Elderly Women Have Lower Rates of Stroke, Cardiovascular Events, and Mortality After Hospitalization for Transient Ischemic Attack

Lichtman, Judith H.; Jones, Steve; Watanabe, Emi; Allen, Norrina B.; Wang, Yun; Howard, Virginia J.; Goldstein, Larry B.

doi:10.1161/strokeaha.108.543009

Cited by 16 publications

(32 citation statements)

References 44 publications

(69 reference statements)

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“…A recent US study of patients with TIA Ͼ65 years, also using hospitalization data, reported that women were significantly less likely than men to die in the year after a TIA. 3 Our results extend this research by controlling for expected survival and demonstrating a sex difference in relative survival across all ages. Importantly, we found that significant differences between women and men in relative survival were confined to the first year after a TIA hospitalization.…”

Section: Discussionsupporting

confidence: 80%

“…Early stroke rates vary 1,2 and recent studies report low early stroke risk with modern urgent TIA care. [3][4][5][6] In contrast to the emphasis on early stroke risk, detailed analyses of survival after TIA, and how survival varies by age, sex, and medical history have rarely been reported. Multicenter or population-based reports suggest that between 5% and 8% of patients will die within 6 months of their TIA, 7,8 and others report 5% to 15% dying by 1 year.…”

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confidence: 99%

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Relative Survival After Transient Ischaemic Attack

Gattellari

Goumas

Biost

et al. 2012

Stroke

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Background and Purpose-There is a lack of modern-day data quantifying the effect of transient ischemic attack (TIA) on survival, and recent data do not take into account expected survival. Methods-Data for 22 157 adults hospitalized with a TIA from July 1, 2000, to June 30, 2007, in New South Wales, Australia, were linked with registered deaths to June 30, 2009. We estimated survival relative to the age-and sex-matched general population up to 9-years after hospitalization for TIA comparing relative risk of excess death between selected subgroups. Results-At 1 year, 91.5% of hospitalized patients with TIA survived compared with 95.0% expected survival in the general population. After 5 years, observed survival was 13.2% lower than expected in relative terms. By 9 years, observed survival was 20% lower than expected. Females had higher relative survival than males (relative risk, 0.79; 95% CI, 0.69 -0.90; PϽ0.001). Increasing age was associated with an increasing risk of excess death compared with the age-matched population. Prior hospitalization for stroke (relative risk, 2.63; 95% CI, 1.98 -3.49) but not TIA (relative risk, 1.42; 95% CI, 0.86 -2.35) significantly increased the risk of excess death. Of all risk factors assessed, congestive heart failure, atrial fibrillation, and prior hospitalization for stroke most strongly impacted survival. Conclusions-This study is the first to quantify the long-term effect of hospitalized TIA on relative survival according to age, sex, and medical history. TIA reduces survival by 4% in the first year and by 20% within 9 years. TIA has a minimal effect on mortality in patients Ͻ50 years but heralds significant reduction in life expectancy in those Ͼ65 years. Key Words: follow-up Ⅲ relative survival Ⅲ transient ischaemic attack T ransient ischemic attack (TIA) is a recognized predictor of early stroke risk and its stroke outcomes have attracted intense interest. Early stroke rates vary 1,2 and recent studies report low early stroke risk with modern urgent TIA care. [3][4][5][6] In contrast to the emphasis on early stroke risk, detailed analyses of survival after TIA, and how survival varies by age, sex, and medical history have rarely been reported. Multicenter or population-based reports suggest that between 5% and 8% of patients will die within 6 months of their TIA, 7,8 and others report 5% to 15% dying by 1 year. 3,9 -11 However, the significance of these findings is uncertain. Given the advanced age at which TIA commonly occurs, it is unclear whether the observed mortality exceeds otherwise expected mortality.Calculating relative survival accounts for the "background risk" of death and identifies the excess risk of mortality above and beyond that expected from the age-and sex-matched general population. Previous population-based or multicenter studies reporting relative survival are only of historic interest with cohorts recruited from 1950 to 1988. 11-16 These studies are small-scale in terms of geographical scope and sample size (79 -330 participants), further lim...

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Section: Discussionsupporting

confidence: 80%

mentioning

confidence: 99%

Relative Survival After Transient Ischaemic Attack

Gattellari

Goumas

Biost

et al. 2012

Stroke

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“…Previous studies have considered TIA as a harbinger of an impending ischemic stroke and have aimed to detect demographic, clinical, or lifestyle factors significantly associated with risk for stroke occurrence after TIA [2,3,[5][6][7]. The few studies that have reported the complete results of multivariate analysis did not use risk-adjustment to account for patient types clustering at local hospitals or used geographically biased cohorts whose sizes were approximately 1% to 3% of the current study [3,5,6,12,13].…”

Section: Discussionmentioning

confidence: 98%

“…Previous studies have typically focused on a single hospital or small geographic region [2,3,5,6]. Alternatively, others have relied on broader sources such as Medicare data [7,14], which may impose significant biases due to the study population being restricted to patients over the age of 65 and generally greater morbidity. In our dataset, 35% of the TIA patients were younger than 65 and would therefore not be represented in any analysis of Medicare data.…”

Section: Discussionmentioning

confidence: 99%

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Quantifying the Contribution of Risk Factors for Ischemic Stroke in Patients with a History of TIA

2012

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Background. Patients with a history of transient ischemic attack (TIA) are known to be at higher risk for a stroke. We sought to investigate predictors of individual risk for an ischemic stroke within 30 days of a TIA. Methods and Results. A retrospective analysis of 57,585 TIA admissions was collected from 155 United States hospitals. Data describing each admission included demographic and clinical data, and information about the admitting hospital. Cerebrovascular disease was the primary readmission reason (19% of readmissions) in the TIA patient population. The prevalence of 30-day ischemic stroke readmissions was 11 per 1,000 TIA admissions; however, 53% of stroke readmissions occurred within one week. Hierarchal regression models suggested that peripheral vascular disease and hypertensive chronic kidney disease were significant individual stroke risk factors, whereas history of myocardial infarction, essential hypertension, and diabetes mellitus was not associated with significant stroke risk. Certified stroke centers were not associated with significantly lower stroke readmission rates. Conclusions. The results suggest that cardiovascular comorbidities confer the most significant risk for an ischemic stroke within 30 days of a TIA. Interestingly, certified stroke centers do not appear to be associated with significantly lower stroke-readmission rates, highlighting the challenges managing this patient population.

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