Does Inflammation Predispose to Recurrent Vascular Events after Recent Transient Ischaemic Attack and Minor Stroke? the North West of England Transient Ischaemic Attack and Minor Stroke (NORTHSTAR) Study

2011 ◽  
Vol 6 (3) ◽  
pp. 187-194 ◽  
Author(s):  
Johann R. Selvarajah ◽  
Craig J. Smith ◽  
Sharon Hulme ◽  
Rachel Georgiou ◽  
Charles Sherrington ◽  
...  
Keyword(s):  
Transient Ischaemic Attack ◽  
Minor Stroke ◽  
Vascular Events ◽  
North West ◽  
The North ◽  
Ischaemic Attack

scholarly journals Decreasing referrals to transient ischaemic attack clinics during the COVID-19 outbreak: results from a multicentre cross-sectional survey

BMJ Open ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. e041514
Author(s):  
Lucio D'Anna ◽  
Ambreen Sheikh ◽  
Raj Bathula ◽  
Salwa Elmamoun ◽  
Adelaide Oppong ◽  
...  
Keyword(s):  
Transient Ischaemic Attack ◽  
Online Survey ◽  
Stroke Care ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Future Studies ◽  
North West ◽  
The North ◽  
Number Of Patients ◽  
Ischaemic Attack

ObjectiveThe COVID-19 pandemic is having major implications for stroke care with a documented significant fall in hospital acute stroke admissions. We investigated whether COVID-19 has resulted in a decreased number of referrals to the transient ischaemic attack (TIA) clinics across the North West London region.Setting and designAll the TIA clinical leads of the North West London region received an invitation by email to participate in an online survey in May 2020. The survey questionnaire aimed to assess the number of patients with suspected TIA consecutively referred to each of the TIA clinics of the North West London region between 1 March and 30 April 2020, the COVID-19 period, and between 1 March and 30 April 2019.ResultsWe had a response rate of 100%. During the COVID-19 period, the TIA clinics of the North West London region received 440 referrals compared with 616 referrals received between 1 March and 30 April 2019 with a fall in the number of the referrals by 28.6%. In April 2020 compared with April 2019, the number of the referrals declined by 40.1%.ConclusionsThis multicentre analysis documented a significant reduction in the number of patients referred with suspected TIA to the specialised rapid access outpatient clinics in the North West London region during the COVID-19 pandemic. Future studies are needed to confirm our findings and to better characterise the incidence of cerebrovascular disease during the COVID-19 pandemic.

scholarly journals Development of a Digital Lifestyle Modification Intervention for Use after Transient Ischaemic Attack or Minor Stroke: A Person-Based Approach

2021 ◽  
Vol 18 (9) ◽  
pp. 4861
Author(s):  
Neil Heron ◽  
Seán R. O’Connor ◽  
Frank Kee ◽  
David R. Thompson ◽  
Neil Anderson ◽  
...  
Keyword(s):  
Focus Group ◽  
Scoping Review ◽  
Transient Ischaemic Attack ◽  
Lifestyle Modification ◽  
Data Entry ◽  
Personal Control ◽  
Minor Stroke ◽  
User Engagement ◽  
Self Confidence ◽  
Ischaemic Attack

This paper describes the development of the ‘Brain-Fit’ app, a digital secondary prevention intervention designed for use in the early phase after transient ischaemic attack (TIA) or minor stroke. The aim of the study was to explore perceptions on usability and relevance of the app in order to maximise user engagement and sustainability. Using the theory- and evidence-informed person-based approach, initial planning included a scoping review of qualitative evidence to identify barriers and facilitators to use of digital interventions in people with cardiovascular conditions and two focus groups exploring experiences and support needs of people (N = 32) with a history of TIA or minor stroke. The scoping review and focus group data were analysed thematically and findings were used to produce guiding principles, a behavioural analysis and explanatory logic model for the intervention. Optimisation included an additional focus group (N = 12) and individual think-aloud interviews (N = 8) to explore perspectives on content and usability of a prototype app. Overall, thematic analysis highlighted uncertainty about increasing physical activity and concerns that fatigue might limit participation. Realistic goals and progressive increases in activity were seen as important to improving self-confidence and personal control. The app was seen as a useful and flexible resource. Participant feedback from the optimisation phase was used to make modifications to the app to maximise engagement, including simplification of the goal setting and daily data entry sections. Further studies are required to examine efficacy and cost-effectiveness of this novel digital intervention.

scholarly journals Usability and Acceptability of a Novel Secondary Prevention Initiative Targeting Physical Activity for Individuals after a Transient Ischaemic Attack or “Minor” Stroke: A Qualitative Study

2020 ◽  
Vol 17 (23) ◽  
pp. 8788
Author(s):  
Neil Heron ◽  
Sean R. O’Connor ◽  
Frank Kee ◽  
Jonathan Mant ◽  
Margaret E. Cupples ◽  
...  
Keyword(s):  
Physical Activity ◽  
Secondary Prevention ◽  
Transient Ischaemic Attack ◽  
Recurrence Risk ◽  
Relevant Information ◽  
Minor Stroke ◽  
Group Discussions ◽  
Self Evaluation ◽  
Ischaemic Attack ◽  
Optimal Approach

Behavioural interventions that address cardiovascular risk factors such as physical inactivity and hypertension help reduce recurrence risk following a transient ischaemic attack (TIA) or “minor” stroke, but an optimal approach for providing secondary prevention is unclear. After developing an initial draft of an innovative manual for patients, aiming to promote secondary prevention following TIA or minor stroke, we aimed to explore views about its usability and acceptability amongst relevant stakeholders. We held three focus group discussions with 18 participants (people who had experienced a TIA or minor stroke (4), carers (1), health professionals (9), and researchers (4). Reflexive thematic analysis identified the following three inter-related themes: (1) relevant information and content, (2) accessibility of format and helpful structure, and (3) strategies to optimise use and implementation in practice. Information about stroke, medication, diet, physical activity, and fatigue symptoms was valued. Easily accessed advice and practical tips were considered to provide support and reassurance and promote self-evaluation of lifestyle behaviours. Suggested refinements of the manual’s design highlighted the importance of simplifying information and providing reassurance for patients early after a TIA or minor stroke. Information about fatigue, physical activity, and supporting goal setting was viewed as a key component of this novel secondary prevention initiative.

