How can I effectively educate patients about the risk factors and prevention strategies for TIA?

To effectively educate patients about the risk factors and prevention strategies for transient ischaemic attack (TIA), focus on immediate actions, modifiable risk factors, and lifestyle changes.

• Immediate Actions and Recognition:
  • Provide all people with suspected TIA and their family/carers with information on the recognition of stroke and TIA symptoms ¹.
  • Advise them to call 999 immediately if symptoms occur ¹.
  • Inform patients that information on stroke and TIA is available on the NHS website (www.nhs.uk) and patient information is available from the Stroke Association (www.stroke.org.uk) ¹.
  • Advise patients not to drive until they have been seen by a specialist, who will provide definitive guidance ¹. For a single TIA, patients must not drive for 1 month but do not need to notify the DVLA. For multiple TIAs, they must not drive for 3 months and must notify the DVLA, with driving resuming after 3 months if no further TIAs have occurred ¹.
• Modifiable Risk Factors and Management:
  • Optimise management of comorbidities, which are significant risk factors for TIA and stroke ¹. These include:
    • Hypertension: Management is crucial as 50–80% of people with TIA/stroke have hypertension, and treatment is highly effective ¹.
    • Diabetes mellitus ¹.
    • Atrial fibrillation: Anticoagulation is a key prevention strategy for people with non-valvular atrial fibrillation ¹. Review stroke risk for those not taking an anticoagulant if they reach age 65 or develop diabetes, heart failure, peripheral arterial disease, coronary heart disease, stroke, TIA, or systemic thromboembolism ⁴.
    • Obesity: Refer people who are overweight or obese to a weight management service if appropriate ¹.
    • Obstructive sleep apnoea: Screen people with stroke or TIA for this and refer anyone suspected for a respiratory/sleep medicine assessment ¹.
    • Heart failure ¹.
    • Sickle cell disease ¹.
  • Medication Adherence: Emphasise the importance of adherence to prescribed therapies, such as aspirin (300 mg daily immediately for suspected TIA unless contraindicated) ¹,². For those on anticoagulation, discuss factors that may contribute to poor control, including cognitive function, adherence, illness, interacting drug therapy, and lifestyle factors ⁴.
  • Lifestyle Interventions: Advise on diet and lifestyle factors that contribute to cardiovascular risk ¹.
    • Recommend a Mediterranean-type diet, which is high in monounsaturated fat, plant-based foods, fish, nuts, and olive oil, and low in red meat and processed foods ¹.
    • Advise reducing sodium intake by at least 1g per day (2.5g salt per day) ¹.
    • Arrange annual influenza immunisations ¹.
    • Advise against routinely supplementing the diet with micronutrients ¹.
  • Hormonal Considerations:
    • Do not offer pre-menopausal women with stroke or TIA the combined oral contraceptive pill; consider progestogen-only and non-hormonal methods instead ¹.
    • Advise post-menopausal women with ischaemic stroke or TIA who wish to start or continue HRT on the risks and benefits, but do not offer HRT for secondary vascular prevention ¹.

  Patients have the right to be involved in discussions and make informed decisions about their care ²,³.