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TIA delays put pressure on GPs to treat

Waiting times for transient ischaemic attack clinics are more than double the recommended standard, putting pressure on GPs to initiate treatment, say researchers.

UK national guidelines recommend that TIA patients are seen within seven days of referral, as they are at increased risk of stroke during this time. But a new study looking at 711 patients from five TIA clinics in Liverpool and Greater Manchester, found the average waiting time to see a specialist was 15 days.

The researchers found a suspiciously low stroke incidence at three months in TIA patients seen in clinic - because the highest risk patients were suffering major strokes and/or death and not attending the TIA clinic.

‘What is the point in having a rapid access TIA service, if in fact we see people quite late and the risk of stroke is relatively low in the people that we see?' said Dr Craig Smith, a specialist registrar in stroke medicine and an author of the study.

Dr Mark Davis, a member of the Primary Care Cardiovascular Society and a GP in Leeds, condemned the delay in specialist assessment, saying: ‘If someone should be seen rapidly if they have a TIA, then it is unacceptable to have a service that doesn't deliver that.

‘This is an opportunity for practice-based commissioning to improve the situation,' he addedd.

Dr Jonathan Mant, senior clinical lecturer in the Department of Primary Care and General Practice at the University of Birmingham, said GPs should consider treating patients with TIA immediately.

‘The evidence is that if you can modify their risk early on, then it is worth it' he said.

Professor Peter Rothwell, director of the Stroke Prevention Research Unit at the University of Oxford agreed, recommending GPs initiated treatment with aspirin, a statin, an ACE inhibitor and clopidogrel.

‘These treatments work and the sooner patients are on them the better, especially where GPs are in areas where there isn't a rapid TIA service and patients are waiting for 2 or 3 weeks,' he said.

The new research is published online in the Journal of Neurology, Neurosurgery and Psychiatry.

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