KUALA LUMPUR, Dec 9 — Experts have called for improved coordination between pre-hospital, acute, and post-stroke rehabilitation care in Malaysia to improve outcomes across all age groups.
Assoc Prof Dr Wan Asyraf Wan Zaidi, a consultant neurologist at Hospital Canselor Tuanku Muhriz (HCTM) UKM, said emergency medical service (EMS) protocols must be standardised for stroke triage, besides improving ambulance facilities and paramedic training. The government can partner with the private sector to reduce costs.
“Stroke pathways should include pre-hospital notification, in-hospital stroke codes, and rehab referrals. Post-stroke rehab must be integrated into discharge planning with community follow-up,” he told CodeBlue.
Dr Wan Asyraf also recommended stroke awareness at the primary school level with the FAST Heroes [1] campaign, as well as the BEFAST acronym (PeRMATA in Bahasa Malaysia) for the general public as a primary prevention campaign.
The BEFAST acronym stands for: Balance difficulties, Eyesight changes, Face weakness, Arm weakness, Speech difficulties, and Time to call 999.
Dr Law Wan Chung, a consultant neurologist and head of the neurology unit at Sarawak General Hospital (SGH), echoed Dr Wan Asyraf’s call for a need for a unified national approach across the continuum of stroke care.
“That’s why we need a national policy – because this will allow us to manage the whole patient journey, including pre-hospital and contact with hospitals,” Dr Law told CodeBlue.
“Patients have a stroke and then come to hospital to be treated by the emergency department and by the medical neurology team. And then they go for rehabilitation and rejoin the community. It’s a continuum of care.
“In order to do this, we need a national policy to ensure that everybody practises according to up-to-date standard guidelines.”
The neurologist noted that Malaysia still lacks rehab services, physiotherapy, occupational therapy, and speech therapy. “The ratio of our therapies to population is a lot lower than our neighbouring countries,” said Dr Law.
Dr Law and Dr Wan Asyraf have previously urged Malaysia to implement a national stroke policy [2], like in the neighbouring countries of Thailand, Vietnam, and Indonesia, to reduce mortality and improve stroke outcomes.
Two WSO-Certified Advanced Stroke Centres In Malaysia
Malaysia has two advanced stroke centres certified by the World Stroke Organization (WSO): HCTM UKM and Hospital Sultan Abdul Aziz Shah (HSAAS) UPM. Both university hospitals are located in the Klang Valley.
HCTM [3] and HSAAS [4] received their WSO certification in August 2024 and October 2024 respectively.
“A certified stroke centre offers faster and precise diagnosis and treatment, access to thrombolysis and thrombectomy, as well as multidisciplinary care for better recovery,” Dr Wan Asyraf told CodeBlue.
“Even if it’s further, the benefit of timely reperfusion and structured care outweighs delays at non-certified stroke centres. A certified stroke centre must have a stroke unit, not just an ICU (intensive care unit).”
Thrombolysis is the use of clot-busting drugs to break up or dissolve blood clots, whereas thrombectomy is a procedure that mechanically removes a clot from the brain.
Certified stroke centres have a comprehensive team and adequate support for 24/7 coverage, explained Dr Wan Asyraf, whereas stroke-ready hospitals may not have round-the-clock coverage, for example.
Dr Law said initial treatment for stroke must be started as soon as possible. “Every minute during a stroke, the brain loses about 2,000,000 neurons.”
CodeBlue previously reported [5] that SGH, Raja Perempuan Zainab II Hospital (HRPZ II) in Kelantan, Tuanku Ja’afar Seremban Hospital (HTJS) in Negeri Sembilan, and KPJ Ipoh Specialist Hospital in Perak won awards from the WSO in Vietnam last July for excellence in stroke care.
Last November 15, the Ministry of Health (MOH) announced that Taiping Hospital in Perak [6] won an award from Angels that recognises stroke care; the hospital also received another Angels award for emergency medical services. The town of Taiping was recognised as an Angels Region.
National Stroke Registry Underutilised Due To Voluntary Data Entry
Experts say an updated National Stroke Registry, mandated under a national policy, would be a game-changer for benchmarking outcomes and guiding resource allocation.
“The National Stroke Registry has been around since 2009. We’ve been encouraging all hospitals, especially those that treat stroke patients, to key in their data – be it public, private, or MOE (Ministry of Education) hospitals,” said Dr Law.
“We need the data actually because the data will give us an idea of where we stand, where our weaknesses are, and how to improve further.”
Despite expanding coverage in the National Stroke Registry, it’s still incomplete and requires long-term funding and planning, said Dr Wan Asyraf.
“This registry must identify hospitals with poor door-to-needle times or door-to-puncture time, and benchmark thrombolysis and thrombectomy rates. It should also track functional outcomes, death and discharge destinations, and guide resource allocation and training,” he explained.
Dr Law lamented that the National Stroke Registry suffers from poor hospital participation.
“A lot of centres do not key in all their data, deeming it as extra work,” he said.
“If we have comprehensive national data, that will be a very, very good step forward because it helps us to monitor and audit ourselves.”
Malaysia’s Stroke Profile: Younger, Female
Malaysia’s stroke profile is evolving, with rising incidence and younger populations affected.
“Younger onset cases are increasingly common. One in four strokes now occur in Malaysians under 50,” said Dr Wan Asyraf, citing risk factors like hypertension, diabetes, smoking, and sedentary lifestyles.
Dr Law said Malaysia’s stroke incidence is increasing every year. About five to 10 years ago, the country saw nearly 50,000 stroke admissions a year. However, current trends indicate Malaysia reaching 60,000 stroke admissions annually now.
“We are seeing more and more younger patients below 60 years old. At the moment, there are still more male stroke patients than female stroke patients, but what is surprising to us is the increase in young stroke patients,” he told CodeBlue. “The highest percentage increase is among women between 35 and 40 years old.”
The youngest stroke patient that Dr Law has seen is a teenager.
In summary, Malaysia faces an increasing number and younger incidence of stroke, coupled with insufficient stroke-ready hospitals and fragmented pre- and post-stroke care. Until Malaysia adopts a coordinated national approach, systemic gaps will persist and stroke survival rates will remain suboptimal.
References
- Angels Team (2023, August 10). Fast Heroes Unleashed in Malaysia. Link.
- CodeBlue (2025, November 25). Malaysia Needs National Stroke Policy Like Neighbouring Countries, Say Neurologists. Link.
- Admin HCTM (2024, August 27). Congratulations – HCTM Received Advanced Stroke Center Certification by the World Stroke Organization (WSO). Link.
- Rahim, A.A.A (2024, October 25). WSO iktiraf HSAAS UPM sebagai pusat strok utama di Malaysia. Link.
- Boo, S.L. (2025, July 25). Four Malaysian Hospitals, Neurologist Win Global Stroke Awards. Link.
- Kementerian Kesihatan Malaysia (2025, November 15). Hospital Taiping Dianugerahkan Pengiktirafan Antarabangsa. Link.
