Why it’s time we invested in stroke care

Every three seconds, someone in the world suffers a stroke* – a condition that can rob individuals of their independence, health, income and future. Yet with timely care, many strokes are not just survivable but treatable. With the combined annual direct and indirect cost of stroke currently estimated to be in excess of $891 billion, investing in stroke care is not just a healthcare necessity – it is an economic and societal imperative. The emotional and quality-of-life benefits to patients and their loved ones are immeasurable.

As we race to meet the United Nations’ Sustainable Development Goal (SDG) 3.4 of reducing by one-third premature mortality from non-communicable diseases (NCDs) by 2030, investment in the infrastructure and human resources needed to treat stroke is the single biggest action we can make towards that goal. Heart disease and stroke are the two most common NCDs and while massive investment has already gone into treating heart disease, access to the latest treatments for stroke remains severely limited in most parts of the world.**

In many geographies it is virtually non-existent.

As strong proponents of universal access to care, and committed members of the recently announced World Stroke Organization (WSO) Advocacy Coalition, we propose a staged approach aligned with recent World Health Organization guidance, to implementing the infrastructure, training and logistics needed to ensure as many patients as possible receive the timely treatment they deserve – with timely being the key word. Every minute of delay between the onset of a stroke and the beginning of treatment results in the death of around 1.9 million brain cells. For stroke, time is brain.

Most strokes – globally more than 62% – are caused by interruption of the blood supply to the brain due to a blood clot fully or partially blocking an artery. For these ischemic strokes there are now two proven treatments :

In either case, treatment needs to start within hours after the patient suffers a stroke – typically up to 4.5 hours for thrombolysis and up to 24 hours for mechanical thrombectomy.

While the time window for thrombolysis is shorter, its low cost and ease of administration – only requiring an intravenous injection in the patient’s arm – make it an attractive target for the first-phase introduction of dedicated stroke care services. The investment required is primarily education and training so that the public and first responders recognize stroke symptoms and emergency department staff know how to triage patients and route them to an appropriate care team or stroke centre. It can be implemented in any hospital with access to a CT scanner – an essential diagnostic imaging tool for confirming an ischemic stroke.

In a second round of investment, advanced stroke centres capable of performing mechanical thrombectomy can be established in hospitals with an image-guided therapy system, also known as a catheterization laboratory or cath lab – many of which are already in place to treat heart disease – by training interventionists in the required procedures and devices. Investment in mechanical thrombectomy has the added advantage that it treats severe strokes – the large vessel occlusion strokes – that currently impose the heaviest socio-economic burden with life-long disabilities if left untreated.

Despite the availability of low-cost thrombolytic drugs for decades, the number of eligible patients who receive them remains persistently low. Likewise, mechanical thrombectomy, proven safe and effective 10 years ago, lacks the attention required to support reimbursement and infrastructure. Globally, the number of eligible stroke patients with access to thrombectomy is extremely low, with a median rate of less than 3%.

If you are under the impression that this is because only high-income countries can afford well-developed stroke care networks, evidence from Latin America would suggest otherwise. Brazil and Chile have already introduced mechanical thrombectomy as well as thrombolysis in their public health systems. Uruguay, Costa Rica, Panama and Colombia have recently followed suit.

Two main reasons are stopping the rest of the world: a lack of awareness that stroke can be treated cost-effectively and, where that is overcome, lack of knowledge and expertise needed to develop and implement an effective national plan. The good news is that help is available. The recently announced WSO ‘Stroke Action Now’ Advocacy Coalition is committed to supporting strategic articulation of the beneficial economic and patient-outcome arguments for action on stroke care to governments around the world. It already includes WSO partner organizations such as the American Stroke Association and European Stroke Organisation, together with industry partners including Philips and Medtronic – leading global companies advancing access to stroke care and playing a crucial role in achieving the coalition’s objectives.

The coalition will also build on existing initiatives such as the WSO Global Stroke Alliance’s programme of Ministerial Meetings, where representatives from different countries’ Ministries of Health come together with stroke experts to share experiences, identify gaps in stroke care, discuss successful implementation models and formulate region-specific actionable plans for stroke prevention, treatment and rehabilitation.

The clock is ticking. With less than six years to meet the 2030 SDG target, unlocking progress on stroke must become a global health priority. The upcoming United Nations High-Level Meeting on NCDs in September 2025 presents a unique opportunity to rally international support for this cause. Governments can take the lead by prioritizing stroke in national health budgets. Healthcare providers can advocate for advanced training and infrastructure development. Communities can amplify awareness efforts, ensuring no one is left behind in the fight against stroke.

Investing in stroke is investing in people – patients, families and care providers. Together, we can build a world where stroke is no longer a leading cause of death and disability. The tools, knowledge and examples of success are already within reach. Join us in this mission to combat stroke and improve care worldwide. Together, we can make a difference.

-------------------------------------------------------

* Calculation based on an estimated 12 million new strokes globally every year.

** In Europe, around 80% of eligible coronary artery disease patients are treated compared to an average of around 7% of all ischemic stroke patients in the Europe region receiving thrombectomy treatment.