25.: Efficacy and Safety of a TIA Electronic Support Tool (FASTEST): A cluster randomized controlled trial

We aimed to test whether a transient ischemic attack (TIA)/stroke electronic decision support (EDS) tool in primary care can safely improve guideline adherence and reduce recurrent stroke/vascular event rates (FASTEST Trial ACTRN12611000792921). A multi-center, single-blind, parallel-group, cluster randomised (1:1) controlled trial in New Zealand was carried out. Randomisation occurred at the practice levels. Eligible patients presented to a participating practice as their first point of health care contact after experiencing symptoms their general practitioner interpreted as a TIA or stroke. Patients in the intervention group were managed with the aid of the EDS while control patients were managed routinely. We prespecified two main outcomes: 90 day stroke rate and guideline adherence. Secondary outcomes include vascular event and/or death rate and adverse event rate. Those assessing outcomes were blinded to outcome, but patients and treating clinicians were not. Twenty-nine practices were randomized to the intervention and 27 to the control arm registering 172 and 119 eligible patients, respectively. In the intervention group 90 day stroke rate was less than half the rate in the control group although this did not reach statistical significance (1.2% versus 4.2%; odds ratio [OR] 0.27, 95% confidence interval [CI] 0.05–1.41; p = 0.098). Guideline adherence was substantially improved (76.2% versus 41.2%; OR 4.57; 95%CI 2.39–8.71; p < 0.0001), the 90 day vascular event/death rate was significantly lower (3.5% versus 11.9%; OR 0.27; 95%CI 0.09–0.78; p = 0.016), and there was no increase in adverse events (p = 0.7). As compared with routine care the use of a stroke/TIA EDS tool resulted in improved guideline adherence, fewer subsequent vascular events and/or death, and no increase in adverse events.