Is virtual care effective in treating patients with transient ischemic attack or minor stroke?

A new study by researchers at ICES and Sunnybrook Health Sciences Centre has found that virtual care visits for transient ischemic attack or minor stroke rapidly increased during the COVID-19 pandemic, while care and short-term health outcomes remained stable.

Patients are not usually admitted to hospital after an emergency department (ED) visit for a transient ischemic attack (TIA) or minor stroke. However, these events often precede major disabling strokes and require urgent follow-up in stroke prevention clinics.

During the COVID-19 pandemic, patients across the province transitioned to virtual care appointments with their physicians by telephone or video conference. This study, published in CMAJ Open, evaluated whether care and outcomes for 47,601 Ontario patients with TIA or minor stroke remained stable with the increasing use of virtual care.

“The rapid rise in telemedicine visits after TIA or minor stroke did not negatively impact care or health outcomes,” says lead author Amy Yu, a neurologist, associate scientist at Sunnybrook Health Sciences Centre and adjunct scientist at ICES. “Telemedicine may have benefits beyond protection against infectious disease exposure, such as improved access to stroke experts for patients living in remote regions, reduced time and costs related to travel for the patient, environmental benefits, and the facilitation of caregiver engagement.”

In 2020-2021, compared to the period of 2015-2020, the study identified 47,601 patients with TIA (75%) or ischemic stroke (25%):

• Virtual care visits rapidly increased after April 1, 2020, with 83% of patients having at least one virtual care visit within 90 days of emergency department discharge compared to 4% at baseline.
• Investigations for stroke, renewal of medications, and clinical outcomes (death or readmission to hospital) remained stable throughout the study period.

These findings would suggest that virtual care is an effective healthcare delivery method that can be complementary to in-person care for TIA or minor stroke.

The study also found that some patient groups were vulnerable to missing follow-up appointments regardless of access to virtual care. For example, patients in lower income neighbourhoods, when compared to other population groups, or individuals living in rural areas in comparison to those in urban centres.

One limitation of the study is that widespread virtual care use coincided with the start of the pandemic, so it was difficult to distinguish the effects of one versus the other on TIA and stroke care and outcomes. However, the researchers adjusted for all major vascular comorbidities, and all patients in the study were discharged from the ED without hospital admission, suggesting that their event was likely not severe.

“It was reassuring to find that hospital admissions and deaths remained stable after the widespread adoption of telemedicine, particularly because previous findings from other studies have shown that patients with minor strokes were less likely to seek medical attention during the pandemic,” says Moira Kapral, senior author on the paper, professor at the Institute of Health Policy, Management and Evaluation at the University of Toronto and senior core scientist at ICES.

The study, “Telemedicine use and outcomes after transient ischemic attack and minor stroke during the COVID-19 pandemic,” was published in CMAJ Open.
Author block: Yu AYX, Jeremy P, Austin PC, Lee DS, Porter J, Fang J, Redelmeier DA, Kapral MK.

Sunnybrook Health Sciences Centre is inventing the future of healthcare for the 1.3 million patients the hospital cares for each year through the dedication of its more than 10,000 staff and volunteers. An internationally recognized leader in research and education and a full affiliation with the University of Toronto distinguishes Sunnybrook as one of Canada’s premier academic health sciences centres. Sunnybrook specializes in caring for high-risk pregnancies, critically-ill newborns and adults, offering specialized rehabilitation and treating and preventing cancer, cardiovascular disease, neurological and psychiatric disorders, orthopaedic and arthritic conditions and traumatic injuries. The Hospital also has a unique and national leading program for the care of Canada’s war veterans. www.sunnybrook.ca

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Misty Pratt
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