This investigation assessed the effect of urgent assessment and early initiation of existing treatments on the risk of early recurrent stroke in patients presenting with a transient ischaemic attack (TIA) or minor stroke. The investigators conducted a prospective before (phase 1: April 1, 2002, to Sept 30, 2004) versus after (phase 2: Oct 1, 2004, to March 31, 2007) study of the effect on process of care and outcome of more urgent assessment and immediate treatment in clinic, rather than subsequent initiation in primary care, in all patients with TIA or minor stroke not admitted direct to hospital. The study was nested within a rigorous populationbased incidence study of all TIA and stroke (Oxford Vascular Study; OXVASC), with identical methods of case ascertainment, investigation, and follow-up for both phases. Of 1278 OXVASC patients presenting with TIA or stroke (634 in phase 1 and 644 in phase 2), 607 were referred or presented direct to hospital, 620 were referred for outpatient assessment (591 [95%] to the study clinic), and 51 were not referred to secondary care. The median delay to assessment in the study clinic was reduced from 3 days in phase 1 to >1 day in phase 2, and median delay to first prescription of treatment decreased from 20 days to 1 day. The 90-day risk of recurrent stroke in the patients referred to the study clinic was significantly reduced from 10·3% in phase 1 to 2·1% in phase 2. The reduction in risk was not related to age or sex, and early treatment was not associated with an increased risk of intracerebral haemorrhage or other bleeding.
