259061 Outcomes following transient ischemic attack (TIA): Do Primary Stroke Centers make a difference?

Wednesday, October 31, 2012 : 8:30 AM - 8:50 AM

Elizabeth J. Rodgers, MA, MSPH , California Tobacco Control Program, California Department of Public Health, Sacramento
Toshi Hayashi, PhD , California Heart Disease and Stroke Prevention Program, California Department of Public Health, Sacramento, CA
David J. Reynen, MA, MPPA, MPH, CPH , California Heart Disease and Stroke Prevention Program, California Department of Public Health, Sacramento, CA
Lily A. Chaput, MD, MPH , California Heart Disease and Stroke Prevention Program, California Department of Public Health, Sacramento, CA
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.

Learning Areas:
Chronic disease management and prevention
Clinical medicine applied in public health
Provision of health care to the public
Public health or related organizational policy, standards, or other guidelines
Public health or related research

Learning Objectives:
List three characteristics of Joint Commission-certified Primary Stroke Centers. Describe how standardized, evidence-based clinical care of TIA patients can lower their risk of a future stroke-related event. Explain why TIA patients at a Primary Stroke Center might have better outcomes than those treated at non-certified facilities.

Keywords: Chronic Diseases, Evidence Based Practice

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I received my Master of Science degree from the Harvard School of Public Health in 2010, where I studied chronic disease prevention. I was a California Epidemiologic Investigation Service Fellow with the Chronic Disease Control Branch of the California Department of Public Health from 2010-2011, where I worked as a program evaluator on several federally funded grants focusing on cardiovascular disease prevention. I am currently a Research Scientist for the California Tobacco Control Program.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.