 |
|
New Transient Ischemic Attack and Stroke
Outpatient Management by Primary Care Physicians
Larry B. Goldstein, MD;
John Bian, MS;
Gregory P. Samsa, PhD;
Arthur J. Bonito, PhD;
Linda J. Lux, MPH;
David B. Matchar, MD
Arch Intern Med. 2000;160:2941-2946.
Background Patients with transient ischemic attack (TIA) or stroke frequently first contact their primary care physician rather than seeking care at a hospital emergency department. The purpose of the present study was to identify a group of patients seen by primary care physicians in an office setting for a first-ever TIA or stroke and characterize their evaluation and management.
Methods Practice audit based on retrospective, structured medical record abstraction from 27 primary care medical practices in 2 geographically separate communities in the eastern United States.
Results Ninety-five patients with a first-ever TIA and 81 with stroke were identified. Seventy-nine percent of those with TIA vs 88% with stroke were evaluated on the day their symptoms occurred (P = .12). Only 6% were admitted to a hospital for evaluation and treatment on the day of the index visit (2% TIA; 10% stroke; P = .03); only an additional 3% were admitted during the subsequent 30 days. Specialists were consulted for 45% of patients. A brain imaging study (computed tomography or magnetic resonance imaging) was ordered on the day of the index visit in 30% (23% TIA, 37% stroke; P = .04), regardless of whether the patient was referred to a specialist. Carotid ultrasound studies were obtained in 28% (40% TIA, 14% stroke; P<.001), electrocardiograms in 19% (18% TIA, 21% stroke; P = .60), and echocardiograms in 16% (19% TIA, 14% stroke; P = .34). Fewer than half of patients with a prior history of atrial fibrillation (n = 24) underwent anticoagulation when evaluated at the index visit. Thirty-two percent of patients (31% TIA, 33% stroke; P = .70) were not hospitalized and had no evaluations performed during the first month after presenting to a primary care physician with a first TIA or stroke. Of these patients, 59% had a change in antiplatelet therapy on the day of the index visit.
Conclusions Further primary care physician education regarding the importance of promptly and fully evaluating patients with TIA or stroke may be warranted, and barriers to implementation of established secondary stroke prevention strategies need to be carefully explored.
From the Department of Medicine (Neurology) (Dr Goldstein), Duke Center for Cerebrovascular Disease (Drs Goldstein, Samsa, and Matchar), Stroke Policy Program, and Center for Clinical Health Policy Research (Drs Goldstein, Samsa, and Matchar and Mr Bian), Duke University, and Durham Veterans Affairs Medical Center (Dr Goldstein), Durham, NC; and Research Triangle Institute, Research Triangle Park, NC (Dr Bonito and Ms Lux).
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
Advances in Prevention and Health Services Delivery 2007
Goldstein and Rothwell
Stroke 2008;39:258-260.
FULL TEXT
Attitudes and Current Practice of Primary Care Physicians in Acute Stroke Management
Roebers et al.
Stroke 2007;38:1298-1303.
ABSTRACT
| FULL TEXT
Validation of the ABCD Score in Identifying Individuals at High Early Risk of Stroke After a Transient Ischemic Attack: A Hospital-Based Case Series Study
Tsivgoulis et al.
Stroke 2006;37:2892-2897.
ABSTRACT
| FULL TEXT
Timing of TIAs preceding stroke: Time window for prevention is very short
Rothwell and Warlow
Neurology 2005;64:817-820.
ABSTRACT
| FULL TEXT
Recommendations for the Establishment of Stroke Systems of Care: Recommendations From the American Stroke Association's Task Force on the Development of Stroke Systems
Task Force Members et al.
Stroke 2005;36:690-703.
FULL TEXT
Recommendations for the Establishment of Stroke Systems of Care: Recommendations From the American Stroke Association's Task Force on the Development of Stroke Systems
Schwamm et al.
Circulation 2005;111:1078-1091.
FULL TEXT
Reconsideration of TIA diagnostic criteria
Sherman
Neurology 2004;62:S20-S21.
FULL TEXT
Management and outcomes of transient ischemic attacks in Ontario
Gladstone et al.
CMAJ 2004;170:1099-1104.
ABSTRACT
| FULL TEXT
Early risk of stroke after transient ischemic attack: back to the future
Verro
CMAJ 2004;170:1113-1114.
FULL TEXT
The patient with transient cerebral ischemia: a golden opportunity for stroke prevention
Johnston and Hill
CMAJ 2004;170:1134-1137.
ABSTRACT
| FULL TEXT
The redefinition of TIA: The uses and limitations of DWI in acute ischemic cerebrovascular syndromes
Warach and Kidwell
Neurology 2004;62:359-360.
FULL TEXT
Knowledge and management of transient ischemic attacks among US primary care physicians
Nguyen-Huynh et al.
Neurology 2003;61:1455-1456.
FULL TEXT
Transient ischaemic attacks: desired diagnosis and management by Polish primary care physicians
Tomasik et al.
Fam Pract 2003;20:464-468.
ABSTRACT
| FULL TEXT
Educating the Next Generation of Physicians About Stroke: Incorporating Stroke Prevention into the Medical School Curriculum Editorial Comment: Incorporating Stroke Prevention into the Medical School Curriculum
Billings-Gagliardi et al.
Stroke 2001;32:2854-2859.
ABSTRACT
| FULL TEXT
|
