Ominous 'Mini-Strokes' Often Dismissed by Primary Care Doctors
Feb. 10, 2000 (New Orleans) -- New research presented here at a meeting of the American Stroke Association suggests that stroke is much more common in the United States than previously believed. But all too often, physicians treating mini-strokes -- a known precursor to stroke -- are sending patients home without even an aspirin.
Both the rise in stroke incidence and the laissez-faire attitude of the nation's primary care physicians have alarmed stroke experts meeting here. Larry B. Goldstein, MD, of Duke University, tells WebMD that his study of stroke treatment by primary care physicians has convinced him that patients with symptoms should "go directly to the nearest emergency department -- don't call the doctor, where one can get caught in voice-mail hell." A complete diagnostic workup and time are both crucial to a good outcome with strokes, he says. His study suggests that primary care physicians are dropping the ball in both areas.
Goldstein, who spoke at a press conference, says that his study of records from 27 general medical practices in the Durham, N.C., area and in Rochester, N.Y., showed that about 90% of patients who call a primary care physician with symptoms of a transient ischemic attack (TIA) -- the so-called mini-stroke -- are seen that day. "But only a small number -- just 6% -- are hospitalized, and only 3% are hospitalized within 30 days," he says.
Goldstein says that although the hospitalization rates are "interesting," the more troublesome finding was that "about a third of the patients had no specific evaluation, and yet 60% of those without a specific workup neither had antiplatelet therapy initiated nor had therapy adjusted."
These figures are especially worrisome, says Goldstein, because most people with stroke or TIA "are never seen by a neurologist, and virtually none are seen by a stroke neurologist. Most of the care is by primary care physicians." If primary care physicians aren't doing a complete evaluation, he says, they can't make use of new treatments, such as surgery to clean out the arteries that carry blood to the brain or use of new clot-busting drugs.