A follow-up analysis of transient ischemic attack patients suggests unsatisfactory disease management and possible underutilization of carotid endarterectomy in Lazio, Italy.
We evaluated the disease management of transient ischemic attack in patients admitted to Lazio hospitals from July 1997 to June 1998. We assessed the effects of patient characteristics including chronic comorbidities on the use of diagnostic procedures, endarterectomy, and on the risk of adverse cerebrovascular outcome or death. There were 2,608 patients in the study who were followed up over a 18- to 30-month period. Carotid surgery was performed on 1.15% of the subjects, total mortality was 34.7 per 1,000 person-years and adverse cerebrovascular outcome was observed in 38.1 per 1,000 person-years. Chronic comorbidities did affect the mortality rate and the rate of adverse outcome, but not the rate of endarterectomies. Carotid surgery was infrequently performed in study subjects. It seems that this potentially stroke-preventive treatment was not offered to suitable candidates in many instances.
Saitto
Carlo
C
Department of Epidemiology, Local Health Authority RME, Rome, Italy. saitto@asplazio.it
Ancona
Carla
C
Fusco
Danilo
D
Vantaggiato
Giampiero
G
Arcà
Massimo
M
Perucci
Carlo A
CA
D000368:Aged; D015897:Comorbidity; D019468:Disease Management; D016894:Endarterectomy, Carotid / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D002546:Ischemic Attack, Transient / Q000401:mortality* / Q000601:surgery*; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D015996:Survival Rate