091
Factors associated with non-adherence to the stroke management guidelines: early anti-platelet therapy in suspected TIA
Bhutta M, Eveson D
The Leicester TIA Registry, Department of Stroke Medicine, University Hospital Leicester NHS trust, UK
Introduction: The National Clinical Guideline for Stroke indicates aspirin to be started immediately in people with suspected TIA. In the Leicester one-stop TIA clinic, 26% of suspected TIA referrals are not treated with Aspirin or an alternative anti-platelet agent prior to attendance. Factors associated with pre-clinic anti-platelet use were studied.
Method: Case records of consecutive patients referred as ‘suspected TIA’ were analysed. Patients were excluded where there was obvious contraindication to anti-platelet therapy (eg. recent haemorrhage, Warfarin therapy, severe anaemia, allergy). Pre-clinic antiplatelet use was defined as prescription of Aspirin, Clopidogrel or Dipyridamole at the time of clinic attendance. Factors associated with pre-clinic anti-platelet use were analysed in a multiple logistic regression analysis.
Results: A total of 1295 patients were included. In multiple logistic regression, pre-clinic anti-platelet use was more likely (OR, 95% CI, p value) in males (1.41, 1.03–1.92, p < 0.05), patients older than the median age of 68 (1.56, 1.13–2.17, p < 0.01), in patients taking four or more drugs at baseline (3.48, 2.37-5.14, p < 0.0005) and in patients receiving a final diagnosis of cerebrovascular disease (1.89, 1.37-2.61, p < 0.0005). Patients referred by their GP were less likely to be prescribed anti-platelets than those from other sources (0.55, 0.37–0.81, p < 0.001). The referrer's ABCD2 score did not influence the likelihood of a pre-clinic anti-platelet prescription (1.07, 0.95–1.20, p = 0.29).
Conclusions: Independent factors related to pre-clinic anti-platelet use for suspected TIA were gender, polypharmacy, cerebrovascular diagnosis and age. GPs were less likely to adhere to stroke guidelines in respect of anti-platelet therapy in comparison to other referral sources.
092
Cognitive impairment after first ever TIA
Wilson DM1, Madden M1, Power M2, Fullerton K3, Wiggam MI3, Passmore AP1
1Ageing Research Group, Queens University Belfast, Northern Ireland, 2Stroke Unit, Ulster Hospital, Northern Ireland, 3Stroke Unit, Belfast City Hospital, Northern Ireland
Introduction: Cognitive impairment after stroke is common and predicts survival and institutionalization. Transient Ischaemic Attack (TIA) is often the first manifestation of cerebrovascular disease (CVD) and is a risk factor for subsequent stroke. We assessed the prevalence of cognitive impairment in patients after first ever TIA.
Method: Subjects with probable or definite first TIA defined by the standard definition were identified at the Neurovascular clinic. The diagnosis was confirmed by a senior stroke physician. A control group was also recruited. Subjects with prior stroke, TIA or dementia were excluded. The Montreal Cognitive Assessment (MoCA) is useful in identifying mild cognitive problems and was therefore used to assess cognition.
Results: Twenty-nine subjects with first ever TIA (mean age 69.0 years, 47% male) and 30 controls (mean age 64.0 years, 50% male) were recruited over a 6 month period. Mean MoCA score was significantly lower in the TIA group (26.7 vs. 28.7 p = 0.009). Rates of cognitive impairment (MoCA<26) were significantly higher in the TIA group (10/29 [34%] vs. 2/30 [7%], p = 0.010).
Conclusion: Cognitive impairment appears to be common after first ever TIA, present in over one third of subjects in this study. Further follow-up is planned to see how cognition changes with time in these subjects. Individuals with a decline in cognition after first TIA may be at risk of further cognitive decline or dementia in the long term. Early identification may provide a window of opportunity for potential interventions.
093
ABCD2 scores: are they a useful tool on TIA referral forms?
Kee YK, Abili O, Lawrence E, Mahmood S
Department of Stroke Medicine, Mayday University Hospital, UK
Introduction: The ABCD2 score is regarded as a useful tool in determining the recurrent stroke risk in patients with TIAs. However, it has now become commonly used as a triage tool to differentiate between high and low risk TIAs. It has been incorporated into many TIA clinic referral forms. There has been little research looking at the reliability of scores by non-specialists doctors and the usefulness of the score in determining whether appropriate patients are referred to TIA services.
Method: The ABCD2 score is part of our TIA clinic referral form. ABCD2 scores were collected from the referral forms of patients referred to clinic over the period of a year. We compared the scores from the referring physicians to scores done by the specialists in the TIA clinic.
Results: A total of 441 patients were referred to the TIA clinic. 116 patients (26%) had completed ABCD2 scores from their referring physician. 185 (40%) were non stroke. 89 patients (20%) had strokes and 158 patients (36%) had TIAs. 41 (26%) of TIA patients had completed ABCD2 scores by their referring physicians. 20 (49%) patients were scored correctly by the referring physician, 14 (34%) were given higher scores by the stroke specialists.
Conclusion: There is a poor recording and concordance of ABCD2 scores by referring physicians in our study. This may reflect a lack of knowledge among non-specialists. More training is required among referring physicians regarding the ABCD2 score to ensure that patients are triaged appropriately.
