Patient behavior immediately after transient ischemic attack according to clinical characteristics, perception of the event, and predicted risk of stroke.
Giles MF., Flossman E., Rothwell PM.
BACKGROUND AND PURPOSE: Little research has been done on patients' behavior after transient ischemic attack (TIA). Recent data on the high early risk of stroke after TIA mean that emergency action after TIA is essential for effective secondary prevention. We therefore studied patients' behavior immediately after TIA according to their perceptions, clinical characteristics, and predicted stroke risk. METHODS: Consecutive patients with TIA participating in the Oxford Vascular Study or attending dedicated hospital clinics in Oxfordshire, UK, were interviewed. Predicted stroke risk was calculated using 2 validated scores. RESULTS: Of 241 patients, 107 (44.4%) sought medical attention within hours of the event, although only 24 of these attended the emergency department. A total of 107 (44.4%) delayed seeking medical attention for > or =1 day. Correct recognition of symptoms (42.2% of patients) was not associated with less delay. However, patients with motor symptoms or duration of symptoms > or =1 hour were more likely to seek emergency attention (hazard ratio, 2.1; 95% CI, 1.4 to 3.2; P=0.00005), as were those at higher predicted stroke risk (P=0.001). The other main correlate with delay was the day of the week on which the TIA occurred (P<0.001), with greater delays at the weekend. Delay was unrelated to age, sex, or other vascular risk factors. CONCLUSIONS: Many patients delay seeking medical attention after a TIA irrespective of correct recognition of symptoms, although patients at higher predicted risk of stroke do act more quickly. Public education about both the urgency and nature of TIA is required.