Outcomes following transient ischemic attack (TIA): Do Primary Stroke Centers make a difference?

Transient Ischemic Attack (TIA) – sometimes called a “mini-stroke” – is an event lasting less than 24 hours. Nearly half of all individuals who experience a TIA have an ischemic stroke within 5 years. The Joint Commission Primary Stroke Center (PSC) certification program recognizes hospitals that provide standardized comprehensive stroke care. Prior research has shown that when compared to stroke patients treated at non-PSCs, those treated at a PSC are less likely to die within one year. Whether treatment at a PSC impacts the outcome from TIA is unknown.

Competing risk survival analyses were used to compare stroke-related outcomes for TIA patients treated in a PSC with those treated in a non-PSC. Patients who had a prior stroke-related hospitalization within 180 days of the index event were excluded from analysis. Using administrative data on hospitalizations and deaths in California, 10,059 patients met the inclusion criteria of a TIA in 2007 and 2,026 had a subsequent TIA or stroke by the end of 2008.

After controlling for age and gender, TIA patients treated at a PSC were significantly less likely to have a subsequent TIA or stroke by the end of 2008, compared to those treated at non-PSC hospitals (Estimated Subhazard Ratio= 0.90 [95% CI 0.82-0.99]). Future analyses will examine the impact of socio-economic status, comorbid conditions, and hospital characteristics.

These preliminary findings suggest that, in addition to improving outcomes for stroke patients, PSCs are effective at preventing stroke-related events in TIA patients. These findings may inform treatment policies for TIA patients.