Monash study reveals how to achieve better outcomes for hospitalised stroke patients

Assoc Prof Dominique Cadilhac

How patients with mini-stroke are managed in hospitals directly impacts their longer term survival, according to latest research from Monash University.

The practice of managing patients with acute stroke in specialised stroke units is already recommended, with the odds of death or dependency reduced by over 20% compared with management in an alternate hospital ward.

However, until now there has been limited data to support the best management of patients with transient ischemic attack (TIA) or mini-stroke if they require admission to hospital. 

Published this week in the high impact journal Neurology, the study led by School of Clinical Sciences’ Associate Professor Dominique Cadilhac and Dr Joosup Kim reveals that TIA patients requiring hospital admission and who are treated in a specialist stroke unit have a 45% reduced risk of death at 180 days compared with management in an alternate hospital ward.

“Stroke Unit care involves management by clinicians with specialist training and expertise in stroke who provide greater access to evidence-based care, including acute therapies and secondary prevention treatment,” said Associate Professor Cadilhac, Head of Translational Public Health and Evaluation Division, Stroke and Ageing Research.

“In alternate hospital wards, patients are managed by a range of health professionals who may not have specific expertise in stroke or TIA.”

“While some patients with TIA can be treated in a hospital emergency department and discharged with good specialist stroke follow-up, some require admission to hospital,” said Professor Velandai Srikanth, Head of Stroke and Ageing Research at Monash University and Monash Health stroke physician.

“Patients hospitalised with TIA have a high risk of stroke in the near future and need to be treated appropriately and quickly—preferably in a stroke unit.”

Using data obtained from the Australian Stroke Clinical Registry, Associate Professor Cadilhac and colleagues analysed more than 3000 TIA patient admissions from 40 hospitals between 2010 and 2013.

“Hospitalised patients with TIA managed in stroke units had better survival at 180 days than those treated in alternate wards, probably because of better risk management in a stroke unit setting,” said Associate Professor Cadilhac.

“This is the largest reported study of TIA outcomes after hospital admission according to the setting of patient management.”

“Overall, our findings provide evidence that Australian patients hospitalised for TIA are less often managed in a stroke unit than patients with a confirmed stroke, and that this practice should be reconsidered.”

Professor Srikanth said there are different models of care for patients with TIA in Australia.

“At Monash Medical Centre, the majority of patients with TIA are rapidly investigated and treated in the emergency department according to a carefully designed and effective stroke unit protocol, and followed up in specialist TIA outpatient clinics run by stroke specialists.”

“Patients requiring hospital admission are usually managed by the stroke unit specialists – and the data from this important study supports the practice at Monash Health,” added Professor Srikanth.

“Improving availability of specialised stroke care in Australia, and elsewhere, will improve the management of patients hospitalised with TIA,” said Associate Professor Cadilhac.

“For the first time, these findings provide evidence that patients with TIA who require admission and are treated in a stroke unit have improved longer-term survival rates.”