Many patients don't know they had minor stroke, need emergency care

Many studies have focused on patients' responses to major strokes, but few have examined patients' awareness of minor strokes. So researchers studied patients' behaviors and attitudes and found the participants frequently failed to recognize when they were having a minor stroke and therefore failed to seek immediate medical care.

Surprisingly, people of all demographics -- regardless of age, gender, education and socioeconomic status -- showed an overall lack of awareness about how to recognize a stroke, said Arvind Chandratheva, a clinical research fellow in the Stroke Prevention Research Unit in the Department of Clinical Neurology at the University of Oxford in the United Kingdom.

In the study, researchers analyzed 1,000 patients in the United Kingdom (average age 73), of whom 459 had transient ischemic attacks (TIAs) and 541 suffered a minor stroke.

Minor stroke was defined as minimal deficits based on the NIH Stroke scale assessing consciousness, vision, sensation, movement, speech and language. TIA, sometimes known as a "mini stroke," occurs when a blood clot temporarily clogs an artery and blocks blood flow to the brain. TIAs and minor strokes don't typically cause permanent harm, but early treatment is critical to prevent the possibility of a stroke with permanent neurological deficits.

Researchers, investigating factors that cause delays in seeking timely treatment, found that:

• Sixty-eight percent of TIA patients and 69 percent of minor stroke patients didn't know the cause of their symptoms.
• Only 47 percent of TIA patients and 46 percent of minor stroke patients sought medical attention within three hours -- when a clot-busting drug is approved to treat some strokes.
• Sixty-seven percent of TIA patients and 74 percent of minor stroke patients sought medical attention within 24 hours. TIA patients who didn't correctly recognize their symptoms were less likely to call emergency services.
• Seventy-seven percent of patients went to their primary care physicians first instead of seeking emergency medical care.
• Thirty percent of patients experiencing a recurrent stroke didn't seek timely medical attention.

These figures "indicate a lack of public awareness that TIA is a medical emergency," Chandratheva said.

TIA patients were more likely to delay seeking medical care if their motor or speech function were normal, if symptoms didn't last long, or if they experienced symptoms on a Friday, a weekend or a holiday, researchers said. The findings suggest a need for more public education, researchers said.

"There has been very little sustained public education, but for a prolonged impact, sustained national campaigns are required," Chandratheva said.

Stroke is the No. 3 killer and a leading cause of long-term severe disability in the United States, according to American Heart Association statistics. About 15 percent of strokes are preceded by a TIA, which is a strong predictor of being at risk for a major stroke. In the United States, where awareness about minor stroke is also low, TIA can affect up to a half million people. Because many study participants went to their primary care physicians first, the researchers said that primary care physicians can play an active role in educating patients about the signs of TIA.

"Primary care physicians have to have the systems in place to refer high-risk TIA patients directly to dedicated hospital TIA services where they can be assessed, imaged and treated immediately," Chandratheva said.

Researchers said it's uncertain if the pattern would be found in other populations or healthcare systems.

Co-authors are: Daniel S. Lasserson, M.A., M.B.B.S.; Olivia C. Geraghty, M.R.C.P; and Peter M. Rothwell, M.D., Ph.D. Author disclosures are on the manuscript.

The study was funded by the UK Medical Research Council, National Institute of Health Research, U.K. Stroke Association, Dunhill Medical Trust and NIHR Biomedical Research Centre, Oxford.