Risk factors

TIA patients not getting secondary prevention therapy

Associate Professor Andrew Wong

Many patients with TIA are not receiving guideline-recommended secondary prevention measures such as dual antiplatelet therapy and lipid-lowering agents, an Australian study has found.

The lack of adherence to guideline recommendation was particularly noticeable for TIA patients discharged from emergency departments, an audit carried out at the Royal Brisbane and Women’s Hospital revealed.

Better communication of secondary prevention measures to GPs was also identified as an area for improvement in the review of records for 149 people who presented to the hospital’s Emergency and Trauma Centre (ETC) with probable TIA in 2018.

The study found that 82% of patients were in the high-risk TIA group, but less than 10% of admitted patients received dual-antiplatelet therapy (DAPT), with almost 80% receiving aspirin or clopidogrel. About 75% of admitted patients had lipid testing and received statins.

Provision of dual antiplatelet therapy was lower for TIA patients who were discharged from the emergency department, with around 60% receiving aspirin or clopidogrel and about 16% receiving Asasantin (aspirin/dipyridamole). None of the discharged patients received lipid testing or statin therapy.

Rates of investigation such as carotid assessment and brain CT or MRI were also lower for discharged patients.

Less than 2% of patients had discharge communication conveying specific treatment plans to the GP, and 8% re-presented with an ischaemic stroke or TIA within 12 months.

The study authors, led by Dr Wang Lim and Associate Professor Andrew Wong, said the audit had highlighted opportunities to improve commencement of secondary prevention in high-risk TIA patients, and improve communication between providers.

On the basis of the results the hospital had introduced improvement strategies such as feedback to physicians, and the implementation of a TIA management decision support tool  for admitted patients

Speaking to the limbic, Associate Professor Wong said TIA was a medical issue warranting urgent management, and the finding that one in 12 of the patients re-presented with an ischaemic stroke or TIA within 12 months was a  reminder that these patients were a high risk cohort.

“All TIA management options can be initiated in an outpatient setting, so patients presenting to a specialist for early follow-up can benefit from these approaches,” he said.

“The treating specialist needs to remember the importance of prompt initiation of management changes if managing TIA in an outpatient setting,” he added.

This study also highlighted the importance of communicating TIA management changes to the treating GP, said Professor Wong. Based on the findings from the study, his hospital had introduced a discharge summary template with medical management recommendations for TIA based on Australian Stroke Foundation guidelines.

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