'Rapid Access' To Minor Stroke Clinics Not Happening Fast Enough, UK

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Main Category: Stroke
Article Date: 22 Nov 2007 - 0:00 PDT

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According to an article in Neurology Neurosurgery and Psychiatry (BMJ), 'rapid access' to minor stroke clinics is not happening within seven days, as it should. A transient ischemic attack (TIA) - another name for a minor stroke - significantly raises the patient's chances of experiencing a major stroke, especially during the first few days following the minor stroke, explain the authors.

In fact, according to some studies, a patient who has sustained a minor stroke may have a one-in-four chance of sustaining a major stroke within a week.

Hence early assessment is crucial, explain the authors. UK guidelines say that a TIA patient should be seen by specialist within 7 days of the start of symptoms. Unfortunately, this is taking, on average, 15 days.

The researchers analyzed data on 711 patients who had sustained a TIA - they were all seen at five centers in the North West of England. The patients were monitored for three months in case they had a recurrent TIA, heart attack, stroke, or died. 126 of them, about one-in-five, had a major stroke or at least an additional TIA during this period.

Thirty of those patients had a first stroke. 100 patients experienced at least one further TIA, although just four of them had a subsequent major stroke. Three patients died.

The total number of strokes was below what they had expected, explain the researchers. This was probably because the delay in accessing services meant that high risk patients had already had a stroke.

The 15 day delay between the TIA and assessment at a 'rapid access' TIA clinic is "representative of current UK practice", write the authors. A mere third of UK centers manage to achieve a seven day standard.

The authors concluded "Our findings suggest that current provision of TIA services, where delayed presentation to "rapid access" TIA clinics is common, does not appear to provide an appropriate setting for urgent evaluation or timely secondary prevention in those who may be at the highest risk of stroke."

"Prognosis in patients with transient ischaemic attack (TIA) and minor stroke attending TIA services in the North West of England: The NORTHSTAR Study"
Online First J Neurol Neurosurg Psychiatry
Dr. Craig Smith et al
2007; doi 10.1136/jnnp.2007.129183
http://jnnp.bmj.com

Written by - Christian Nordqvist
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