Anxiety influences TIA diagnosis (P7.134)

Objective: To assess whether ICD9 codes for anxiety or depression are associated with TIA diagnosis. Background: The short duration of symptoms and multitude of non-vascular mimics make diagnosis of TIA subjective and vulnerable to misdiagnosis. Pathophysiology is the same for TIA and IS; therefore, the proportion of TIA versus IS should be the same regardless of patient/physician/hospital characteristics. However, we previously have shown that physician specialty, hospital type and patient demographics influence the TIA-IS ratio and hypothesized that patient characteristics also matter. Design/Methods: Cases were identified using primary ICD9 discharge codes at three Montefiore hospitals from January 2009-June 2014. Depression and anxiety were identified by secondary ICD9 codes. Mantel-Haenszel chi-square and Student’s t-test were used for univariate and logistic regression for multivariate comparisons. Results: There were 1543 TIA and 4982 IS cases, for a TIA-IS ratio of 0.3. In univariate analysis, anxiety (154 cases, OR 2.3, 95[percnt] CI 1.7-3.1, p<0.0001) but not depression (454 cases, 1.2, 1.0-1.5, p=0.12) was associated with TIA diagnosis. In multivariate analysis, anxiety (OR 2.1, 95[percnt] CI 1.5-2.9) remained an independent predictor of TIA diagnosis alongside age (0.99, 0.98-0.99), sex (male versus female, 0.7, 0.6-0.8), race/ethnicity (black versus white or Hispanic, 0.7, 0.7-0.8), and hospital site (community versus academic, 2.1, 1.8-2.4), all p<0.0001. Conclusions: We found an elevated TIA-IS ratio among patients with a concurrent ICD9 code for anxiety. The ABCD2 score, assessing symptoms and vascular risk factors, is promoted as a criterion for admission; however, these data suggest that comorbid conditions such as anxiety along with demographic and hospital factors also influence TIA diagnosis. The validity and meaning of an ICD9 code for anxiety is uncertain. The code may be associated with over-diagnosis of TIA as well as increased recognition of true TIA. Disclosure: Dr. Sugrue has nothing to disclose. Dr. Bhupali has nothing to disclose. Dr. Labovitz has nothing to disclose.