What percentage of patients with minor transient ischemic attack (TIA) or minor ischemic stroke require follow-up by family medicine in the acute phase?

From the Guidelines

All patients with minor stroke should be followed up by family medicine in the acute phase, which is 100%. After initial emergency assessment and treatment, patients with minor stroke require prompt follow-up care by their family physician, typically within 24-48 hours of discharge or diagnosis. This follow-up is essential for monitoring neurological status, managing risk factors, adjusting medications, addressing complications, and coordinating rehabilitation services. Family physicians play a crucial role in the continuity of care by ensuring adherence to secondary prevention strategies, monitoring for post-stroke depression, and addressing functional limitations, as recommended by the American Heart Association/American Stroke Association 1. They also serve as the central coordinator for the multidisciplinary stroke care team, which may include neurologists, physical therapists, occupational therapists, and other specialists. Early and consistent follow-up by family medicine has been shown to improve outcomes and reduce the risk of recurrent stroke. According to the American Heart Association/American Stroke Association, primary care clinicians should establish the foundation for care, including understanding the patient's experience, classifying the pathogenesis of the stroke, and identifying precursors that may have contributed to the stroke 1.

Some key aspects of follow-up care include:

• Monitoring neurological status and managing risk factors, such as hypertension, diabetes, and hyperlipidemia 1
• Adjusting medications, including antithrombotic therapy, statins, and antihypertensive medications 1
• Addressing complications, such as post-stroke depression and functional limitations 1
• Coordinating rehabilitation services, including physical, occupational, and speech therapy 1
• Ensuring adherence to secondary prevention strategies, including lifestyle modifications and medication adherence 1

By providing prompt and comprehensive follow-up care, family physicians can improve outcomes and reduce the risk of recurrent stroke in patients with minor stroke.

From the Research

Percentage of Patients with Minor Stroke Requiring Follow-up

• The provided studies do not directly address the percentage of patients with minor stroke who require follow-up by family medicine in the acute phase of the stroke 2, 3, 4, 5, 6.
• However, the studies suggest that patients with minor stroke may still be at risk of poor outcomes, such as recurrent ischemic events or disability, and may benefit from timely and appropriate treatment 2, 3, 5, 6.
• The studies also highlight the importance of individualized treatment approaches, taking into account the patient's specific characteristics, such as age, comorbidities, and stroke severity 2, 3, 5.
• Additionally, the studies emphasize the need for early recognition and treatment of minor stroke, as well as the importance of secondary prevention strategies to reduce the risk of recurrent events 2, 3, 5, 6.

Factors Influencing Outcome in Minor Stroke

• Age and baseline NIHSS score are independent predictors of poor outcome in patients with minor stroke 6.
• Motor impairment, particularly impairment of the right motor arm, is also a major determinant of poor outcome 6.
• Cardioembolic aetiology is negatively associated with poor outcome, suggesting that patients with this type of stroke may have a better prognosis 6.

Treatment Approaches for Minor Stroke

• Dual antiplatelet therapy with aspirin and clopidogrel may be effective in reducing the risk of recurrent ischemic events in patients with minor stroke 2, 3, 5.
• Thrombolysis, such as with rt-PA, may also be considered in patients with minor stroke, particularly those with disabling symptoms or high-risk features 3, 6.
• The choice of treatment approach should be individualized based on the patient's specific characteristics and needs 2, 3, 5.