Vito Murgolo knows how quickly life can change.
The Montreal resident survived a heart attack in February 2019, suffered a stroke in April 2021, and underwent open-heart surgery this year. Now, at 55, he still lives with weakness on his right side.
“My health has degraded because of the stroke. It’s like my life stopped four years ago. It’s hard to get back.”
Murgolo remembers waking up on April 16, 2021 unable to move the right side of his body and struggling to speak.
His girlfriend immediately noticed something was wrong and took him to hospital. At first, they did not realize he was having a stroke.
His condition continued to worsen, prompting his girlfriend to take him to the McGill University Health Centre, where he was stabilized before being transferred to the Montreal Neurological Institute-Hospital.
Because it was during the COVID-19 pandemic, visitors were restricted. His son, Luca, could only see him through a video call.
“I didn’t know what to do because it was during COVID,” Luca said. “I couldn’t even go to the hospital and see him.”
During a FaceTime call, he immediately noticed the effects of the stroke.
“I couldn’t understand what he was saying. His mouth was a bit crooked and honestly it affected me a lot seeing my dad like that. It was very hard to take.”
Doctors later diagnosed Murgolo with a lacunar stroke, which affected his motor skills.
“I had no more speaking. I walked with a limp. I couldn’t move my right arm. And I had to learn all that back again,” he said.
His experience reflects a broader reality in Canada, where stroke remains one of the leading causes of adult disability, and where care has evolved significantly over the past two decades.
On June 2, Heart & Stroke marked the 20th anniversary of the Canadian Stroke Best Practice Recommendations, evidence-based national guidelines introduced in 2006 to improve how stroke is diagnosed, treated and managed.
“Looking back over 20 years, the stroke best practices have revolutionized stroke care across Canada and influenced advances around the world,” said Doug Roth, CEO of 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 recommendations were developed by Heart & Stroke and the Canadian Stroke Network to bring together the latest evidence into a Canadian framework for stroke care.
“The Canadian Stroke Best Practice Recommendations compile all of the relevant research about stroke care and create these usable summaries of that research to help clinicians and health systems understand how to best provide stroke care,” said Katie White, director of health systems at Heart & Stroke.
She said the guidelines were created to reflect Canadian needs at a time when stroke care was being actively improved across the country.
“There were guidelines in other countries, but they were a way for us to have Canadian-specific guidelines for stroke care,” White said. “Particularly at that time, there was so much system effort going into improving stroke care in the country.”
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The recommendations have grown substantially since then.
“When the guidelines started, we had one document and only 96 recommendations that covered the continuum of care,” White said. “We’ve really built on those over the last 20 years.”
Today, they cover prevention, emergency treatment, rehabilitation and recovery.
One of the biggest shifts has been treating stroke as a coordinated system of care rather than a series of isolated interventions.
“We now think of stroke really as a system of care,” White said.
“It isn’t about just providing the right care in the emergency department, for example, but it is really about thinking about our entire system from the community and what happens when paramedics arrive, all the way through to rehab and recovery and community participation.”
Experts say that approach has helped standardize care across the country.
“Before the best practices, we had a stroke system of care that didn’t exist as a system,” said Dr. Eric Smith, a stroke neurologist with the Calgary Stroke Program and a Heart & Stroke-funded researcher.
“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.”
A Canadian study found that integrated stroke systems were associated with more than a 20 per cent reduction in stroke deaths.
The number of designated stroke units in Canada has also increased, rising from 58 in 2009 to 95 in 2022.
Patients treated in specialized stroke units are more likely to survive, return home and regain independence.
Over the past two decades, stroke treatment has advanced significantly through therapies such as clot-busting drugs and endovascular thrombectomy, a procedure used to remove blood clots from the brain.
“What the guidelines do is take the most recent evidence and the strongest evidence and put it in the hands of the people who provide care,” White said.
“What we have seen in the last 20 years has been significant advances in stroke care.”
She said these interventions help reduce brain damage and improve long-term outcomes.
“All of those interventions help to reduce the amount of damage that happens to a brain,” White said. “That both increases survival and helps reduce the amount of disability a person might live with.”
Dr. Michael Hill, a stroke neurologist and researcher, said the guidelines helped translate research breakthroughs into routine clinical practice.
“When intravenous thrombolytics were approved it changed how people thought about stroke — that it was in fact treatable and we could actually do something,” Hill said.
“The stroke best practices furthered and promoted that concept. 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.”
Despite those advances, experts stress that rapid action remains one of the most important factors in improving outcomes.
More than 108,000 strokes occur in Canada each year — roughly one every five minutes — and nearly one million Canadians are living with the effects of stroke.
White said public awareness campaigns such as FAST remain essential.
“FAST stands for face. So, is it drooping? Arms, can you raise them both? And if you can only raise one, that’s a sign. Speech, is it slurred or jumbled?” she said.
“And then the T is the important bit. The T is the action. So T stands for time, or time to call 911.”
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She said awareness has improved across the country.
“We see increased recognition. We know that more Canadians know more of the signs of stroke, which is incredibly important.”
Luca believes that quick action made a difference in his father’s case.
“Thank God they caught the signs very early because it could have been a lot worse,” he said.
While survival rates have improved, stroke remains a leading cause of adult disability in Canada and costs the economy more than $3.6 billion annually.
White said rehabilitation and long-term recovery are becoming increasingly important as more people survive stroke.
“The rate of stroke is on the rise, both because we have an aging population and while stroke can happen at any age, it is more common as people get older,” she said. “But we do see more stroke happening in younger populations.”
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She said ensuring access to rehabilitation remains a key challenge.
“I think that some of the biggest challenges in front of us really relate to rehabilitation and recovery and ensuring that our systems of care are ready to help provide the rehabilitation and recovery supports that all of these people who are experiencing stroke and surviving with strokes will need in order to really thrive in the community.”
For Murgolo, recovery remains a daily reality.
He says he cannot walk for more than 10 minutes without becoming exhausted and remains unable to work. Weakness on his right side persists, and he struggles with concentration.
“I have everything back except the strength,” he said.
Both father and son hope others learn from their experience.
“I would go straight to the hospital. Even if you’re not sure what it is or what it could be, go straight to the hospital or call 911,” Luca said.
Murgolo echoed that message.
“When you get the symptoms of a stroke, you have to act right away,” he said. “Even if it’s not a stroke, a false alarm, if you get the symptoms, like you feel dizzy or disoriented, go to a hospital…It’s getting it right away that helps saves lives.”
White agrees.
“My key message is knowing those signs of stroke and acting fast when you or someone you’re with is experiencing them,” she said.
“There are things that we can do to help, but we need people to call 911 and get into our healthcare systems as fast as possible, and that is the best way that we can reduce the disability a person might experience, as well as increase their chances of survival.”
