hospital admissions for recurrent stroke within 90 days (2% vs. 8%), hospital bed-days (672 vs. 1957), and instances of new disability at 6 months (6% vs. 11%). Average hospital costs attributed to vascular causes were also significantly lower in phase two (£432 vs. £1056 per patient).

Comment: The main EXPRESS study showed that urgent management of TIA and minor stroke in the outpatient setting greatly reduces recurrent-stroke risk. The current findings provide "real-world" context for the main result from the perspectives of patients, care providers, hospital administrators, and policymakers. These findings show that prompt management of patients with TIA and minor stroke leads not only to clinically meaningful benefits, but to substantial cost savings as well.

— Hermelinda Abcede, MD, and Bruce Ovbiagele, MD

Dr. Abcede is a PGY-3 resident, Department of Neurology, University of California, Los Angeles Medical Center. Dr. Ovbiagele is Director of the Olive View-UCLA Stroke Program and Associate Professor, Department of Neurology, University of California, Los Angeles Medical Center.

Published in Journal Watch Neurology May 26, 2009

Citation(s):

Luengo-Fernandez R et al. Effect of urgent treatment for transient ischaemic attack and minor stroke on disability and hospital costs (EXPRESS study): A prospective population-based sequential comparison. Lancet Neurol 2009 Mar; 8:235.

• Medline abstract (Free)

2011 Top Stories