Contemporary Epidemiology of Transient Ischemic Attack in Dijon, France (2013–2015)

Abstract

Background: We aimed to evaluate the epidemiological features of transient ischemic attack (TIA). Methods: All TIAs were prospectively collected in Dijon, France, using a population-based registry (2013–2015). TIAs were considered the first-ever in patients who had no previous cerebrovascular events (CVEs); otherwise they were considered recurrent TIAs. Annual incidence (first-ever TIAs) and attack rates (first-ever and recurrent TIAs) were calculated. Results: Four hundred twenty TIAs were registered (255 first-ever and 165 recurrent TIAs, mean age: 74.1 ± 15.7 years). The age-standardized incidence rate (to the 2013 European population) was 61 (95% CI 46–76) and the attack rate was 81 (95% CI 64–99) per 100,000/year. Patients with TIA as a recurrent event had a greater prevalence of risk factors and preventive treatments. However, one third of them were not receiving antithrombotic agents or antihypertensive treatments, and half were not treated with statins at the time of their recurrence. The mean ABCD² score was 4.3 ± 1.3, and 72% of patients had a high risk of recurrence (score ≥4). In patients with available MRI (23%), an infarct lesion was seen in 15.5%. Conclusions: TIA is a frequent occurrence and a large proportion of patients have a high risk of recurrence, thus highlighting the need to establish dedicated emergency services to administer prompt secondary prevention.

Transient ischemic attack: Incidence and early risk of stroke in northern Portugal from 1998–2000 to 2009–2011

“…This rise in men compared to women is particularly noticed in those under 65 years. The lower risk of TIA among women aged 55-64 years compared to men of same age is observed in other community-based studies undertaken during the 2000s [1][2][3][4][5][6][7][8][9][10] with available data ( Figure 2) and can be justified by the pre-menopausal gender protection effect conjugated with a more likely diagnosis of TIA mimics. A significant male/female odds ratio was previously reported by Warlow, 16 with high disparities in risk found among those aged 55-75 years, while in our study it is found in the youngest.…”

“…Even with these restrictions, we decided to analyze changes over time, contrary to other communitybased studies describing separately a ''contemporary TIA profile,'' but with a substantially increase in incidence and different inclusion criteria. 9,10 Despite the contribution of better medical knowledge and population awareness to a predictable increase in incidence, improvements of primary and secondary prevention balanced this trend, contributing to a relative stability in incidence and stroke risk. The exhaustive data collection process including all transient focal symptoms/signs allowed us to include in both periods a wider range of cases mirroring the whole spectrum of disease, a probable source of differential bias in other studies.…”

“…In recent years, several community-based studies on transient ischemic attacks (TIAs) incidence and prognosis have been published [1][2][3][4][5][6][7][8][9][10] ; however, few data about trends over time are available. 9,[11][12][13] Contrasting to a declining stroke incidence in high-income countries, 14 there is no clear time trend in TIA incidence, although slight increases were reported in most population-based studies.…”

Updated Criteria for Population-Based Stroke and Transient Ischemic Attack Incidence Studies for the 21st Century

“…Additionally, adjudication of potential TIA events in a community setting is particularly challenging because of TIA mimics and hospitalisation bias. 24,25 However, there are already a few population-based studies in which both stroke and TIA were ascertained and registered at the same time in the same study population, [26][27][28][29][30][31] thus providing support for the feasibility of such joint stroke and TIA incidence studies in different populations.…”

Incidence and Outcomes of Acute Cerebrovascular Events: Methodology of the Population-Based Normandy Stroke Study

“…A previous study in the Dijon registry has shown that the rate of hospitalization among patients with a stroke in France is above 95% [48]. This rate is much lower among TIA patients and a recent epidemiological study, almost 20% of all cases were identified solely among one nonhospital source [49] . However, there is no well-organized out stroke clinic with easy access to imaging and cardiac investigations in our area, which may be in competition with the traditional hospital system.…”