Recurrent Stroke was Associated with Poor Quality of Life in Patients with Transient Ischemic Attack or Minor Stroke: Finding from the CHANCE Trial

Introduction: The risk of recurrent stroke following a transient ischemic attack (TIA) has been estimated to be as much as 5 percent in the first 48 hours and ten percent in the first week following initial TIA symptoms, but can be modified as a result of intensive risk factor management. Care pathways for these patients vary between different regions within Alberta with Edmonton admitting more TIA patients and Calgary using computed tomography angiography (CTA) based triage. To examine regional differences in the quality of care, the rate of admission for stroke within 90 days of an index ED visit for TIA/minor stroke was investigated. Methods: Data analysts from the Data Integration, Measurement and Reporting (DIMR) branch of Alberta Health Services (AHS) used the National Ambulatory Care Reporting System (NACRS) to identify patients in Alberta who were admitted for stroke within 90-days of an index emergency department (ED) visit for TIA/minor stroke from April 2010 to March 2016. Information extracted included patient demographics, region of residence (Edmonton, Calgary or non-major urban [NMU]), return diagnosis and timing of return ED visit. Analysis included descriptive summaries and proportions were compared using a χ2 test. Results: During the study period, there were 26,232 index visits to Alberta EDs for TIA/minor stroke. 5426 (26.1%) of patients were admitted on their index visit. Calgary (22.5%) had lower rates of admission on index visit followed by Edmonton (31.4%) and the NMU (46%). 20,806 (79.3%) were discharged home following their index visit. Of the patients discharged on their index visit 729 (3.5%) had an admission for stroke within 90-days of their index ED visit with rates in Edmonton (3.8%) and the NMU regions (3.8%) being significantly higher than Calgary (2.8%, p<0.01). Conclusion: Our study demonstrates significantly lower rates of admission for stroke within 90-days of ED visit for minor stroke/TIA in Calgary compared to Edmonton and the NMU. Further work should focus on validating this result and consideration of standardized care pathways that promote effective resource utilization and quality of care.

Download Full-text

Abstract 41: Prognostic Value of Perfusion MRI in Patients with Transient Ischemic Attack or Minor Stroke

Stroke ◽

10.1161/str.48.suppl_1.41 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Joon Hwa Lee ◽

Hyunjin Jo ◽

Jihoon Cha ◽

Woo-Keun Seo ◽

Oh Young Bang ◽

...

Keyword(s):

Cardiovascular Event ◽

Transient Ischemic Attack ◽

Recurrent Stroke ◽

Perfusion Mri ◽

Minor Stroke ◽

Secondary Outcome ◽

Stroke Recurrence ◽

Composite Outcome ◽

Stroke Patients ◽

Ischemic Attack

Background and purpose: We aimed to investigate the role of perfusion MRI parameters (TTP: time to peak, CBF: cerebral blood flow, CBV: cerebral blood volume) as a prognostic factor for the risk of stroke recurrence or cardiovascular outcome in patients with transient ischemic attack (TIA) or minor stroke. Methods: We retrospectively reviewed TIA or minor stroke patients who underwent our stroke MRI protocol (DWI, perfusion MRI, and MRA) in a consecutively collected stroke registry. Primary outcome was nonfatal stroke recurrence and secondary outcome was cardiovascular composite outcome. Multivariate analysis was used to examine the association of perfusion MRI parameters and angiographic findings with the risk of stroke recurrence and cardiovascular event. Results: Of the 326 patients who met inclusion criteria, we identified 15(4.6%) nonfatal strokes and 25(7.7%) cardiovascular composite events during the first 1 year after the index TIA or minor stroke. The presence of regional delayed perfusion on TTP maps (p=0.002) and regional hyperperfusion on CBV maps (p<0.001) were associated with recurrent stroke. In MRA images, concomitant stenosis of the intracranial arteries and/or extracranial carotid arteries was associated with cardiovascular events (p=0.009). Using multivariate cox proportional hazard analysis, presence of regional hyperperfusion on CBV remained an independent predictor of recurrent stroke (HR 10.82, 95% CI 4.19-38.67, p<0.001) and cardiovascular event (HR 6.30, 95% CI 2.67-18.25, p<0.001). The AUC of the CBV maps was also greater than other parameters for the prediction of stroke recurrence (AUC=0.701, 95% CI 0.54-0.86) and cardiovascular composite outcome (AUC=0.628, 95% CI 0.50-0.76). Conclusions: Increased CBV on perfusion MRI, representing the hemodynamic status of postischemic hyperperfusion, could be more useful than other perfusion parameters in predicting poor prognosis of TIA or minor stroke patients.

