Stroke rate slashed at prevention clinic

CBC News

Weakness in one side of the body is a warning sign for stroke. (Pablo Martinez Monsivais/Associated Press)

A new stroke prevention clinic in Ottawa is helping patients treated for mini-strokes from developing the full-blown version, doctors report. A transient ischemic attack, or TIA, is a mild stroke that causes stroke symptoms such as sudden numbness of the face, arm or leg. The symptoms last for less than 24 hours and then resolve on their own without disabling neurological effects, but it is a marker for early risk of stroke.

At the Ottawa Hospital Stroke Clinic, patients with TIA symptoms are quickly assessed in the emergency department (ED) and referred to the stroke clinic for brain imaging, medication adjustment, counselling about stroke risk factors and surgery in some cases.  Dr. Mukul Sharma, deputy director of the Canadian Stroke Network, and his co-authors found that 3.2 per cent of people who experienced TIA at the stroke prevention clinic developed a full-blown stroke within 90 days, compared with about 10 per cent at other centres.

"The beauty of this is that we added very few staff," said Sharma, lead author of the study in the November issue of the journal Stroke, and director of The Ottawa Hospital Stroke Clinic.

A booking clerk was one of the few staff that was added as part of the program.

"It really is that ability to juggle bookings and the acuity of the visit that I think make this process work. I've likened it to getting an orchestra playing the same tune."

The study looked at 1,099 patients diagnosed with TIA, and 1,004 or 92 per cent of them were referred to the stroke clinic for assessment.

Stroke warning signs

• Weakness, numbness or tingling in face, arms or legs, especially on one side of the body.

• Trouble speaking or understanding speech.

• Sudden blurring, double vision or loss of vision.

• Sudden severe headache.

• Dizziness, loss of balance.

The hospital uses a triaging system to ensure patients with the highest stroke risk are seen as soon as possible.

"We believe that the reduced stroke rate can be attributed to the system of care that combines the ED care and the clinic process," the study's authors concluded.

Under the new system, staff in the emergency department tick off boxes on a checklist when diagnosing the TIA, order tests, and prescribe medications right away.

The checklist is faxed to the stroke clinic, where the investigations are quickly processed to confirm TIA and decide on the best treatment.

Shorter waits for clinic

The treatment includes lifestyle changes that evidence suggests have the same magnitude of benefits as medications that are prescribed, Sharma said.

The rate of admissions was less than two per cent under the new system, which helps both the patients and the health-care system, the researchers said.

Before the new process, it took four months to get patients into the clinic. Now the clinic aims to see patients considered at high risk in 48 hours and a week for those at low risk, Sharma said.

The researchers said one of the limitations of the study was that they lacked baseline MRI or CT information to tell whether early strokes were due to progression of initial symptoms or a new event.

The study's authors called for more studies with those images to explore their finding of a difference between the timing of stroke versus another TIA.

Almost one-third of the full strokes occurred within two days of the TIA, the study's authors found. In comparison, almost half of the recurrent TIAs occurred between 30 days and 90 days.

The study was funded by the Canadian Institutes of Health Research.