07 Oct TIAs, Strokes Decline Over Last Decade
MedicalResearch.com Interview with:
Vijaya Sundararajan, MD, MPH, FACP
Head, Health Outcomes Group, Head, Biostatistics Hub
Research Advisor, Centre for Palliative Care
Department of Medicine Eastern Hill Academic Centre
Melbourne Medical School
Faculty of Medicine, Dentistry and Health Sciences University of Melbourne
Medical Research: What are the main findings of this study?
Dr. Sundararajan: The main findings of the study are that over the last 10 years, there has been a measurable decline in people having a stroke 3 months after a new mini stroke (TIA); a mini stroke is also known as a ‘warning sign for stroke’. There has also been an overall decline in of the proportion of people having these mini strokes in the Australian State of Victoria (population 5.6million). These trends probably reflect improved primary and secondary prevention efforts for the last decade. These improvements are likely to include increased use of preventive medications and surgery for carotid artery narrowing in people identified as being at high risk of having a stroke, as well as improved behaviors (e.g. reducing smoking, improving diets, uptake of physical activity, among others).
The most important aspect of our results is many fewer strokes occur when people with a TIA are managed in a hospital with a stroke unit (up to 6%). Even when the patient’s TIA is managed in an Emergency Department and the patient released without admission, if the hospital has a stroke unit, these patients appear to have better outcomes. This likely reflects the cohesion and organization of the stroke unit in implementing the necessary tests and treatments promptly, and setting up the infrastructure to follow patients up.
Medical Research: What should patients and clinicians take away from this report?
Dr. Sundararajan: Clinicians and patients should take away from the report that the impact of modifying risk factors such as elevated blood pressure, heart rhythm abnormalities, cholesterol, blood sugar and smoking is of great importance, and probably has had an impact at a population level in reducing the risk of stroke, a disease with a large mortality and morbidity burden. The decline in TIA rates may also reflect improving primary care, with GPs paying much more attention to these factors than in previous years, although more can possibly be done in this regard.
Medical Research: What further research do you recommend as a result of this study?
Dr. Sundararajan: The next step is to assess whether we can further differentiate outcomes after TIA based on levels of treatment with particular medications and the type of care they receive. For example, do patients who consistently take/refill their anti-hypertensive medications do better than those who do not? Do patients who see a stroke neurologist as an outpatient after their TIA have lower stroke rates?
Trends Over Time in the Risk of Stroke After an Incident Transient Ischemic Attack
Vijaya Sundararajan, Amanda G. Thrift, Thanh G. Phan, Philip M. Choi, Ben Clissold, and Velandai K. Srikanth
Stroke. 2014;STROKEAHA.114.006575published online before print September 25 2014, doi:10.1161/STROKEAHA.114.006575