Gorelick Philip B
Department of Neurology and Rehabilitation, University of Illinois College of Medicine, Chicago, 912 S Wood St, IL 60612, USA.
Am J Manag Care. 2009 Jun;15(6 Suppl):S177-84.
Transient ischemic attack (TIA) and stroke are a common public health problem. Stroke is a leading cause of death in the United States, and TIA occurs frequently. In the United States it is estimated that there are 780,000 strokes and 240,000 TIAs annually. Many TIAs and strokes, however, may go unreported, and subclinical ("silent") strokes and undiagnosed stroke and TIA symptoms in the community are common. This is of concern because TIA and stroke have evidence-based treatments to prevent subsequent or recurrent stroke, and access to rapid diagnostic and treatment facilities for these conditions has been shown to be highly effective to reduce the risk of stroke. Government-funded and managed care health initiatives play an important role in the prevention of stroke in TIA and stroke patients. Evidence-based guidelines should be incorporated into organizational treatment paradigms for these patients. We will discuss general concepts about TIA and stroke, emphasize specific issues in relation to TIA and stroke in Medicare and Medicaid populations, and provide examples of government-funded initiatives to improve TIA and stroke diagnosis and treatment.
短暂性脑缺血发作（TIA）和中风是常见的公共卫生问题。中风是美国主要的死因之一，且TIA频繁发生。据估计，美国每年有78万例中风和24万例TIA发作。然而，许多TIA和中风病例可能未被报告，社区中未被诊断出的亚临床（“无症状”）中风以及未被诊断的中风和TIA症状很常见。这令人担忧，因为TIA和中风有基于证据的治疗方法来预防后续或复发性中风，而且已证明获得针对这些病症的快速诊断和治疗设施对于降低中风风险非常有效。政府资助和管理式医疗健康倡议在预防TIA和中风患者的中风方面发挥着重要作用。基于证据的指南应纳入这些患者的组织治疗模式中。我们将讨论关于TIA和中风的一般概念，强调医疗保险和医疗补助人群中与TIA和中风相关的具体问题，并提供政府资助的改善TIA和中风诊断及治疗的倡议示例。
