Stroke Care Must Move From Hospitals To Communities: Experts

As hypertension, diabetes, obesity, smoking, unhealthy diets and physical inactivity become increasingly common, experts are calling for a fundamental shift in India’s approach to stroke — from hospital-centric treatment to prevention, early recognition and timely intervention closer to communities.

The message came at the Indian Stroke Association CME, “Save the Brain – Stroke is Preventable and Treatable", organised recently by the Department of Neurology, AIIMS New Delhi. The meeting brought together more than 400 healthcare professionals under the theme “Expanding Stroke Care in India – From Prevention to Advanced Treatment".

Opening a wider discussion on the future of stroke care, Prof. Nikhil Tandon, Director, AIIMS New Delhi, said the focus of stroke medicine must move beyond identifying neurological damage to preserving brain function.

“We should aspire to learn neurology from preserved brain function, not from the loss of brain function caused by stroke,” he said.

The shift is critical because stroke is a time-sensitive emergency. Every minute between the onset of symptoms and treatment can influence the extent of brain damage and the degree of disability left behind. Recognising warning signs early, reaching an appropriate facility quickly, obtaining timely brain imaging and initiating the right treatment can mean the difference between independent recovery and long-term dependence.

The CME, which also marked the centenary of cerebral angiography and paid tribute to its pioneer Egas Moniz, highlighted the need to strengthen the entire chain of stroke care—from prevention and community awareness to advanced intervention and rehabilitation.

Aradhana Patnaik, Additional Secretary and Mission Director, National Health Mission, Union Health Ministry, stressed the importance of prevention, early recognition and coordinated referral.

She underlined the potential of Ayushman Arogya Mandirs and frontline workers, including ASHAs, ANMs, community health officers and medical officers, to identify people at risk and improve awareness of stroke symptoms.

A hub-and-spoke model, experts said, could connect peripheral health facilities with specialised stroke centres, allowing patients to be stabilised and referred without losing precious time.

Prof. M. Srinivas, Member, NITI Aayog, the government’s top think tank, emphasised that stroke care cannot end with emergency treatment. A continuum — covering risk-factor control, early diagnosis, acute treatment, rehabilitation and community-based support — is essential.

He also highlighted the NITI Aayog brain-health initiative in 12 aspirational districts and suggested that school students could become effective ambassadors for stroke awareness, taking simple messages on blood pressure control, healthy lifestyles and early recognition into their families and communities.

At the advanced-care end, Prof. Shailesh B. Gaikwad, Chief Neurosciences Centre and Head of Neuroimaging and Interventional Neuroradiology at AIIMS, stressed the need to expand neurovascular intervention services beyond major metropolitan centres.

He also called for greater development and adoption of Make-in-India neurovascular devices, which could reduce dependence on imported technologies and potentially make advanced stroke treatment more accessible and affordable.

Yet, surviving a stroke is only the beginning of a long journey for many patients. Stroke can result in paralysis, speech and cognitive difficulties, depression and anxiety, while placing a prolonged emotional and financial burden on families. Rehabilitation, therefore, needs to be built into stroke services from the outset rather than considered an optional or later intervention.

The global burden underlines the urgency. WHO estimates that 11.9 million new strokes occurred worldwide in 2021, while about 93.8 million people were living with stroke and its consequences.

Stroke was the world's third leading cause of death and disability that year. WHO has also warned that the lifetime risk of stroke has increased substantially, with roughly one in four adults expected to experience a stroke.

Much of this burden, however, is linked to preventable or modifiable factors. High blood pressure, smoking, unhealthy diets, physical inactivity, obesity, high blood sugar, high LDL cholesterol and air pollution are among the major contributors.

India faces a particularly formidable challenge. Estimates cited in a WHO-supported report put the country's stroke burden at about 1.29 million cases in 2019, with nearly 699,000 deaths. More recent Indian registry estimates suggest that around 1.44-1.66 million new stroke cases may occur annually, highlighting the need for a stronger prevention and treatment architecture.

For India, therefore, the next phase of stroke care cannot be limited to building sophisticated neurological centres. It must begin much earlier — with controlling blood pressure and diabetes, reducing tobacco use, promoting healthier lifestyles and teaching communities to recognise the first signs of stroke, as per the experts.