Pathway to improved stroke outcomes

In a world-first study researchers at Monash University have shown the risk of stroke after transient ischemic attack (TIA) has significantly declined during the last decade.

Stroke and TIA (also commonly known as a "mini stroke" or a warning of impending stroke) present a significant public health problem worldwide.

According to the Stroke Foundation, 51,000 strokes each year cost the Australian economy around $5 billion - including $3 billion in lost productivity and $1 billion in lost wages.

In research published in Stroke, led by Associate Professor Velandai Srikanth, Head of Stroke and Ageing Research at the School of Clinical Sciences, the population-based cohort study examined nearly 47,000 cases of incident TIA in Victoria.

"These are the first data to demonstrate a yearly decline in the risk of stroke within 90 days after an incident TIA for the last decade," said Associate Professor Srikanth.

The study showed that the declining trend was more likely to be seen in those treated in public hospitals with access to stroke unit care and brain imaging.

Associate Professor Srikanth said the strong decline in stroke risk after 90 days in such settings suggested an important effect of organised acute care post TIA and possibly better secondary prevention.

"The increased use of brain imaging over time and better organisation of rapid TIA management has resulted in higher rates of early use of antiplatelet therapy and carotid artery investigations," he said.

"Rapid treatment pathways, most likely instituted in hospitals with organised stroke units, have resulted in lower rates of stroke after TIA."

Associate Professor Srikanth said Monash Health had led the way in instituting such a pathway in Australia.

Several preventative interventions for cardiovascular disease over the last 20 years may have also positively impacted on the risk of stroke after a TIA, he said. These included the use of antiplatelet, blood pressure and lipid-lowering agents as well as lifestyle programs for smoking and obesity.