Title
Which TIA & minor stroke patients will experience ongoing impairments?
Omolade Onabule Christian Weimar Myzoon Ali on behalf of the VISTA-Plus investigators
Background
Minor stroke refers to an episode where obstruction of the blood supply to the brain causes tissue death in the brain, but symptoms are non-disabling and people experience short-term functional recovery1. Despite having initial clinically mild symptoms, many patients may experience ongoing residual impairments2, 3, and in spite of good functional recovery, ‘hidden’ impairments may affect patients’ quality of life (QoL)4, 5. Minor stroke is also associated with decreased life satisfaction and reduced participation in meaningful activities, such as basic self-care, recreational activities and driving 6, 7. The incidence of minor stroke is rising8. Consequently, there have been calls for further research into the long-term effects of transient ischaemic attacks (TIA) and minor stroke 9. There is a need to address the long term effects of TIA/ minor stroke in a UK setting10. Priority setting work identified and prioritised 11 unanswered research questions relating to the long-term impact of TIA and minor stroke, including, “What is the best way to identify which TIA/ minor stroke patients will experience ongoing impairments?” Aims: We seek to examine the demographic and clinical factors associated with poor long-term outcome following minor stroke in a cohort of registry-based participants.
Methods
Design: Retrospective analyses of registry-based data from the Virtual International Stroke Trials Archive (VISTA-Plus). We will access data on registry participants with minor stroke according to the following definitions: 1) score ≤1 on every National Institutes of Health Stroke Scale (NIHSS) item and normal consciousness or 2) NIHSS ≤31 as being best suited to the definition of “minor stroke.”1 We will extract data on age, sex, baseline NIHSS, medical history, mRS at discharge (where available), mRS at 1 year, length of stay, hyperclycaemia, fever or hypertensive crisis during hospitalisation. Statistical analyses: We will describe people with minor stroke according to the definitions above; continuous variables will be summarised using medians and interquartile ranges; categorical variables will be described using frequencies and percentages. Using regression analyses, we will explore associations between poor functional outcome, defined as a score of ≥3 on the mRS at 1 year and demographic, clinical and medical history variables.
Implications
Our analysis will help to identify subgroups of people, who despite experiencing a mild stroke, achieve a mRS score of ≥3 at 1-year post-stroke. This will increase awareness of the risk factors associated with poor long term outcomes, and inform the development of interventions and support for these populations.
References
1. Fischer U et al. What is a minor stroke? Stroke 41, 661-666. 2010. 2. Moran GM et al. Fatigue, psychological and cognitive impairment following transient ischaemic attack and minor stroke: a systematic review. Eur J Neurol. 21, 1258-1267. 2014. 3. Turner GM, Calvert M, Feltham MG, Ryan R, & Marshall T. Ongoing impairments following transient ischaemic attack: retrospective cohort study. Eur J Neurol. 23, 1642-1650. 2016. 4. Carlsson GE, Moller A, & Blomstrand C. Managing an everyday life of uncertainty-a qualitative study of coping in persons with mild stroke. Disabil Rehabil. 31, 773-782. 2009. 5. Fride Y et al. What are the correlates of cognition and participation to return to work after first ever mild stroke? Top Stroke Rehabil. 22, 317-325. 2015. 6. Spurgeon L, James G, & Sackley C. Subjective experiences of transient ischaemic attack: a repertory grid approach. Disabil Rehabil. 35, 2205-2212. 2013. 7. Carlsson GE, Moller A, & Blomstrand C. Consequences of mild stroke in persons <75 years - a 1-year follow-up. Cerebrovasc Dis 16, 383-388. 2003. 8. Rothwell PM et al. Change in stroke incidence, mortality, case-fatality, severity, and risk factors in Oxfordshire, UK from 1981 to 2004. Lancet 363, 1925-1933. 2004. 9. The Stroke Association. Not just a funny turn: the real impact of TIA. https://www.stroke.org.uk/sites/default/files/sa-the_real_impact_of_tia-report-sp-v5_0.pdf [Last Accessed 05/06/20] . 2018. 10. Turner GM et al. Establishing research priorities relating to the long-term impact of TIA and minor stroke through stakeholder-centred consensus. Research Involvement and Engagement 4[2], DOI 10.1186/s40900-018-0089-z. 2018.
Funding
Funding from is available to support this work as an undergraduate BMedSci project.