title: Transient ischaemic attacks clinics provide equivalent and more efficient care than early in-hospital assessment.
abstract: OBJECTIVE
  Clinics for early management of transient ischaemic attacks (TIAs) have been developed in some stroke centres, resulting in reduced recurrence rates compared to appointment-based outpatient management, thus saving on hospitalization. We analysed the care process, recurrence rates and economic impact of the first year of work in our early-management TIA clinic and compared these with our previous in-hospital study protocols for low- and moderate-risk TIA patients.
  
  
  METHODS
  This was a prospective evaluation of the management of low- to moderate-risk TIA patients, comparing a new TIA clinic model (2010) with a previous hospitalization model (2009). Demographic data, vascular risk factor profiles, diagnostic test performance, secondary prevention measures, final aetiological diagnoses and cerebrovascular recurrences at 7 and 90 days were compared between in-hospital and TIA clinic assessed patients. We also carried out an economic comparison of the costs of each model's process.
  
  
  RESULTS
  Two hundred and eleven low- to moderate-risk TIA patients were included, of whom 40.8% were hospitalized. There were no differences between the TIA clinic assessed and in-hospital assessed patients in terms of risk factor diagnosis and secondary prevention measures. The stroke recurrence rate (2.4% vs. 1.2%; P = 0.65) was low and similar for both groups (CI 95%, 0.214-20.436; P = 0.52). Cost per patient was €393.28 for clinic versus €1931.18 for in-hospital management. Outpatient management resulted in a 77.8% reduction in hospitalizations.
  
  
  CONCLUSIONS
  Transient ischaemic attacks clinics are efficient for the early management of low- to moderate-risk TIA patients compared to in-hospital assessment, with no higher recurrence rates and at almost one-fifth the cost.
authors.affiliation: Department of Neurology and Stroke Centre, La Paz University Hospital, IdiPAZ Health Research Institute, Autónoma University of Madrid, Madrid, Spain.
authors.forename: M M
authors.initials: MM
authors.lastname: Martínez-Martínez
authors.forename: P
authors.initials: P
authors.lastname: Martínez-Sánchez
authors.forename: B
authors.initials: B
authors.lastname: Fuentes
authors.forename: R
authors.initials: R
authors.lastname: Cazorla-García
authors.forename: G
authors.initials: G
authors.lastname: Ruiz-Ares
authors.forename: E
authors.initials: E
authors.lastname: Correas-Callero
authors.forename: M
authors.initials: M
authors.lastname: Lara-Lara
authors.forename: E
authors.initials: E
authors.lastname: Díez-Tejedor
mesh_terms: D000368:Aged; D000554:Ambulatory Care Facilities / Q000191:economics; D019468:Disease Management; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D002546:Ischemic Attack, Transient / Q000150:complications / Q000175:diagnosis / Q000191:economics / Q000517:prevention & control* / Q000628:therapy*; D008297:Male; D010043:Outcome and Process Assessment, Health Care / Q000191:economics; D011446:Prospective Studies; D012307:Risk Factors; D055502:Secondary Prevention / Q000191:economics / Q000706:statistics & numerical data; D020521:Stroke / Q000150:complications / Q000191:economics / Q000517:prevention & control* / Q000628:therapy