Stroke is one of the most serious and acute health problems in modern medicine. Along with being a regional issue, it also presents a significant challenge to the global healthcare sector. Despite advancements in diagnostic methods, reperfusion interventions, imaging techniques, and preventive strategies, stroke remains a leading cause of mortality and long-term disability worldwide. According to the World Stroke Organization (WSO) data for 2025, stroke ranks second in terms of mortality among non-communicable diseases (NCDs). Annually, approximately 15 million cases are reported, with over 7 million fatalities, while millions of patients continue to live with chronic neurological deficits. According to the World Stroke Organization(WSO), stroke is one of the leading causes of loss of productivity, affecting both developed and developing countries.
Epidemiology of Stroke and Global Trends
According to the 2021 data from the Institute for Health Metrics and Evaluation (IHME) and the World Stroke Organization (WSO), the annual incidence of new stroke cases is 11.9 million, with a prevalence of 93.8 million. Of these, the mortality rate is 7.3 million, meaning that this single condition accounts for 10.7% of the global mortality rate. Data published in The Lancet from 1990 to 2021 shows that the global burden of stroke is on the rise and is ranked as the second leading cause of mortality, following ischemic heart disease. Additionally, it is noted that stroke is statistically the third most common cause of years lived with disability (YLD) and disability-adjusted life years (DALY).
Global data on stroke subtypes reveal how differently the disease impacts various regions and countries with different levels of economic development. According to worldwide data, ischemic stroke accounts for 65.3% of cases, intracerebral hemorrhage for 28.8%, and subarachnoid hemorrhage for 5.8%. The proportion of ischemic stroke is particularly high in high-income countries (74.9%), whereas in low- and middle-income countries, this figure is 63.4%. In contrast, the prevalence of intracerebral hemorrhage is higher in low- and middle-income countries (31.1%) compared to high-income countries (17.8%), which indicates the significant impact of a country’s socio-economic status on the structure of stroke cases. Research has shown that since 2015, the incidence of new stroke cases has not decreased and is not dependent on a country’s Socio-Demographic Index (SDI). Ischemic stroke cases are higher in high-income countries, while low-income countries show significantly higher levels of disability adjusted life years (DALY) associated with stroke. This highlights deficiencies in healthcare systems regarding stroke management and rehabilitation in low-income countries. In contrast, well-organized care and rehabilitation services in high-income countries significantly reduce long-term negative outcomes, emphasizing the importance of effective healthcare infrastructure in minimizing disability and improving recovery post-stroke.
In regions such as Southeast Asia, Oceania, and countries with a low Socio-Demographic Index (SDI), the incidence, mortality, prevalence, and DALY rates related to stroke are increasing among individuals under the age of 70. Since 2010, age-standardized mortality rates from cardiovascular diseases, including stroke, have risen in countries like Mexico, the United Kingdom, and the United States. Specifically, the number of stroke cases has increased among individuals under the age of 55. According to 2021 data, of the 11.9 million new stroke cases, 6.3 million (52.4%) occurred in men, and 5.7 million (47.4%) in women. Regionally, the highest stroke burden, according to the latest data, has been observed in Central Asia, Southern Africa, and East Asia.
In 2021, summarizing data from only middle- and low-income countries, new stroke cases accounted for 83.3%, prevalence for 76.7%, fatal cases for 87.25%, and DALY for 89.4%. Based on this statistical data, the World Stroke Organization (WSO) predicts that by 2050, mortality will increase by 50%, with more than 90% of these deaths occurring in low- and middle-income countries. According to the president of the World Stroke Organization, Sheila Martins: “The cost of inaction is simply too high to continue waiting for much longer. We need the world to act now.” These words reflect the rapid increase over the past 30 years in the number of people under 55 who either die from or become disabled by stroke. The World Stroke Organization (WSO) attributes this rise to the growing trends in major stroke risk factors, such as elevated blood pressure, obesity, diabetes, physical inactivity, tobacco use, air pollution, and others. A systematic review published in The Lancet highlights that stroke incidence could be reduced by up to 84%, as many of the causative factors are modifiable. Specifically, metabolic risks directly associated with stroke account for 68.8%, environmental risks for 36.7%, and behavioral risks for 35.2%. These figures contribute to the overall burden of stroke, posing a significant threat and suggesting the potential for healthcare system overload in the coming decades.
Epidemiological Data on Stroke in Georgia
According to the updated data from the World Health Organization (WHO) for 2021, stroke remains one of the leading causes of mortality in Georgia. The overall mortality rate is 335 cases per 100,000 population, with stroke ranking second both in women (351.7 cases per 100,000) and in men (317.6 cases per 100,000). This statistic underscores the significant societal and economic burden of the disease in the country.
A study conducted in the Imereti region surveyed 2,811 individuals, of whom only 251 were diagnosed with stroke, resulting in an overall stroke prevalence of 8.9%. Among these, ischemic stroke accounted for 7.8% of cases, while hemorrhagic stroke made up 0.7%. Ischemic stroke was more common in men, whereas hemorrhagic episodes were more frequent in women. The leading modifiable risk factors identified included age, arterial hypertension, tobacco use, and diabetes mellitus. Most of the stroke patients were relatively young, around the age of 50. The study found that 65% of patients experienced cognitive decline after stroke, 60% remained disabled, and 25% developed post-stroke depression. Notably, none of the patients who had ischemic stroke between 2000 and 2020 received thrombolysis or thrombectomy, pointing to the limited resources for stroke management in the country during that period.
