Vascular disease: the tsunami of health care

The gap between existing knowledge and the patient care provided in stroke has become more apparent. The translational gap is evidence of our scientific progress, but the sheer magnitude of our implementation gap is astounding. For instance, almost 5 decades ago we recognized the risk factors for stroke, yet in Canada until recently fewer than 20% of cases of hypertension were effectively controlled. We recognize that continued exposure to risk factors will not only lead to clinically evident strokes, but far more frequently to silent strokes resulting in cognitive decline. In addition, the same risk factors cause damage to other organs. This growing gap between existing knowledge and its translational delivery is leading our politicians to demand more practical returns. As scientific and clinical opinion leaders in stroke, we have a huge opportunity now to lead the process of narrowing the translational gap. We need to keep our emphasis on individual research excellence but temper it with a social mission to improve stroke prevention, care and rehabilitation. Toward this end, the Canadian Stroke Network partnered with the Heart and Stroke Foundation of Canada to develop the 'Canadian Stroke Strategy', an approach to focus research, increase training of stroke specialists, coordinate the care of patients, and bring 'systems change' to respond to the growing gap in all facets of stroke care. Lessons learned from both successes and failures can inform our translational efficiency in the future and facilitate collective progress in stroke care.