Awareness of Stroke Risk after TIA in Swiss General Practitioners and Hospital Physicians.
BACKGROUND
Transient ischemic attacks (TIA) are stroke warning signs and emergency situations, and, if immediately investigated, doctors can intervene to prevent strokes. Nevertheless, many patients delay going to the doctor, and doctors might delay urgently needed investigations and preventative treatments. We set out to determine how much general practitioners (GPs) and hospital physicians (HPs) knew about stroke risk after TIA, and to measure their referral rates.


METHODS
We used a structured questionnaire to ask GPs and HPs in the catchment area of the University Hospital of Bern to estimate a patient's risk of stroke after TIA. We also assessed their referral behavior. We then statistically analysed their reasons for deciding not to immediately refer patients.


RESULTS
Of the 1545 physicians, 40% (614) returned the survey. Of these, 75% (457) overestimated stroke risk within 24 hours, and 40% (245) overestimated risk within 3 months after TIA. Only 9% (53) underestimated stroke risk within 24 hours and 26% (158) underestimated risk within 3 months; 78% (473) of physicians overestimated the amount that carotid endarterectomy reduces stroke risk; 93% (543) would rigorously investigate the cause of a TIA, but only 38% (229) would refer TIA patients for urgent investigations "very often". Physicians most commonly gave these reasons for not making emergency referrals: patient's advanced age; patient's preference; patient was multimorbid; and, patient needed long-term care.


CONCLUSIONS
Although physicians overestimate stroke risk after TIA, their rate of emergency referral is modest, mainly because they tend not to refer multimorbid and elderly patients at the appropriate rate. Since old and frail patients benefit from urgent investigations and treatment after TIA as much as younger patients, future educational campaigns should focus on the importance of emergency evaluations for all TIA patients.
Institute of Primary Health Care BIHAM, University of Bern, Bern, Switzerland.
Sven
S
Streit
Institute of Primary Health Care BIHAM, University of Bern, Bern, Switzerland.
Philippe
P
Baumann
Institute of Complementary and Integrative Medicine, University Hospital Zurich, Zurich, Switzerland.
Jürgen
J
Barth
Department of Neurology, University Hospital Bern, University of Bern, Bern, Switzerland.
Heinrich P
HP
Mattle
Department of Neurology, University Hospital Bern, University of Bern, Bern, Switzerland.
Marcel
M
Arnold
Department of Neurology, University Hospital Bern, University of Bern, Bern, Switzerland.
Claudio L
CL
Bassetti
Institute of Primary Health Care BIHAM, University of Bern, Bern, Switzerland.
Damian N
DN
Meli
Department of Neurology, University Hospital Bern, University of Bern, Bern, Switzerland.
Urs
U
Fischer
D004632:Emergency Medical Services; D005260:Female; D058005:General Practitioners / Q000706:statistics & numerical data*; D007722:Health Knowledge, Attitudes, Practice; D006761:Hospitals; D006801:Humans; D002546:Ischemic Attack, Transient / Q000150:complications*; D008297:Male; D008875:Middle Aged; D012017:Referral and Consultation; D018570:Risk Assessment; D020521:Stroke / Q000150:complications*; D011795:Surveys and Questionnaires; D013557:Switzerland