Quick Stroke Treatment Improves Outcomes
THURSDAY Feb. 5, 2009 -- Rapid assessment and treatment in a specialist emergency outpatient clinic reduces death, disability, costs and hospital bed-days experienced by patients who suffer a minor stroke or transient ischemic attack (TIA), British researchers report.
The results represent the second part of what is known as the EXPRESS study.
There's an 8 percent to 10 percent risk of recurrent stroke in the first few days after a minor stroke or TIA.
The study compared patients who received treatment at a specialty clinic (phase 2 patients) to those treated at a standard referral appointment-based clinic (phase 1 patients). The first part of the EXPRESS study, reported in October 2007, found that phase 2 patients were 80 percent less likely than phase 1 patients to suffer a recurrent stroke within 90 days.
The second part of the study found that phase 2 patients had a lower 90-day risk of a fatal or disabling stroke -- one of 281 patients (0.3 percent) vs. 16 of 310 (5.1 percent) of phase 1 patients. Phase 2 patients also had fewer hospital admissions (five vs. 25), hospital bed-days (427 vs. 1,365), and lower medical costs.
The study was published online and will appear in the March print issue of The Lancet Neurology.
"In the U.K., most patients with TIA or minor stroke are managed in weekly outpatient clinics after referral by a primary-care physician. This system results in about half of all patients waiting for more than 14 days to be assessed and treated, during which time the risk of recurrent stroke is at its highest," the study authors wrote.
"The EXPRESS study showed that urgent assessment of TIA and minor stroke, in combination with early initiation of preventive treatment, reduced the risk of early recurrent stroke by about 80 percent. This further analysis shows that, for patients referred to the EXPRESS study outpatient clinic, there were also reductions in fatal or disabling recurrent strokes, 90-day hospital bed-days, costs of admission, and overall disability level at six months' follow-up."
These results in the U.K. would mean about 10,000 strokes would be prevented annually. It would also generate savings of 290,000 hospital bed-days and savings of $98 million in acute care costs alone. The reductions in disability rates at six months might also lead to a reduction in the long-term use of the health service in the community.
The U.S. Food and Drug Administration has more about stroke prevention and treatment.
Posted: February 2009
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