Download Full-text

The quality of medication optimization among patients with transient ischemic attack or minor stroke

Journal of the American College of Clinical Pharmacy ◽

10.1002/jac5.1149 ◽

2019 ◽

Vol 3 (1) ◽

pp. 36-46

Author(s):

Jaclyn Myers ◽

Dawn M. Bravata ◽

Jason Sico ◽

Laura Myers ◽

Seemant Chaturvedi ◽

...

Keyword(s):

Transient Ischemic Attack ◽

Minor Stroke ◽

Ischemic Attack ◽

Medication Optimization

Download Full-text

Acute and long-term impairments regarding emotional symptoms and quality of life in patients suffering from transient ischemic attack and stroke

Neurological Research ◽

10.1080/01616412.2020.1866370 ◽

2021 ◽

pp. 1-11

Author(s):

Alexander Prost ◽

Katharina Kubitz ◽

Johann Pelz ◽

Carsten Hobohm ◽

Andreas Hinz ◽

...

Keyword(s):

Quality Of Life ◽

Transient Ischemic Attack ◽

Emotional Symptoms ◽

Ischemic Attack

Download Full-text

Predicting recurrent stroke after minor stroke and transient ischemic attack

Expert Review of Cardiovascular Therapy ◽

10.1586/erc.09.105 ◽

2009 ◽

Vol 7 (10) ◽

pp. 1273-1281 ◽

Cited By ~ 6

Author(s):

Philippe Couillard ◽

Alexandre Y Poppe ◽

Shelagh B Coutts

Keyword(s):

Transient Ischemic Attack ◽

Recurrent Stroke ◽

Minor Stroke ◽

Ischemic Attack

Download Full-text

Research on Influence of Clopidogrel on Life Quality in Patients with Transient Ischemic Attack and its Influencing Factors

Journal of Advances in Medicine Science ◽

10.30564/jams.v1i1.23 ◽

2018 ◽

Vol 1 (1) ◽

pp. 16

Author(s):

Lanbo Chen ◽

Xiaohong Gu ◽

Bo Dong

Keyword(s):

Quality Of Life ◽

Influencing Factors ◽

Transient Ischemic Attack ◽

Life Quality ◽

Health Related Quality ◽

Related Quality ◽

Health Related ◽

Ischemic Attack ◽

Aspirin Group

Purpose: To analyze the basic situation and health related quality of life (HRQOL) results of patients with transient ischemic attack (TIA), and to study the influencing factors of health related quality of life in patients receiving clopidogrel. Method: Divide the TIA patients into clopidogrel group, aspirin group and untreated group. Measure HRQOL scores of TIA patients using the short form 36 questionnaire (SF-36) scale and analyze influencing factors of HRQOL with one-way ANOVA and multivariate stepwise linear regression statistical methods. Results: The differences of HRQOL scores among three groups are of statistical significance (F = 4.29, P = 0.00). There is no difference in HRQOL score between clopidogrel group and aspirin group (t = 5.35, P = 0.00), but HRQOL scores of clopidogrel group and aspirin group are higher than those of the untreated group (t = 6.14, P = 0.00; t = 5.16, P = 0.00). The HRQOL scores of clopidogrel group are positively correlated with diet, exercise, gender and family harmony (P < 0.05), but negatively correlated with diabetes, hypertension, smoking, drinking, hyperlipidemia, age, career and ABCD2 score (P < 0.05). Conclusion: TIA patients who received secondary prevention with clopidogrel and aspirin show better life quality results than those who did not. There were many factors influencing clopidogrel's treatment effect. Paying attention to middle-aged and elderly, the obese, mental workers and female TIA patients, teach TIA patients to quit smoking, drinking and eating low-salt and low-fat food, actively treating their hypertension, hyperlipidemia and diabetes and laying emphasis on psychological counseling and exercise can significantly improve the treatment effect of clopidogrel.

