 |
| 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.”
