The researchers found that other diagnoses compounded TIA survivors' risk of dying. Congestive heart failure more than tripled it. Prior hospitalization for stroke more than doubled it, while a type of irregular heart rhythm called atrial fibrillation doubled it. High cholesterol didn't seem to pile on more risk after a TIA, suggesting that patients receiving that diagnosis were following heart-healthy recommendations to exercise more, stop smoking and eat healthfully, study authors said.
Gattellari and her co-authors said their findings were important because they revealed "the true impact of TIA on mortality" and could be used to inform decisions about follow-up care and strategies to prevent repeat TIAs.
"The most effective strategies are to set targets for cholesterol, blood pressure, exercise, weight, and diabetic control and smoking cessation, adjusting the medication over time to achieve target cholesterol and blood pressure levels," said study co-author Dr. John M. Worthington, a neurologist and associate professor at UNSW.
As the Hong Kong doctors did with Swisher, doctors usually administer anti-clotting drugs, such as aspirin, aspirin-like drugs or anticoagulants within hours of a TIA. "These drugs will usually continue for the life of the patient," Worthington said.
He cited "strong recent evidence that the more urgent and comprehensive the medical care, the better the outcome." Combining that care with lifestyle changes, "gives the patient the best chance for reducing their risk for all cardiovascular disease and risks," he said. "Our study emphasizes the importance of close, long-term management of risk factors after TIA."
"In a nutshell, TIA management is about urgent care, lifestyle changes, use of effective medications and close long-term follow-up," Gattellari told ABCNews.com.
Unfortunately, there still is no gold-standard method for diagnosing a TIA. Its transient nature means that brain imaging technologies like CT scans cannot detect it, so diagnosis relies predominantly on doctors' judgment. About a quarter of cases considered TIAs in the emergency room turn out, upon further investigation, to be strokes. About a quarter turn out to be some other disorder that mimics a TIA, the authors wrote.