Rapid evaluation after high-risk TIA is associated with lower stroke risk.
Wu CM., Manns BJ., Hill MD., Ghali WA., Donaldson C., Buchan AM.
BACKGROUND: Current 'standard of care' for patients presenting with a 'high-risk' TIA varies, with use of several outpatient and inpatient approaches. We describe the clinical outcomes and costs for high risk TIA patients who received care in a 'rapid evaluation unit', and compare these to a historical 'high-risk' cohort. METHODS: The study cohort was comprised of patients with TIA admitted to a 'rapid evaluation unit' during the period March 2002 to April 2003. The comparison cohort was established by screening Calgary Health Region ER discharge records to identify all patients presenting with a diagnosis of TIA during the year 2000. A 'high-risk standard care cohort' was then identified based on the clinical admission criteria used to select patients for the rapid evaluation unit. Outcomes (stroke within 90 days, death) and costs were identified using chart review and provincial administrative data. RESULTS: The early risk of stroke in the high risk standard care group (392 patients) was 9.7%, compared to 4.7% in the rapid evaluation cohort (189 patients) (p = 0.05). Median 1-year costs post TIA were CAN $8360 for patients in the rapid evaluation cohort, compared with CAN $4820 for patients in the high risk standard care group (p < 0.001). CONCLUSIONS: The risk of early stroke was lower for patients in the rapid evaluation cohort compared to the high risk standard care cohort, suggesting that the use of rapid evaluation programs in patients with TIA at high risk of stroke may be beneficial, but incur greater costs over the course of the first year.