“The progress we have seen in stroke care is monumental,” says Dr. Patrice Lindsay, Director, Health Systems, Heart & Stroke. “Just over thirty years ago when someone experienced a stroke, there was almost nothing that could be done for them. This has completely changed, today there is so much that can be done to treat stroke and support recovery.”
Canada has been a global leader in driving stroke innovation. World-class research and coordinated systems of stroke care have resulted in more prevention, improved diagnosis, increased life-saving treatments, better rehabilitation and enhanced recovery support. Canadian expertise has also directly contributed to the improvement and development of stroke care globally, with Dr Patrice Lindsay leading the development of the WSO Guidelines and Roadmap to Quality Stroke Care - documents that provide the foundations for and drive the implementation of evidence based acute stroke care systems around the world.
Today, stroke in Canada continues to rise. According to new data more than 89,000 strokes occur each year. This increase is due to the aging population (age is a risk factor for stroke) and younger people having strokes (likely due to an increase in risk factors such as high blood pressure, diabetes, unhealthy diet, lack of physical activity). The number of Canadians who are living with stroke has increased to 878,000.
“More people are surviving stroke because of increased public awareness of the signs of this medical emergency and the need to call 9-1-1 right away. And now we have the systems in place to get people experiencing a stroke the right care, at the right hospital, in the right time,” says Dr. Thalia Field, neurologist, Vancouver Stroke Program, and a Heart & Stroke funded researcher.
Nathan Pryor was 38 and in the best shape of his life, training at his Halifax gym when he had a stroke. One of the personal trainers recognized the signs and called 9-1-1 and Nathan was transported to the hospital by ambulance in record time where a team of stroke experts was waiting. He received a CT scan, then a clot- busting drug followed by endovascular thrombectomy (EVT) – a procedure that physically removes clots using a retrievable stent that is threaded through the blood vessels up to the brain. He regained feeling almost immediately and gave his doctor the thumbs up and was able to leave the hospital within days.
“The take-away for me is that stroke can happen to anyone and what is most important is that people recognize the signs and know that it is crucial to get treatment quickly. That is why I did not have severe damage - my treatment was about as quick as it could be,” says Nathan.
Heart & Stroke has been a key contributor to stroke advancements by funding research, raising awareness, driving change throughout stroke systems of care across the country, and advocating for improvements to health policy.
Examples of advancements in stroke prevention, awareness, treatment and recovery over the past 30 – 40 years include:
1999 New life-saving, clot-busting drug used to treat ischemic stroke. Patients with ischemic strokes (the most common kind of stroke) who are treated quickly with clot-busting Alteplase (tPA) are at least 30% more likely to have little to no disability.
2000 ACE inhibitors discovered to significantly reduce the risk of heart attacks and strokes. They lower blood pressure, the number one risk factor for stroke.
2015 ESCAPE trial focusses on endovascular thrombectomy (EVT) to treat major strokes by physically removing blood clots through blood vessels. This new treatment reduces death by 50% and leads to better recovery, and was incorporated into the Canadian Stroke Best Practice Recommendations within weeks of the trial results being released.
2016 The INTERSTROKE study identifies 10 risk factors that account for 90% of the risk of strokes worldwide.
2020 CanStroke Recovery Trials, the first-ever national clinical trials platform focused on stroke recovery, brings together researchers across the country to test and fast-track new discoveries.
Improving stroke systems of care
2000 Canadian Stroke Network launches to fund research and promote excellence in care and services.
2004 Canadian Stroke Strategy revolutionizes stroke management with an integrated approach to prevention, treatment and rehabilitation.
2006 Canadian Stroke Best Practice Recommendations ensure faster and wider adoption of advancements in prevention, diagnosis, treatment and rehabilitation across the country.
Between 2009 – 2022 the number of Canadian hospitals with:
- dedicated stroke teams increased from 74 to 155 hospitals (+81).
- stroke units increased from 58 to 95 hospitals (+37).
- telestroke capacity increased from 71 to 307 hospitals (+236)
- Alteplase (tPA) capability increased from 153 to 232 hospitals (+79).
- EVT (endovascular thrombectomy) treatment capability increased from 0 to 25 hospitals.
Awareness, education and support
Since 2014 the FAST campaign has been helping Canadians recognize the most common signs of stroke and take action:
- Face – is it drooping?
- Arms – can you raise both?
- Speech – Is it slurred or jumbled?
- Time to call 9-1-1 right away.
- Stroke resources, webinars, programs and support for people living with stroke and their caregivers.
Despite advancements, more needs to be done to prevent stroke, raise awareness and ensure access to care is more equitable across the country. Geography and socioeconomic status pose barriers to people receiving specialized stroke care.
Although awareness has increased, according to a recent poll four in ten Canadians do not know any of the FAST signs of stroke. While some excellent resources are available in communities, they are too few and mostly in major centres. Further barriers also exist around awareness, access and cost. Additionally, people in specific demographics are disproportionally affected – women experience worse outcomes and Indigenous communities are burdened by higher rates of stroke and heart disease and face obstacles toaccessing optimal care.