An examination of economic outcomes associated with misdiagnosis or undertreatment of TIA

Abstract

Transient ischemic attack (TIA) is a common cerebrovascular event that is associated with a high risk for secondary stroke, possibly higher than stroke itself. Nevertheless, a TIA is often described as a "mini-stroke," implying a less serious event requiring less urgent treatment. In reality, TIA and subsequent secondary stroke are associated with a very high economic burden. Cerebrovascular disease is the most financially costly of all major disease states, while morbidity and mortality risk is highly elevated in TIA patients. TIA is also associated with a very severe quality-of-life burden, which manifests both in terms of diminished functional independence and high rates of depression. Furthermore, TIA is commonly misdiagnosed and underdiagnosed, often leading to inappropriate treatment. More than half of patients who experience TIA are undiagnosed, while those who do receive a diagnosis are often offered neither diagnostic imaging nor hospital admission. Much of the morbidity and mortality associated with TIA and secondary stroke might be avoided by the application of timely and appropriate treatment. Clinical data have shown that accelerated treatment of TIA during its acute phase is associated with an 80% reduction of secondary stroke risk for the following 3 months, the period of greatest risk.