Hiding in plain sight: impairments after TIA and minor stroke

Conference:

SAPC ASM 2019 - Exeter

Talk Code:

1B.2

Presenter:

Grace Turner

Twitter:

@gracemturner

Co-authors:

Jonathan Mant, Robbie Foy, Lou Atkins, Melanie Calvert

Author institutions:

University of Birmingham, University of Cambridge, University of Leeds, University of Central London

Problem

Despite good functional recovery, many patients experience ‘hidden’ impairments after transient ischaemic attack (TIA) and minor stroke, such as anxiety, depression, fatigue and cognitive impairment. Whilst the current healthcare pathway for these patients focuses on stroke prevention, care for other long-term problems is not routinely given. Without proper treatment, patients with these long-term problems may experience worse quality of life and difficulties resuming work and their activities. This study explored: (i) the long-term impacts of TIA/minor stroke, (ii) current healthcare and follow-up and (iii) barriers to and facilitators of a new follow-up pathway, from the perspective of patients and healthcare providers.

Approach

Semi-structured qualitative interviews with (i) people who have experienced a TIA/minor stroke (n=12) and (ii) healthcare providers from primary, secondary and community care (n=24). Interviews explored:• Experiences of post-TIA impairments, follow-up and access to support;• Perspectives on how to improve follow-up.

Findings

Three themes emerged: (1) residual problems post-TIA/ minor stroke; (2) impact of TIA/ minor stroke on lives; and (3) sources of support.1. Residual problems: Fatigue and anxiety/ depression were reported by most participants. Other problems included: cognitive impairment; loss of confidence; change in personality (e.g. increased anger); physical weakness; speech and vision impairments. 2. Impact on lives: TIA/ minor stroke brought some families closer together, but for other patients it caused relationships to break down. Many patients struggled to return to work and one lost their job as a results of mild cognitive impairment.3. Sources of support: There was huge variation in follow-up support between hospitals and individual clinicians. In general, nurses and AHPs were more holistic compared to doctors who had a medical focus. Many patients sought support from the internet, family/ friends and employers.

Consequences

Residual problems after TIA/ minor stroke are diverse and can have significant impacts on people’s lives and return to work. There is huge variation in follow-up and may patients experience little or no support. There is a need for holistic care which goes beyond medical management and a standardised follow-up pathway. Findings will inform development of a new follow-up pathway which will be tested in a feasibility study.

Submitted by:

Grace Turner

Funding acknowledgement:

GT is funded by is funded by a National Institute for Health Research Postdoctoral Fellowship Award. This article/paper/report presents independent research funded by the National Institute for Health Research (NIHR) (and Health Education England if applicable). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.