Functional status and use of healthcare facilities in long-term survivors of transient ischaemic attack or minor ischaemic stroke

Abstract

Background: Stroke may have a major effect on survivors and on the healthcare system. Aims: To study the functional status and use of healthcare facilities in long-term survivors of a transient ischaemic attack (TIA) or minor ischaemic stroke (MIS) and evaluate associations with baseline and followup characteristics. Methods: Follow-up of patients who had participated in the Dutch TIA Trial or the European Atrial Fibrillation Trial was extended to a mean period of 15.6 years. Patients were interviewed through a postal questionnaire (n = 468) and a sample of this group was also interviewed at home (n = 198). Demographic data, information on comorbidity, functional status (Barthel Index, Frenchay Activities Index and modified Rankin Scale) and use of healthcare facilities were recorded. Results: About one third of the survivors interviewed at home experienced any residual disability and 26% were moderately to severely handicapped. Factors associated with poor functional status were advanced age and the presence of any infarct on a baseline computed tomography scan, the recurrence of a new major stroke or the presence of comorbidity of locomotion. One third of survivors used any kind of professional care, which was predominantly related to the functional status at follow-up. Conclusions: Recurrent stroke and the presence of comorbidity of locomotion are important determinants of long-term disability of survivors of a TIA or an MIS, which, in turn, is strongly associated with the longterm use of professional care. The need for measuring comorbidity with regard to functional status is recommended in research on stroke outcome.

Clinical Types and Outcome of Minor Ischemic Stroke in Northern China: A Retrospective Cohort Study

“…However, we have confirmed that overall survival rate in patients with MIS in the out-patient clinic during the follow-up period of 6 months is favorable (99.2%). Our view is consistent with more studies reported survival of MIS [3] [10]. Although there are one to two reports described poor survival [26] [27], we still believe that the survival status in patients with MIS have a favorable trends.…”

“…In such studies, small stroke or lacunar stroke was usually considered favorable short-term outcome and having had a very low NIHSS score, so this is why it is considered a MIS [3] [4]. In fact, it has been shown that MIS may also result from atheromatous stenosis or occlusion of larger arteries [4] [5] [6], in which the presence of one or more lesions may be associated with a rapidly progressive deficit [7] [8] [9], or even carry a worse prognosis [9] [10]. Thus, MIS has become a common concern public health problem.…”

Subtle Problems in Activities of Daily Living after a Transient Ischemic Attack or an Apparently Fully Recovered Non-disabling Stroke

“…[3][4][5][6][7][8][9] Studies have found that 60%-70% of patients with mild or moderate stroke develop depression, experience decreased QoL, and have impaired recovery. [10][11][12][13][14] However, less is known about the decreases in performance of activities of daily living (ADL) or experienced QoL after a TIA or an NDS. Patients who have suffered a TIA or an NDS do not receive rehabilitation treatment or special care, because they are assumed to be fully recovered and functioning at the same level as before the event.…”

Quantifying the Contribution of Risk Factors for Ischemic Stroke in Patients with a History of TIA

“…However, greater focus on postacute care may provide the best opportunity to reduce stroke rates in TIA patients. Several studies have suggested that patient management after hospitalization for cerebrovascular events is critically important in reducing the rates of readmission and recurrence of secondary cerebrovascular events [21][22][23][24][25]. However, postacute management is typically not as aggressively applied to TIA patients as it is to stroke patients.…”