[CVA and TIA in family practice. Incidence and perspectives]

Although the Cerebro-Vascular Accident (CVA) and the Transient Ischaemic Attack (TIA) are relatively rare in general practice, they subjectively demand great attention because of their specific problems. To get a picture of for example their incidence in the general population and referral patterns in general practice, we collected and analysed the data from a (continuing) morbidity registration over 12 years in four general practices (Department of General Practice/Family Medicine University Nijmegen). The diseases occur mainly over age 50. The incidence of CVA is slightly higher than the incidence of TIA. The incidence of the diseases over the two sexes is practically equal. Because of the overpresentation of older women in the general population, more women than men present these diseases. Male patients are younger than female. Only a part of the patients has been referred or admitted to hospital. The referral depends on age of the patient: The older the patient the lower the referral-rate. The case-fatality of CVA is about 25%. Patients who die within a month, usually die in hospital. When patients survive this period, they die more often at home than in a nursing home. Patients who die in a nursing home, are more often male than female. In older age groups a CVA means more often than not the end of life. In our view a referral is often not in the interest of the patient. If a patient stays at home, the GP has to create a team with family members, a district nurse or a physiotherapist in order to offer the patients optimal medical and psychosocial attendance care.