Stroke risk for patients treated at TIA clinic not higher than those treated at hospitals

Clinics that provide timely care for patients with transient ischemic attacks can be an effective alternative to hospitalization in the prevention of future incidence of stroke, according to a systematic review and meta-analysis published in JAMA Network Open.

“Studies have shown up to an 80% reduction in the risk of stroke after a transient ischemic attack (TIA) with early implementation of secondary stroke prevention strategies,” Shima Shahjouei, MD, MPH, of Geisinger Neuroscience Institute in Pennsylvania, and colleagues wrote.

“Several TIA care pathway models have been proposed mainly to reduce the hospital length of stay and admission costs and to improve outcomes.

“Several studies have indicated that the outpatient management of TIA among selected patients can be safe and cost-effective,” they added. “Nevertheless, in many instances outpatient care for selected patients with TIA is avoided.”

Researchers sought to evaluate and compare risks for stroke occurrence among patients with TIA or minor ischemic stroke (mIS), broken down by method and location of care. They collected data from 226,683 patients involved in 71 studies from eight different databases from the inception of each through Oct. 1, 2020, and included studies evaluating the occurrence of ischemic stroke after TIA or mIS. However, they excluded those that did not feature evaluation time for reporting subsequent stroke, those with retrospective diagnosis of the index event following occurrence of the stroke and those that reported outcomes not limited to patients with TIA or mIS.

Further, Shahjouei and colleagues measured outcomes based on risk for subsequent ischemic stroke among patients with TIA or mIS who received care at rapid-access TIA or neurology clinics, inpatient units, EDs or other unspecified locations within evaluation intervals of 2, 7, 30 and 90 days. They analyzed data from 5,636 patients who received care at TIA clinics and 130,139 patients who were treated in inpatient units. Results showed that patients who were treated at a TIA clinic had risk for stroke after an ischemic event of 0.3% within 2 days, 1% within 7 days, 1.3% within 30 days and 2.1% within 90 days.

Risk for inpatient participants was 0.5% within 2 days, 1.2% within 7 days, 1.6% within 30 days and 2.8% within 90 days.

Compared with the inpatient group, participants treated in a TIA clinic were younger and scored better with respect to age, blood pressure, clinical features, duration of TIA and diabetes.

“There is growing evidence that suggests TIA clinics can be considered an alternative

to hospitalization,” Shahjouei and colleagues wrote. “Despite the very different structures of risk stratification and patient selection, referral patterns, and diagnostic and therapeutic protocols in these TIA clinic models, the risk of cerebral ischemia in patients treated at a TIA clinic did not exceed those treated in an inpatient setting.”