Despite guidelines, secondary prevention medications are less used in patients with transient ischemic attack than stroke
Patient Safety and Quality
The number of cases of transient ischemic attack (TIA) in the United States may be approaching 500,000 per year, and the current estimate of more than 795,000 new or recurrent strokes per year is expected to grow. Patients discharged after a TIA have a similar or higher 1-year risk of death and rehospitalization compared to those with acute ischemic stroke (AIS). In addition, the risks of postdischarge all-cause death, rehospitalization, or hospitalization for recurrent stroke were also similar to or higher for patients with TIA.
According to a new study of 2,800 patients admitted to 100 U.S. hospitals, stroke, affecting 24.3 percent of TIA patients and 20.6 percent of AIS patients, was the most common reason for rehospitalization. The next most common reason for rehospitalization was medical/pulmonary complications.
Although recommendations for secondary prevention of stroke after TIA and AIS are the same, the study found that patients with a TIA are less likely to receive low-density lipoprotein testing than their AIS counterparts, and may receive delayed evaluation for their symptoms. Statins and diabetes medicines were used less frequently after TIA compared with AIS; antiplatelet drugs were used more frequently but the antiplatelet drug warfarin was used less frequently after TIA.
The researchers believe that patient outcomes may be improved by efforts aimed at increasing patient and provider adherence to evidence-based guidelines. This study was supported in part by AHRQ (HS16964).
See "Death and rehospitalization after transient ischemic attack or acute ischemic stroke: One-year outcomes from the Adherence Evaluation of Acute Ischemic Stroke-Longitudinal Registry," by DaiWai M. Olson, Ph.D., Margueritte Cox, M.S., Wenqin Pan, Ph.D., and others in the Journal of Stroke and Cardiovascular Diseases, 2013 [Epub ahead of print].