Effects of a Province-wide Triaging System for TIA: The ASPIRE Intervention

Area of Science:

• Health Services Research
• Neurology
• Public Health Interventions

Background:

• Transient ischemic attack (TIA) management is crucial for preventing stroke recurrence, especially in remote areas.
• Previous data from Alberta indicated high stroke recurrence rates (9.5%) within 90 days post-TIA.
• An organized stroke system in Alberta aimed to improve TIA care.

Purpose of the Study:

• To evaluate the effectiveness of a multifaceted, population-based intervention on reducing recurrent stroke after TIA.
• To assess the impact of the Alberta Stroke Prevention in TIA and mild Strokes (ASPIRE) program on stroke recurrence and other adverse outcomes.

Main Methods:

• A quasi-experimental study using a TIA management algorithm and a 24-hour physician hotline.
• Data linkage of administrative databases (emergency department and hospital discharge abstracts) to identify TIAs and recurrent strokes.
• Interrupted time series regression analysis of age- and sex-adjusted recurrent stroke rates before and after the intervention.

Main Results:

• The 90-day stroke recurrence rate was 4.5% pre-intervention and 5.3% post-intervention.
• The ASPIRE intervention showed no statistically significant reduction in recurrent stroke rates (step or slope change).
• A significant reduction in all-cause mortality was observed post-intervention (OR 0.71, 95% CI 0.56-0.89).

Conclusions:

• The ASPIRE TIA management intervention did not reduce stroke recurrence rates within an established stroke system.
• The observed decrease in mortality may be linked to enhanced surveillance but could also be influenced by secular trends.
• Class III evidence suggests standardized algorithmic triage for TIA does not decrease recurrent stroke rates.