Abstract P208: Transient Ischaemic Attack: How the Patient Perceives it

2011 ◽  
Vol 4 (suppl_1) ◽  
Author(s):  
Mary J MacLeod ◽  
Ali Abdullah
Keyword(s):  
Secondary Prevention ◽  
Transient Ischaemic Attack ◽  
Patient Adherence ◽  
Behavioural Change ◽  
Illness Perception ◽  
Personal Control ◽  
Self Report ◽  
Minor Stroke ◽  
Medical Attention ◽  
Ischaemic Attack

Background: The risk of stroke after Transient Ischaemic Attack (TIA) is 8-11 % within a month. Rapid assessment and early use of preventative therapies can reduce this risk by 80-90%. Many patients do not seek timely medical attention, and may minimise their symptoms. The purpose of this study was to assess patients' perception of the significance of TIA/ minor stroke, and their beliefs and attitudes to secondary prevention interventions. Methods: 120 patients with a recent TIA/minor stroke were given a questionnaire after clinic/ward review. This included the validated Brief Illness Perception Questionnaire (Brief-IPQ: scores 0-10), and Beliefs about Medicines Questionnaire (BMQ: scores 5-25). Patient adherence to secondary prevention medications was assessed by self-report. Results: There was a 56% return rate. Within the brief-IPQ, patients had a mid score for perceived consequences of their event (4.88 (sd2.67)). Only 22% took urgent action at the time of the event. 60% were persuaded to take action by family or friends. Patients scored the midpoint for emotional distress (4.9 (sd 3.4)) and felt they could not exert personal control (4.0(3.2)). They did believed treatment would control their condition (7.7(2.1)). The majority of patients (86.3%) believed in the necessity of medication, with mean necessity score of 18.36(3.5). 14% reported concerns about becoming dependent upon medications and the potential adverse consequences of taking medication. 78% of patients said they complied with their treatment. Conclusions: Patients may not regard TIA or minor stroke as having important implications for their future health. Many only seek medical advice as a result of external pressure. Patients do not feel they have personal control over the condition, but believe medication is necessary and beneficial. These findings will inform strategies for education and behavioural change interventions in people at risk of or who have had a TIA/minor stroke

scholarly journals 237 Systematic Review of Fibrinogen and Risk of Recurrent Stroke and Vascular Events after Ischaemic Stroke or Transient Ischaemic Attack (TIA)

2019 ◽  
Vol 48 (Supplement_3) ◽  
pp. iii1-iii16
Author(s):  
John J McCabe ◽  
Eimear O'Reilly ◽  
Sarah Coveney ◽  
Ronan Collins ◽  
Simon Cronin ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ischaemic Stroke ◽  
Transient Ischaemic Attack ◽  
Prognostic Value ◽  
Recurrent Stroke ◽  
Multivariable Analysis ◽  
Positive Association ◽  
Case Control Studies ◽  
Vascular Events ◽  
Ischaemic Attack

Abstract Background Inflammation is thought to play an important role in atherosclerotic stroke mechanisms. There is growing interest in the prognostic role of inflammatory biomarkers as risk factors for recurrent vascular events, after ischaemic stroke or transient ischaemic attack (TIA). Elevated fibrinogen levels are independently-associated with the risk of first-ever stroke. However, the prognostic value of fibrinogen, after ischaemic cerebrovascular events is uncertain. Methods We searched EMBASE and Ovid Medline, from 1970-January 2019, for any study that measured Fibrinogen after stroke or TIA, and related it to the risk of recurrent stroke or recurrent vascular events. All records were assessed by 2 independent reviewers. Any disagreements between authors regarding eligibility were resolved by consensus. Results We identified 2,520 publications, of which, 15 articles from 16 individual studies were eligible (11 observational cohorts, 3 cohort studies within randomized control trials, 2 case-control studies). The sample size for recurrent stroke and recurrent vascular events was 9,963 and 7,381 patients, in 11 and 10 studies, respectively. The time from event to phlebotomy was <7 days in 5, 7-90 days in 6, and >90 days in 5 studies, respectively. There was marked heterogeneity in statistical methodologies employed to examine the relationship between fibrinogen and outcomes, which did not allow valid meta-analysis (above/below specified threshold (n=4), differences in means/medians (n=5), risk per unit increase (n=1), per standard deviation (n=3), per quartile (n=1), per decile (n=1) or not specified (n=1)). 4 studies adjusted for all conventional vascular risk factors (age, smoking, diabetes, hypercholesterolaemia/statin use, and hypertension). 2 of 11 studies found a positive association with recurrent stroke. 5 of 10 studies found a positive association with recurrent vascular events. Conclusion The prognostic value of Fibrinogen after stroke or TIA remains unclear. Standardised methods and fully-adjusted multivariable analysis are needed in future prognostic studies.

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