The burden of stroke in Georgia remains high, continuing to present a significant challenge for the healthcare system. The lack of early diagnosis and timely intervention, combined with the population’s low awareness of stroke symptoms and delays in emergency care, significantly reduces the opportunity for thrombolysis and therapeutic outcomes. The shortage of specialized stroke centers and interventional services in regional areas is especially notable. Post-stroke rehabilitation, pharmacological treatment, and long-term care are largely dependent on patients’ personal financial resources, complicating the recovery process. Additionally, the shortage of qualified neurological and rehabilitative staff, along with low levels of education and awareness, exacerbates the problem. In an interview with MedScriptum about stroke trends and modern management approaches in Georgia, neurologist Levan Bakhutashvili, a member of the European Stroke Organization (ESO), Georgian Neurology Association, and head of the Neurology Department at Jerarsi, shared insights on the current state of stroke care and management in the country:
Why is it that, despite the high prevalence of ischemic stroke in high-income countries, disability-adjusted life years (DALY) are significantly lower, and patients rarely experience neurological deficits following a stroke, while the opposite is true in low-income countries?
In high-income countries, stroke management is much more organized. The patient is quickly transported to a specialized center, where thrombolysis or thrombectomy is performed, and rehabilitation begins almost immediately. High-income countries have implemented preventive policies, and the population is more informed about the risk factors for stroke. In developing countries, timely intervention and prevention are problematic, which ultimately affects the outcomes of stroke and the rates of disability.
What steps should the healthcare system take to reduce post-stroke disability and improve patients’ functional recovery and quality of life?
First and foremost, prevention by the government should be strengthened. One of the ways to reduce the disease burden is the equitable distribution of stroke centers across regions, ensuring that everyone has access to timely thrombolysis and thrombectomy. It is also important to strengthen the rehabilitation network and educate the population on the rapid recognition of stroke symptoms.
What are the main challenges facing Georgia in terms of stroke cases, their management, and outcomes?
Georgia already has first- and second-level stroke centers where thrombolysis and thrombectomy are performed. I believe this is a significant step forward. However, many challenges remain, such as the incomplete network for post-stroke rehabilitation and the low public awareness regarding appropriate actions during a stroke.
How effective is thrombolysis in stroke patients, and how does its timely administration affect clinical prognosis and functional outcomes?
Timely administration of thrombolysis significantly improves functional recovery and clinical prognosis in stroke patients. In Georgia, the rate of thrombolysis in ischemic stroke cases is approximately 6%, while the international standard is 15.4%. Timely reperfusion reduces the extent of neuronal damage, the depth of neurological deficit, and the risk of post-stroke disability. As a result, patients are more likely to return to independent living and regain work capacity.
What is the geographic disparity in access to thrombectomy, and how does it impact overall stroke outcomes?
Geographic disparities in access to thrombectomy directly impact stroke outcomes. The faster a patient is transferred to a center where thrombectomy can be performed, the higher the chances of functional recovery and quality of life preservation. According to current data, the effectiveness of thrombectomy in Georgia is 6.8%, which is comparable to the international standard of approximately 7.5%.
What is the trend in reducing the average “door-to-needle” time, and how does it affect the patient’s prognosis?
Modern protocols aim to initiate thrombolysis as soon as the patient enters the clinic, with an ideal target of administering thrombolysis within 30 minutes. Therefore, implementing systems that reduce diagnostic and organizational delays, such as prior notification from emergency services and preparedness of the stroke team, directly impact patient prognosis. It has been confirmed that for every 15-minute reduction in the “door-to-needle” time, the chances of functional independence significantly increase, while the risk of mortality decreases. The average time for thrombolysis administration is considered to be 45 minutes or less.
What is the impact of performing thrombectomy in combination with thrombolysis (bridging therapy) on the final prognosis?
Combined thrombolysis followed by thrombectomy almost guarantees complete reperfusion. If there are no contraindications to thrombolysis and there is a large vessel occlusion (LVO), combined intervention is essential. This typically involves starting with thrombolysis followed by thrombectomy.
Which prognostic factors have the greatest impact on functional recovery after thrombectomy?
Several key factors influence the recovery process after thrombectomy. Better outcomes are typically observed in younger patients who have less initial neurological deficit (low National Institutes of Health Stroke Scale (NIHSS) score). Collateral blood supply is also of significant importance, as it protects the penumbra from complete ischemia and enhances rehabilitation potential. Additionally, the experience of the interventionalist and the technical execution of the procedure have a major impact on the final outcome.
Future Prognosis of Stroke and Recommendations from the World Stroke Organization (WSO) and the Lancet Commission:
In recent years, there has been an increase in the prevalence of stroke risk factors in the younger population, which has led to a reduction in the average age of stroke onset (55 years or younger). This trend is expected to become not only a clinical issue but also an economic one, as global costs related to stroke care and rehabilitation continue to rise. According to the World Stroke Organization (WSO), by 2050, global stroke-related costs may reach 1.6 trillion USD, whereas in 2017, this figure was approximately 890 billion USD.
According to the Lancet Commission’s report, improving primary and secondary stroke prevention requires the development of several key areas. These include:
- Improving access to preventive and therapeutic medications, with funding recommended through taxation on sugar, alcohol, and tobacco.
- Strengthening the education of healthcare personnel to improve the recognition of stroke risk factors and early symptoms.
- Financial incentives for specialists in rural areas to ensure equitable access to preventive services and support across regions.
- Promoting behavioral changes at the individual, community, and economic levels.
- Conducting more research in diverse populations to determine effective strategies for stroke prevention.
In response to the growing global burden of stroke, based on large-scale data, there is an urgent need to integrate evidence-based preventive, diagnostic, and therapeutic strategies into healthcare systems. This will help reduce disease outcomes and improve population health.
Source:
World Stroke Organization: Global Stroke Fact Sheet 2025
