Influence of general practice opening hours on delay in seeking medical attention after transient ischaemic attack (TIA) and minor stroke: prospective population based study

Background: Ischaemic stroke is reportedly preceded by transient ischaemic attack (TIA) in 15–30% of all cases. The risk of stroke following TIA is highest in the presence of unstable atherosclerotic plaques in large arteries. The recent population-based Adelaide Stroke Incidence Study describes a population with a low proportion (16%) of stroke attributable to large artery atherosclerosis (LAA). We hypothesized that this population-based ischaemic stroke cohort would have a lower rate of preceding TIA than previously reported. Methods: This paper is a prospective ascertainment of all suspected TIAs and strokes in a 12-month period from 2009 to 2010. Ischaemic stroke pathogenesis was classified by the TOAST criteria. Details of preceding TIA events were scrutinised. Results: In this 12-month period, 318 stroke events in 301 individuals were recorded. Of the total 258 ischaemic strokes, 16% (95% confidence interval [CI] 12–22) were from LAA. Of 258 ischaemic stroke patients, only 11 (4%; 95% CI 2–7) reported symptoms in the preceding 90 days consistent with TIA. Nine (82%) sought medical attention. The median ABCD2 score in this group was 4.5 (IQR: 3–7), and the median time of event prior to stroke was 20 days (IQR: 4–32). Conclusion: In our population-based cohort, rates of TIA preceding ischaemic stroke were much lower than previously reported, probably reflective of effective secondary prevention (active TIA clinics) and primary prevention (limiting LAA prevalence). In our population, further enhancements in TIA care will be of limited yield.

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Population based study of early risk of stroke after transient ischaemic attack or minor stroke: implications for public education and organisation of services

BMJ ◽

10.1136/bmj.37991.635266.44 ◽

2004 ◽

Vol 328 (7435) ◽

pp. 326 ◽

Cited By ~ 466

Author(s):

A J Coull ◽

J K Lovett ◽

P M Rothwell

Keyword(s):

Public Education ◽

Transient Ischaemic Attack ◽

Population Based ◽

Minor Stroke ◽

Population Based Study ◽

Early Risk ◽

Ischaemic Attack

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Prevalence of patent foramen ovale in cryptogenic transient ischaemic attack and non-disabling stroke at older ages: a population-based study, systematic review, and meta-analysis

The Lancet Neurology ◽

10.1016/s1474-4422(18)30167-4 ◽

2018 ◽

Vol 17 (7) ◽

pp. 609-617 ◽

Cited By ~ 37

Author(s):

Sara Mazzucco ◽

Linxin Li ◽

Lucy Binney ◽

Peter M Rothwell

Keyword(s):

Systematic Review ◽

Transient Ischaemic Attack ◽

Patent Foramen Ovale ◽

Meta Analysis ◽

Population Based ◽

Foramen Ovale ◽

Population Based Study ◽

Ischaemic Attack

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

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.4.suppl_1.ap208 ◽

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

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