title: Absolute cardiovascular risk and GP decision making in TIA and minor stroke.
abstract: BACKGROUND
  Transient ischaemic attacks (TIA) and minor strokes (TIAMS) have the same pathophysiological mechanism as stroke and carry a high risk of recurrent ischaemic events. Diagnosis of TIAMS can be challenging and often occurs in general practice. Absolute cardiovascular risk (ACVR) is recommended as the basis for vascular risk management. Consideration of cardiovascular risk in TIAMS diagnosis has been recommended but its utility is not established.
  
  
  OBJECTIVE
  Firstly, to document the ACVR of patients with incident TIAMS and with TIAMS-mimics. Secondly, to evaluate the utility of ACVR calculation in informing the initial diagnosis of TIAMS.
  
  
  METHODS
  The International comparison of Systems of care and patient outcomes in minor Stroke and TIA (InSiST) study is an inception cohort study of patients of 17 Australian general practices presenting as possible TIAMS. An expert panel determines whether participants have had TIAMS or TIAMS-mimics. ACVR was calculated at baseline for each participating patient. In this cross-sectional baseline analysis, ACVR of TIAMS and TIAMS-mimics were compared univariately and, also, when adjusted for age and sex. The diagnostic utility of ACVR was evaluated via receiver operating characteristic (ROC) curves.
  
  
  RESULTS
  Of 179 participants, 87 were adjudicated as TIAMS. The presence of motor and speech symptoms and body mass index were associated with a diagnosis of TIAMS. ACVR was associated with TIAMS diagnosis on univariate analysis, but not when age- and sex-adjusted. ACVR did not significantly improve area under ROC curves beyond that of age and sex.
  
  
  CONCLUSIONS
  In patients presenting with transient or minor neurological symptoms, calculation of ACVR did not improve diagnostic accuracy for TIAMS beyond that of age and sex.
authors.affiliation: Discipline of General Practice, University of Newcastle, Newcastle, Australia.
authors.forename: Jamie
authors.initials: J
authors.lastname: Clarey
authors.affiliation: Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
authors.forename: Daniel
authors.initials: D
authors.lastname: Lasserson
authors.affiliation: Centre for Translational Neuroscience, University of Newcastle, Newcastle, Department of Neurology, John Hunter Hospital, Newcastle.
authors.forename: Christopher
authors.initials: C
authors.lastname: Levi
authors.affiliation: Department of Neurology, John Hunter Hospital, Newcastle, School of Medicine and Public Health, University of Newcastle, Newcastle.
authors.forename: Mark
authors.initials: M
authors.lastname: Parsons
authors.affiliation: Department of Medicine - Austin Health, University of Melbourne, Melbourne, Australia.
authors.forename: Helen
authors.initials: H
authors.lastname: Dewey
authors.affiliation: Centre for Brain Research Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand and.
authors.forename: P Alan
authors.initials: PA
authors.lastname: Barber
authors.affiliation: School of Medicine and Public Health, University of Newcastle, Newcastle.
authors.forename: Debbie
authors.initials: D
authors.lastname: Quain
authors.affiliation: School of Medicine and Public Health, University of Newcastle, Newcastle.
authors.forename: Patrick
authors.initials: P
authors.lastname: McElduff
authors.affiliation: General Practice Training valley to coast, Newcastle, Australia.
authors.forename: Milton
authors.initials: M
authors.lastname: Sales
authors.affiliation: Discipline of General Practice, University of Newcastle, Newcastle, Australia, Centre for Translational Neuroscience, University of Newcastle, Newcastle, General Practice Training valley to coast, Newcastle, Australia. parker.magin@newcastle.edu.au.
authors.forename: Parker
authors.initials: P
authors.lastname: Magin
mesh_terms: D000368:Aged; D001315:Australia; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000150:complications; D003430:Cross-Sectional Studies; D048909:Diabetes Complications; D003937:Diagnosis, Differential; D005260:Female; D058006:General Practice / Q000379:methods*; D006801:Humans; D006949:Hyperlipidemias / Q000150:complications; D007407:Interviews as Topic; D002546:Ischemic Attack, Transient / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology*; D008297:Male; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects; D020521:Stroke / Q000209:etiology / Q000503:physiopathology*; D013997:Time Factors
keywords: Cardiovascular diseases; diagnosis; family practice; risk assessment; stroke; transient ischaemic attack.