TIA Memorandum

27 November 2012 – updated 3 July 2013 Re: Standards for Regional TIA Clinical Pathways in New Zealand

It is now four years since the publication of the New Zealand Guideline for the assessment and management of people with a recent transient ischaemic attack (TIA)1. The 2010 New Zealand Clinical Guidelines for Stroke Management confirmed the recommendations in the 2008 TIA Guideline.

Stroke is a leading cause of death and the major cause of long term adult disability in New Zealand. TIA is defined as stroke symptoms and signs that resolve within 24 hours and is a medical emergency. Recent evidence highlights that the risk of stroke following TIA can be high, especially in the first 48 hours. Strokes that follow a TIA are not minor; one in five are fatal and a further two thirds are disabling.

Reorganisation of services to facilitate prompt treatment of people with TIA can prevent disabling strokes. Based on a generally accepted figure of $50,000 per new stroke in direct health costs in New Zealand, a relatively low number of strokes need to be prevented to justify intensification of services for people with TIA.

The most recent Stroke Foundation National Acute Audit of Stroke Services found that New Zealanders currently do not have sufficient access to organised acute stroke services and only eight out of 21 DHBs provided stroke services theatre consistent with international best practice.

The standard for any TIA clinical pathway in New Zealand is set out below, as a guide for Regional Stroke Networks, DHBs and clinicians. This is based on the New Zealand Clinical Guideline. While it is recognised that different regions will implement their TIA pathway in slightly different ways according to available resources, the National TIA Project Group, with representatives from all the regional stroke networks, has agreed that all TIA pathways should be based on the New Zealand Guideline.