⚕️Celebrating 20 Years of Canadian Stroke Best Practice Recommendations

Thursday, 04 June 2026 04:41.PM

Evidence-based guidelines improve care, save lives and promote recovery

Over the past two decades, the Canadian Stroke Best Practice Recommendations (CSBPR) have played a leading role in transforming stroke diagnosis, treatment and rehabilitation. Initiated in 2006 by Heart & Stroke and the Canadian Stroke Network, the innovative, evidence-based and Canadian-specific guidelines have championed organized stroke care across the country, moved ground-breaking research into practice, and provided indicators to measure performance, resulting in increased survival and improved outcomes.

"Looking back over 20 years, the stroke best practices have revolutionized stroke care across Canada and influenced advances around the world," says Doug Roth, CEO, Heart & Stroke. "With stroke on the rise we need to continue to invest in systems change, research and innovation so that people who experience stroke have the best chance of surviving and having the fullest recovery possible."

The burden of stroke is significant. Stroke can happen at any age and more than 108,000 strokes happen in Canada every year – one every five minutes. A leading cause of adult disability, almost one million people in Canada are now living with stroke. Additionally, stroke costs the Canadian economy more than $3.6 billion per year in direct costs.

The stroke best practices were first released as part of the Canadian Stroke Strategy, to formalize and standardize how stroke care should be organized in Canada. Over the years, hundreds of experts have been involved, and due to the increasing volume of evidence over time the number of modules and guidelines has grown significantly.

"Before the best practices, we had a stroke system of care that didn't exist as a system. It was fragmented and depended on what your individual provider knew. The best practices bring the best stroke expertise to every doctor in Canada. They have led to better care, more lives saved, and better outcomes," says Dr. Eric Smith, stroke neurologist, Calgary Stroke Program and Heart & Stroke funded researcher.

Organized care improves survival and recovery

The stroke best practices emphasize the importance of integrated and organized stroke care – having the required systems, protocols and infrastructure in place supported by dedicated budgets and resources. This has led to significant improvements in patient outcomes. A Canadian study showed that implementing integrated systems of care was associated with more than a 20% decrease in death from stroke. As a direct result of the stroke best practices alongside stroke system development efforts, the number of designated stroke units (specialized unit with a dedicated team) in Canada rose from 58 in 2009 to 95 in 2022. Research shows that people who receive care on a stroke unit have an increased chance of surviving, returning home and regaining independence.

Moving research into patient care

The stroke best practices provide direction for front-line staff to deliver optimal stroke care, based on the most up-to-date evidence. The guideline development process helps overcome the often-long delay between generating research and translating it into practice through both scheduled reviews as well as rapid reviews that can quickly incorporate late-breaking evidence.

"When intravenous thrombolytics [clot-busting drugs] were approved it changed how people thought about stroke – that it was in fact treatable and we could actually do something. The stroke best practices furthered and promoted that concept, so they are both the result of the evolution of stroke treatment, but they also promote the need for continued evolution of stroke research and care," says Dr. Michael Hill, stroke neurologist, Calgary Stroke Program and Heart & Stroke funded researcher. "And when we published the ESCAPE trial for EVT [physically removing clots] it was immediately available at the 11 Canadian sites involved in the trial but getting it into the best practices facilitated getting it into other sites. There are now 27 centres across the country providing this treatment."

Measuring performance

A novel but essential part of the stroke best practices was embedding metrics into the process, to provide a clear understanding of how to measure progress, evaluate implementation and drive quality improvement. The Guidelines International Network (GIN) recognized the Canadian Stroke Best Practice Recommendations in 2008 for the world-leading decision to embed performance measures within the guidelines.

Advocating for improvements to the health system

The stroke best practices provide the evidence and framework for clinicians and system leaders to advocate for investments to improve the system and provide better diagnosis, treatment and rehabilitation.

"From a systems perspective, stroke best practices provide us with important evidence that can help guide ongoing decisions about system improvements and resource allocation to ensure we are able to deliver high-quality patient care," says Sacha Arsenault, provincial director, Stroke Services BC.

In July 2025, Rosetta Antonacci's father had a stroke at his home in Montreal. Minutes after he had collapsed, her brother arrived at his house for a visit. He immediately recognized the FAST signs of a stroke and called 911. "My father was quickly taken to the nearest hospital that provides stroke care. He was given a clot-busting drug followed by endovascular therapy, and once he returned home he was provided with a personalized rehabilitation program. Thanks to this exemplary care, my father has made a nearly 100% recovery. We are very grateful," says Rosetta.

Highlights from 20 years of Canadian Stroke Best Practice Recommendations

• 2006 First edition of the stroke best practices released. The guidelines cover public awareness, patient and family, prevention, acute stroke management, rehabilitation, and follow-up and community reintegration.
• 2008 Second edition published in the Canadian Medical Association Journal. New recommendations address emergency medical services and vascular cognitive impairment.
• 2010 Stroke becomes first disease-specific accreditation program. In partnership with Accreditation Canada a Stroke Services Distinction program is created based on the best practice recommendations.
• 2013 Ground-breaking addition of mood, cognition and depression. The fourth edition recommends depression screening, an innovation for national stroke guidelines. A new module is also added on telestroke (virtual care) to expand stroke care to patients anywhere in the country.
• 2015 Life-saving treatment incorporated into stroke best practices in record time. Dramatic results from the ESCAPE trial, supported by Heart & Stroke funding, reveals that endovascular thrombectomy (EVT) improves outcomes and can cut in half the death rate from major ischemic strokes. The results were rapidly included in the best practice recommendations, making Canada one of the first countries in the world to incorporate this treatment into the healthcare system.
• 2017 Secondary stroke prevention during pregnancy. A consensus statement provides the first broad-based, stroke-specific guidance around secondary stroke prevention in pregnancy in the world.
• 2018 Pregnancy revealed to elevate risk. Although relatively rare, stroke in women during pregnancy is three times higher that stroke in non-pregnant women of the same age. A consensus statement on acute stroke management in pregnancy is the first of its kind in Canada.
• 2020 Decades-old practice changed. A new guideline recommends against taking ASA (acetylsalicylic acid) as a preventive measure for those who do not have a history of stroke or heart disease. Taking ASA daily could potentially do more harm than good, by causing serious side effects such as internal bleeding.
• 2020 Guidance released to ensure care during pandemic. To address the enormous challenges facing the healthcare system as a result of the COVID-19 pandemic, an update is published to ensure continued implementation of evidence-based stroke care across the continuum.
• 2020 Sex and gender requirement added. Sex and gender must now be considered by all stroke best practice writing groups when reviewing evidence including the ratio of male to female participants in trials and if significant sex-based differences are noted in the outcomes.
• 2022 New drug speeds up treatment. Based on the largest acute stroke trial ever run in Canada (AcT Trial), supported by Heart & Stroke funding, new recommendations are released for the use of Tenecteplase (TNK) which is easier to administer than other clot-dissolving drugs – a significant improvement resulting in faster treatment.
• 2024 New module provides guidance around rare type of stroke. Cerebral venous thrombosis (CVT) is a potentially life-threatening, but relatively uncommon type of stroke that occurs more often in women.
• 2025 Rehabilitation module reflects international framework. Due to the broad scope of topics, the module for rehabilitation, recovery and community participation is divided into three parts and is reorganized to better align with a World Health Organization (WHO) framework.

Heart & Stroke is the operational lead of the stroke best practices, managing them in partnership with the Canadian Stroke Consortium, Canadian Neurological Sciences Federation, and CanStroke Recovery Trials Platform Network.

SOURCE: Heart and Stroke Foundation