The burden and management of TIA and stroke in government-funded healthcare programs.

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.