Ageism in services for transient ischaemic attack and stroke: Clinical leadership is key in changing practice

EDITOR—Fairhead and Rothwell report substantial underinvestigation in routine clinical practice in elderly patients with transient ischaemic attack and stroke.1 We found that brain imaging was performed only in a small proportion of older patients admitted with acute stroke.

The most common misconceptions were that imaging older adults after an acute stroke would not change management and therefore was a waste of resources. After the appointment of a clinical lead in stroke, we changed this practice by a continuing audit cycle, development of local acute stroke guidelines, and regular teaching sessions on the importance of appropriate prescribing of antiplatelet agents, risk of haemorrhage with indiscriminate use of antiplatelet agents, consequences of recurrent stroke, and prevention especially in older patients. The table shows that this sustained effort improved the rate of brain imaging in older patients.