Awareness of Stroke Risk after TIA in Swiss General Practitioners and Hospital Physicians

Abstract

BackgroundTransient ischemic attacks (TIA) are stroke warning signs and emergency situations, and, if immediately investigated, doctors can intervene to prevent strokes. Nevertheless, many patients delay going to the doctor, and doctors might delay urgently needed investigations and preventative treatments. We set out to determine how much general practitioners (GPs) and hospital physicians (HPs) knew about stroke risk after TIA, and to measure their referral rates.MethodsWe used a structured questionnaire to ask GPs and HPs in the catchment area of the University Hospital of Bern to estimate a patient’s risk of stroke after TIA. We also assessed their referral behavior. We then statistically analysed their reasons for deciding not to immediately refer patients.ResultsOf the 1545 physicians, 40% (614) returned the survey. Of these, 75% (457) overestimated stroke risk within 24 hours, and 40% (245) overestimated risk within 3 months after TIA. Only 9% (53) underestimated stroke risk within 24 hours and 26% (158) underestimated risk within 3 months; 78% (473) of physicians overestimated the amount that carotid endarterectomy reduces stroke risk; 93% (543) would rigorously investigate the cause of a TIA, but only 38% (229) would refer TIA patients for urgent investigations “very often”. Physicians most commonly gave these reasons for not making emergency referrals: patient’s advanced age; patient’s preference; patient was multimorbid; and, patient needed long-term care.ConclusionsAlthough physicians overestimate stroke risk after TIA, their rate of emergency referral is modest, mainly because they tend not to refer multimorbid and elderly patients at the appropriate rate. Since old and frail patients benefit from urgent investigations and treatment after TIA as much as younger patients, future educational campaigns should focus on the importance of emergency evaluations for all TIA patients.

The effects of Risk Factor‐Targeted Lifestyle Counselling Intervention on working‐age stroke patients' adherence to lifestyle change

“…The ALC is based on the Adherence to Care instrument and the Lifestyle instrument. It includes both multiple‐choice and dichotomous questions concerning the background and respondents' weight control , smoking habits , nutritional habits , physical activity , stress management , alcohol consumption and adherence to medication . Additionally, it contained 5‐point Likert‐type scale (1 = strong agreement, 3 = indecision, 5 = strong disagreement) about adherence to lifestyle change and the factors related to adherence such as motivation , perceived meaning of lifestyle change , support received from family and friends and support received from doctors and nurses at the hospital.…”

“…Twenty‐five per cent of strokes recur within 5 years , and at 10 years following a stroke, the cumulative risk of recurrence is 39.2% . TIAs do not generally cause permanent brain damage, and they are a warning sign that a stroke may happen in future and require emergency treatment . More specifically, 8.1% of strokes occur within 48 hours and 10–20% within 90 days following TIA .…”

Acute stroke awareness of family physicians: translation of policy to practice

“…The difficulty to diagnose and manage TIAs by primary care physicians is well established [ 24 ]. A Swiss survey assessed the referral rate of GPs for TIA after a targeted campaign that increased awareness regarding TIA management and found that although the estimated risk for stroke after TIA within 24 h and 3 months was generally overestimated, only about half of the responding GPs would refer their patient immediately for rigorous work-up [ 25 ].…”

Transient Ischaemic Attacks: It’s time for timely action!

“…Timely management of TIA also depends on the urgency shown by treating physicians in evaluation and treatment, and this is influenced by their knowledge of symptom recognition and management. A study in Switzerland showed that knowledge of TIA was poor among general practitioners and hospital physicians, and only 38% referred patients for emergency assessment [29]. More than 40% of French general practitioners and emergency department physicians were unaware of the current TIA definition, and more than one third were unaware of the relevant national guidelines [30].…”