title: Management, prognosis and predictors of unfavourable outcomes in patients newly hospitalized for transient ischemic attack: a real-world investigation from Italy.
abstract: BACKGROUND
  Understanding the gap between evidence-based recommendations and real-world management is important to inform priority setting and health service planning.
  
  
  METHODS
  The 7,776 residents in the Italian Lombardy Region who were newly hospitalized for transient ischemic attack (TIA) during 2008-2009 entered into the cohort and were followed until 2012. Exposure to medical care including selected drugs, diagnostic procedures and laboratory tests was recorded. A composite outcome was employed taking into account all-cause death and hospitalization for stroke and acute myocardial infarction. A multivariable proportional hazards model was fitted to estimate hazard ratio, and 95% confidence intervals (CI), for the exposure-outcome association.
  
  
  RESULTS
  During the first year after discharge, 8.6, 49.7 and 48.5% of patients did not use any drugs, diagnostic procedures and laboratory tests respectively. Patients exposed to medical care had 59% reduced risk (95% CI, 50 to 66%) with respect to those who did not use any of these services.
  
  
  CONCLUSIONS
  Although the Italian National Health System supplies universal coverage for healthcare, several TIA patients receive suboptimal care. Systematic improvements are necessary in order to improve patient outcomes.
authors.affiliation: Laboratory of Healthcare Research & Pharmacoepidemiology, Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy. giovanni.corrao@unimib.it.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Corrao
authors.affiliation: Laboratory of Healthcare Research & Pharmacoepidemiology, Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Rea
authors.affiliation: Operative Unit of Territorial Health Services, Lombardy Region, Milan, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Merlino
authors.affiliation: Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Mazzola
authors.affiliation: Department of Pathophysiology and Transplantation, University of Milano, Milan, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Annoni
authors.affiliation: Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.|Geriatric Unit, San Gerardo University Hospital, Monza, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Annoni
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019468:Disease Management; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002546:Ischemic Attack, Transient / Q000175:diagnosis / Q000453:epidemiology / Q000401:mortality / Q000628:therapy; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009313:National Health Programs / Q000592:standards / Q000706:statistics & numerical data*; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D011379:Prognosis; D055815:Young Adult
keywords: Acute myocardial infarction; Healthcare utilization database; Mortality; Population-based cohort study; Stroke; Transient ischemic attack