Download Full-text

Quality of Care for Veterans With Transient Ischemic Attack and Minor Stroke

JAMA Neurology ◽

10.1001/jamaneurol.2017.4648 ◽

2018 ◽

Vol 75 (4) ◽

pp. 419 ◽

Cited By ~ 14

Author(s):

Dawn M. Bravata ◽

Laura J. Myers ◽

Greg Arling ◽

Edward J. Miech ◽

Teresa Damush ◽

...

Keyword(s):

Quality Of Care ◽

Transient Ischemic Attack ◽

Minor Stroke ◽

Ischemic Attack

Download Full-text

Abstract WP56: Refinement of imaging predictors of recurrent events following Transient Ischemic Attack and Minor Stroke.

Stroke ◽

10.1161/str.44.suppl_1.awp56 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

Myles Horton

Keyword(s):

White Matter ◽

Transient Ischemic Attack ◽

Recurrent Events ◽

Recurrent Stroke ◽

Initial Assessment ◽

Minor Stroke ◽

White Matter Disease ◽

Ischemic Attack ◽

Symptom Progression ◽

Prior Stroke

Background: Transient ischemic attack (TIA) and minor stroke have a high risk of recurrent stroke. We recently showed in the CATCH study that predefined radiographic abnormalities on CT/CTA and MRI predicted recurrent events after TIA and minor stroke. Specifically, the study recognized the predictive value of CT/CTA abnormalities that were defined apriori: acute ischemia on CT, intracranial or extracranial occlusion or stenosis > 50% (the CT/CTA positive metric), and diffusion-weighted imaging positivity on MRI. Aims: To improve upon the CT, CTA, MRI and clinical parameters that predict recurrent events after TIA and minor stroke. Our secondary aim was to explore predictors of stroke progression versus recurrence. Methods: 510 consecutive TIA and minor stroke patients (NIHSS score of <4) had CT/CTA and most had MRI. Primary outcome was recurrent events (combined outcome of stroke progression or distinct recurrent stroke) within 90 days. Imaging parameters not included in the original CATCH imaging (CT/CTA and MRI) metrics were assessed for prediction of recurrent events. We also completed an exploratory analysis comparing predictors of symptom progression versus recurrence. Results: There were 36 recurrent events (36/510, 7.1% (95%CI: 5.0-9.6)) including 19 progression and 17 recurrent strokes. On CT/CTA: white matter disease, prior stroke, aortic arch focal plaque≥4mm, or intraluminal thrombus did not predict recurrent events. On MRI: white matter disease, prior stroke, and microbleeds did not predict recurrent events. The only additional clinical predictor was symptom fluctuation (hazard ratio 2.3; 95% CI: 1.05-5.0). Parameters predicting symptom progression included: ongoing symptoms at initial assessment, symptom fluctuation, intracranial occlusion, intracranial occlusion or stenosis, and the CT/CTA metric. No parameter was strongly predictive of recurrent stroke. Conclusions: There was no imaging parameter that could improve upon our original CT/CTA or MRI metrics to predict recurrent events after TIA and minor stroke. Only the addition of symptom fluctuation to the CT/CTA metric improved the prediction of recurrent events. Imaging was more predictive of symptom progression than distinct recurrent events.

Download Full-text