Article

Characteristics of patients hospitalized for transient ischemic
attack (TIA) management before and during this hospitalization and follow-up are
not well documented on very large populations. METHODS: Among the 51 million
beneficiaries of the French national health insurance general scheme (77% of
French population), those subjects hospitalized for a first TIA in 2010 were
included using the national health insurance information system (SNIIRAM). The
frequencies of comorbidities during the previous five years and drug treatments
received during the previous year and the first month after discharge were
estimated from the SNIIRAM and then compared to data derived from the permanent
randomized sample of all health insurance beneficiaries based on standardized
morbidity ratios (SMR). The three-year outcome and factors associated with at
least one readmission for TIA or ischemic stroke during the three months
following the first hospitalization were investigated. RESULTS: A total of 18,181
patients were included (mean age: 69 years, 55% of women). The crude incidence of
hospitalized TIA was 0.36 per 1000. Before hospitalization, patients presented a
significantly higher rate of carotid and cerebral atherosclerosis (2.4% SMR=1.4),
atrial fibrillation (9.1%, SMR=1.3), ischemic heart disease (13.7%, SMR=1.3),
valvular heart disease (9.7%, SMR=1.5), and treatment with platelet aggregation
inhibitors (29%, SMR=1.4), antihypertensives (60%, SMR=1.2) and antidiabetics
(16%, SMR=1.5). These SMR decreased with age. One month after discharge from
hospital, 82% of patients still alive filled at least one prescription for
antithrombotic therapy (platelet aggregation inhibitor : 74%, vitamin K
antagonist: 12%), one class of antihypertensive in 57% of patients, an
antiarrhythmic in 9% of patients, an antidiabetic treatment in 14% of patients
and a lipid-lowering agent in 53%. During the month following discharge from
hospital, 3.2% of patients were readmitted at least once for TIA, 1.9% were
readmitted for ischemic stroke and 1.5% of patients died. These figures were
3.9%, 2.4% and 2.9% at three months, and 7.2%, 5% and 16.3% at three years,
respectively. On multivariate analysis, factors associated with readmission for
TIA or ischemic stroke were age >/= 65 years and antidiabetic treatment before
hospitalization. In contrast, male gender, admission to a stroke unit and length
of stay were associated with a lower readmission rate. CONCLUSIONS: These results
illustrate the value of administrative databases to study TIA. Hospitalizations
for TIA were relatively frequent and the recurrence rate was similar to that
reported in similar recent studies. Level of primary and secondary prevention
must be improved.
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