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Title: Missed opportunities for primary prevention of stroke and transient ischaemic attack (TIA) and residual impairments after TIA
Author: Turner, Grace Mary
ISNI:       0000 0004 5372 028X
Awarding Body: University of Birmingham
Current Institution: University of Birmingham
Date of Award: 2016
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The research investigated: (i) potential missed opportunities for primary prevention of stroke and transient ischaemic attack (TIA) with pharmacotherapy through a retrospective case series analysis and (ii) fatigue, psychological and cognitive impairment following TIA through a systematic review and retrospective cohort study. The case series and cohort studies used electronic primary care medical records from The Health Improvement Network (THIN). The case series analysis found preventative drugs were under prescribed to people with clinical indications for these drugs prior to stroke or TIA. There were potential missed opportunities for prevention in 49% (7,836/16,028) of people with stroke or TIA who were eligible for lipid lowering drugs, 52% (1,647/3,194) for anticoagulant drugs and 25% (1,740/7,008) for antihypertensive drugs. Improving prescription of these drugs has the potential to reduce the incidence and subsequent burden of stroke and TIA. The systematic review revealed there were few high quality studies investigating residual impairments in people with TIA and minor stroke; however, there was limited evidence to suggest a relatively high prevalence of cognitive impairment and depression post-TIA and minor stroke. The retrospective cohort study found that TIA patients were significantly more likely to consult in primary care for fatigue, psychological and cognitive impairment compared to matched controls. This association remained when adjusted for the potential confounding variables and the presence of the impairment prior to TIA. These findings suggest that impairments exist after initial symptoms of TIA have resolved and challenge the ‘transient’ characterisation of TIA. Residual impairments should be considered by primary care clinicians when treating patients following TIA.
Supervisor: Not available Sponsor: National Institute for Health Research (NIHR) ; School for Primary Care Research (SPCR), University of Birmingham
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available
Keywords: RA0421 Public health. Hygiene. Preventive Medicine