An overview of hyperacute stroke services and National Stroke Registry in Malaysia - Improving stroke care through evidence

INTRODUCTION: Stroke is a leading cause of death and disability in Malaysia. This paper provides an overview of the stroke burden, hyperacute stroke services, importance, and challenges of stroke registries. It also details findings from the National Stroke Registry (NSR) Malaysia that have advanced knowledge on local patterns, inequalities and temporal trends in stroke presentation, care processes and outcomes.

MATERIALS AND METHODS: A recent survey that involved all the government (Ministry of Health, MOH) and university hospitals in Malaysia was conducted by a group of neurologists and researchers to provide insights into the hyperacute stroke services in Malaysia from 2012 to 2023.

RESULTS: The results from the survey found that out of 142 MOH hospitals, 29 (20%) hospitals offer only intravenous thrombolysis (IVT) service, and seven (5%) hospitals offer both IVT and mechanical thrombectomy (MT) services. The majority or two-thirds of MOH hospitals still offer office hour services for both IVT and MT. For university hospitals, four (67%) out of six university hospitals provide both IVT and MT services and one (16%) university hospital provides only IVT service. Most university hospitals offer 24-hour services for IVT and MT. The availability of IVT service across MOH hospitals has increased significantly from 2012 to 2023. Thus, there was a substantial increase in the number of IVT cases treated in MOH hospitals. The growth in MT service has been more gradual. Only 22% of the MOH hospitals that provide hyperacute stroke services are equipped with acute stroke unit (ASU). Whereas ASU is available in 80% of the university hospitals that offer hyperacute stroke services. The higher availability of ASU in university hospitals compared to MOH hospitals may be due to better resources, specialised expertise, and advanced facilities in the university hospitals. The National Stroke Registry (NSR) Malaysia was established in 2009 to monitor stroke management practices, patient outcomes and promote quality improvement initiatives.

CONCLUSION: Despite suboptimal adherence on several key performance indicators, the NSR reports recent improvements in thrombolysis rates, reduced mortality, and better functional outcomes. Key recommendations center on promoting greater participation, feedback systems, adequate funding, and governance structures to translate registry findings into national policies and targeted interventions for equitable access to quality stroke care.