Better outcomes for hospitalized patients with TIA when in stroke units

Dominique A. Cadilhac, Joosup Kim, Natasha A. Lannin, Christopher R. Levi, Helen M. Dewey, Kelvin Hill, Steven Faux, Nadine E. Andrew, Monique F. Kilkenny, Rohan Grimley, Amanda G. Thrift, Brenda Grabsch, Sandy Middleton, Craig S. Anderson, Geoffrey A. Donnan, James Hughes, Martin Jude, Fiona Ryan, Melissa Gill, Geoffrey Herkes, Andrew Wong, Noel Saines, Richard Geraghty, Pradeep Bambery, Christopher Staples, Amanda Siller, Richard White, Arman Sabet, Eva Salud, Martin Dunlop, Nisal Gange, Paula Easton, Graham Mahaffey, Graham Hall, Carolyn De Wytt, Sean Butler, Paul Laird, Karen Hines, David Douglas, M Admin, Suzana Milosevic, Joel Iedema, Stephen Read, Francis Hishon, David Blacker, Tim Bates, Helen Castley, Mark Mackay, Christopher Bladin, Ernie Butler, Peter O’Brien, Douglas Crompton, Sharan Ermel, Michael Pollack, Frances Simmonds, Julie Bernhardt, Erin Lalor, John McNeil, Mark Simcocks, Andrew Lee, Richard Lindley, Greg Cadigan, Peter Hand, Andrew Evans, Andrew Wesseldine, Susan Hillier

To investigate differences in management and outcomes for patients admitted to the hospital with TIA according to care on a stroke unit (SU) or alternate ward setting up to 180 days post event. TIA admissions from 40 hospitals participating in the Australian Stroke Clinical Registry during 2010-2013 were assessed. Propensity score matching was used to assess outcomes by treatment group including Cox proportional hazards regression to compare survival differences and other appropriate multivariable regression models for outcomes including health-related quality of life and readmissions. Among 3,007 patients with TIA (mean age 73 years, 54% male), 1,110 pairs could be matched. Compared to management elsewhere in hospitals, management in an SU was associated with improved cumulative survival at 180 days post event (hazard ratio 0.57, 95% confidence interval 0.35-0.94; p = 0.029), despite not being statistically significant at 90 days (hazard ratio 0.66, 95% confidence interval 0.33-1.31; p = 0.237). Overall, there were no differences for being discharged on antihypertensive medication or with a care plan, and the 90- to 180-day self-reported outcomes between these groups were similar. In subgroup analyses of 461 matched pairs treated in hospitals in one Australian state (Queensland), patients treated in an SU were more often prescribed aspirin within 48 hours (73% vs 62%, p < 0.001) and discharged on antithrombotic medications (84% vs 71%, p < 0.001) than those not treated in an SU. Hospitalized patients with TIA managed in SUs had better survival at 180 days than those treated in alternate wards, potentially through better management, but further research is needed.