Relative Survival After Transient Ischaemic Attack

Abstract

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...

Vascular Disease, ESRD, and Death

“…Previous studies have demonstrated a strong association between vascular disease and death in the general population (27,28), as well as between vascular disease and death in hemodialysis patients (19,29). Vascular disease can be a cause or consequence of CKD, and our results suggest that either preventing the development of vascular disease or more aggressively managing prevalent cases may be a reasonable initial goal in reducing CKD mortality.…”

Four-Year Follow-Up of Transient Ischemic Attacks, Strokes, and Mimics

“…19 In a large cohort of hospitalized TIA patients, 10% had died by 1 year. 17 Why was the stroke risk in our cohort so low? This may represent a true effect of improved awareness combined with urgent TIA clinic assessment and treatment; 38.8% of our patients were already on aspirin by the time they arrived at the clinic.…”

“…Some are population based, [11][12][13][14] whereas others have reported on patients presenting to hospitals and emergency departments. [15][16][17][18][19] Most outpatient studies were conducted before the establishment of daily rapid access TIA clinics based on the EXPRESS study 6 model. They do not, therefore, take into account the influence of early secondary prevention on prognosis.…”

Trends Over Time in the Risk of Stroke After an Incident Transient Ischemic Attack

“…A sensitivity analysis was conducted restricting the sample to cases of TIA who were hospitalized with a diagnosis of TIA in the principal diagnostic position and who had not had a TIA or stroke in the previous 5 years (a 5-year clearance); this case definition is likely to overlap with published analyses of cases of TIA presenting to hospital 5,18 and is likely to remove ≈97% of prevalent TIAs and strokes in comparison to the 2-year clearance which removes 93%. 19 In Australia, the principal diagnosis is defined as the diagnosis chiefly responsible for occasioning a service event or episode.…”