One-Year Risk of Stroke After Transient Ischemic Attack or Minor Stroke in Hunter New England, Australia (INSIST Study)

aut.relation.journalFrontiers in Neurologyen_NZ
aut.researcherDrabsch, Julie
dc.contributor.authorTomari, Sen_NZ
dc.contributor.authorLevi, CRen_NZ
dc.contributor.authorHolliday, Een_NZ
dc.contributor.authorLasserson, Den_NZ
dc.contributor.authorValderas, JMen_NZ
dc.contributor.authorDewey, HMen_NZ
dc.contributor.authorBarber, PAen_NZ
dc.contributor.authorSpratt, NJen_NZ
dc.contributor.authorCadilhac, DAen_NZ
dc.contributor.authorFeigin, VLen_NZ
dc.contributor.authorRothwell, PMen_NZ
dc.contributor.authorZareie, Hen_NZ
dc.contributor.authorGarcia-Esperon, Cen_NZ
dc.contributor.authorDavey, Aen_NZ
dc.contributor.authorNajib, Nen_NZ
dc.contributor.authorSales, Men_NZ
dc.contributor.authorMagin, Pen_NZ
dc.description.abstractBackground: One-year risk of stroke in transient ischemic attack and minor stroke (TIAMS) managed in secondary care settings has been reported as 5-8%. However, evidence for the outcomes of TIAMS in community care settings is limited. Methods: The INternational comparison of Systems of care and patient outcomes In minor Stroke and TIA (INSIST) study was a prospective inception cohort community-based study of patients of 16 general practices in the Hunter-Manning region (New South Wales, Australia). Possible-TIAMS patients were recruited from 2012 to 2016 and followed-up for 12 months post-index event. Adjudication as TIAMS or TIAMS-mimics was by an expert panel. We established 7-days, 90-days, and 1-year risk of stroke, TIA, myocardial infarction (MI), coronary or carotid revascularization procedure and death; and medications use at 24 h post-index event. Results: Of 613 participants (mean age; 70 ± 12 years), 298 (49%) were adjudicated as TIAMS. TIAMS-group participants had ischemic strokes at 7-days, 90-days, and 1-year, at Kaplan-Meier (KM) rates of 1% (95% confidence interval; 0.3, 3.1), 2.1% (0.9, 4.6), and 3.2% (1.7, 6.1), respectively, compared to 0.3, 0.3, and 0.6% of TIAMS-mimic-group participants. At one year, TIAMS-group-participants had twenty-five TIA events (KM rate: 8.8%), two MI events (0.6%), four coronary revascularizations (1.5%), eleven carotid revascularizations (3.9%), and three deaths (1.1%), compared to 1.6, 0.6, 1.0, 0.3, and 0.6% of TIAMS-mimic-group participants. Of 167 TIAMS-group participants who commenced or received enhanced therapies, 95 (57%) were treated within 24 h post-index event. For TIAMS-group participants who commenced or received enhanced therapies, time from symptom onset to treatment was median 9.5 h [IQR 1.8-89.9]. Conclusion: One-year risk of stroke in TIAMS participants was lower than reported in previous studies. Early implementation of antiplatelet/anticoagulant therapies may have contributed to the low stroke recurrence.en_NZ
dc.identifier.citationFrontiers in Neurology 12:791193. doi: 10.3389/fneur.2021.791193
dc.publisherFrontiers Mediaen_NZ
dc.rights© 2021 Tomari, Levi, Holliday, Lasserson, Valderas, Dewey, Barber, Spratt, Cadilhac, Feigin, Rothwell, Zareie, Garcia-Esperon, Davey, Najib, Sales and Magin. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
dc.subjectCommunity-based studyen_NZ
dc.subjectMinor strokeen_NZ
dc.subjectOne-year risk of ischemic strokeen_NZ
dc.subjectStroke-mimic syndromeen_NZ
dc.subjectTransient ischemic attacken_NZ
dc.titleOne-Year Risk of Stroke After Transient Ischemic Attack or Minor Stroke in Hunter New England, Australia (INSIST Study)en_NZ
dc.typeJournal Article
pubs.organisational-data/AUT/Faculty of Health & Environmental Science
pubs.organisational-data/AUT/PBRF/PBRF Health and Environmental Sciences
pubs.organisational-data/AUT/PBRF/PBRF Health and Environmental Sciences/HY Public Health & Psychosocial Studies 2018 PBRF
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