John Rocke, Lauren Sanders, Carmel Croc1, Lisa Qu, Neil Shuey
Purpose: Retinal Artery Occlusion (RAO) and Amaurosis Fugax (AmF) are ophthalmological emergencies. No speciftc secondary prevention guidelines exist for these conditions, with consensus opinion to follow Stroke/Transient Ischaemic Attack (TIA) management recommendations. We adapted the evidence-based Monash TIA pathway (M3T) to guide investigations and initiation of secondary pre- vention from the Emergency Department (ED) of a specialist eye hospital. Follow-up occurs in the afftl- iated hospital?s TIA clinic with urgency triaged according to underlying CRAO/AmF mechanism (Carotid stenosis: 2 days, atrial ftbrillation: 1 week, other: 2 weeks). Our primary objective was to deter- mine the effectiveness of the ftrst year of the path- way on patient management and referral.
Method: Audit was performed for all ED presenta- tions coded as RAO or AmF from December 2015 to January 2017. Data regarding investigations and follow-up were prospectively collected. Additional ED presentation and initial management informa- tion were retrospectively extracted from medical records. Statistical analyses were then performed with SPSS and Stata 12.
Results: There were 197 initial diagnoses of RAO/AmF, with 100/197 (50.8%) referred to the TIA clinic for follow-up. Pathway use was signift- cantly associated with increased initiation/adjust- ment of medical therapy: antiplatelets 78.6% (66/84) vs 35.1% (27/77), p<0.001; statins 67.0% (61/91) vs 16.2% (12/74), p<0.001. Increased pro- portions of patient discharged/transferred on any antiplatelet/anticoagulant were observed with path- way use (96.0%, 95/99) compared with no pathway use (69.0%, 58/84, p<0.001) and similarly for statins (84.8%, 84/99 vs 47.6%, 39/82, p<0.001). Median time to clinic: 8 days (IQR 4-12). Conclusion: Pathway use for RAO/AmF is associ- ated with improved initiation of appropriate second- ary prevention.