Immediate Treatment of TIA or Minor Stroke Reduces Costs and Disability
Specialty outpatient treatment of transient ischemic attack or minor stroke cut the risk of recurrent stroke and reduced hospital admissions, lengths of stay, costs, and disability, researchers here found. Compared with patients receiving more delayed treatment, those who received treatment within 24 hours had a significantly reduced rate of fatal or disabling stroke after 90 days (0.36% versus 5.16%, P=0.0005), Peter Rothwell, M.D., Ph.D., of John Radcliffe Hospital here, and colleagues reported online in The Lancet Neurology.
Urgent treatment reduced hospital admissions for recurrent stroke (1.8% versus 8.1%, P=0.001), number of bed-days due to vascular causes (427 versus 1,365, P=0.016), and mean length of stay (29 versus 11 days, P=0.02).
In addition, a smaller proportion of patients who received immediate care became newly disabled at six months (5.7% versus 10.6%, P=0.031).
Urgent care was associated with an estimated savings of about $890 per patient, which, if extrapolated to the entire population of the U.K., could yield savings of nearly $100 million in acute care costs per year, the researchers said.
"In addition," they said, "the reductions in disability rates at six months might lead to a reduction in the long-term usage of the health service in the community."
The results came from the Early Use of Existing Preventive Strategies for Stroke (EXPRESS) study. In October 2007, Dr. Rothwell and colleagues reported that immediate care following transient ischemic attack or minor stroke reduced the risk of recurrent stroke within 90 days by 80% compared with referral to an appointment-based outpatient clinic.
The current analysis evaluated hospital admissions, associated costs, and new disability after six months.
The EXPRESS study was nested within the Oxford Vascular Study (OXVASC) and evaluated the phased introduction of an urgent-care program.
In the first phase, 310 patients were referred to appointment-based outpatient clinics by their primary care physicians. The clinics then sent treatment recommendations back to the physicians, who issued the prescriptions.
In the second phase, 281 patients were referred to a clinic where they received immediate assessment and treatment.
One-third of the patients were 80 or older and 45% were male.
Time to treatment was 19 days in the first phase and one day in the second (P<0.0001).
Although urgent treatment was associated with lower costs per patient, the researchers did not account for the costs of setting up urgent-care outpatient clinics for patients with transient ischemic attack and minor stroke.
Additional limitations of the study included the fact that patients were not randomized, the potential influence of external biases, and the short time frame for follow-up.
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