Abstract
Recent observational studies demonstrated a high incidence of stroke in the early period after transient ischemic attack (TIA). Immediate access to a stroke specialized facility for correct diagnosis and treatment is essential in the secondary prevention of early stroke after TIA. Appropriate cooperation between general practitioners (GPs) and stroke specialists in hospitals, namely a strong network between medical clinics and general hospitals, is necessary for immediate referral of patients with suspected TIA to stroke specialized hospitals. In order to clarify the actual practice and problems as to TIA, we conducted a survey using a questionnaire that included seven questions which was sent by mail to 495 general practitioners in five districts of Nagoya city. The response rate to the sent questionnaires was 32%. More than half of the respondents had some problems in TIA practice, one of which was no confidence to distinguish whether patients’ symptoms were caused by TIA or not. The other problem was unclear referral criteria on how to decide the time of referral. The survey also revealed that up to 87% of GPs who examined patients while TIA symptoms were continuing immediately referred patients to stroke specialized hospitals. On the contrary, in cases of GPs who examined patients after disappearance of TIA symptoms, the rate of immediate referral decreased to only 44%. This was an increasing risk of early stroke after TIA. In addition, predictive scores of stroke risk after TIA such as ABCD2 score seemed to be widespread because most of GPs neglect blood pressure, which is one of the 5 items of ABCD2 score. These results were entirely consistent with those of the prior survey conducted in Osaka district, suggesting a common recognition of Japanese GPs for TIA.
