Dear Editor-in-Chief

Stroke is defined as “rapidly developing clinical signs of focal (or global) disturbance of cerebral function, lasting more than 24 hours or leading to death with no apparent cause other than that of vascular origin ” (1). Stroke is recognized as ten leading causes of mortality worldwide in 2011 with increasing trend of mortality over the past decade (2). Alarmingly, mortality due to stroke and heart disease has been projected to increase to almost 23.6 million in 2030 (3). In Malaysia, dis-eases of the circulatory system which include stroke ranked first in the list of principal causes of mortality (4). This imposes a significant burden on total health expenditure. Based on Health Ex-penditure Report 1997-2011, the total health ex-penditure for Malaysia increased from RM 8,188 million in year 1997 to RM 37,871 million in year 2011 for the total population of 29,062,000. For the same period, the health spending as a share of Gross Domestic Product (GDP) ranged from 2.9 % to 4.3 % of GDP. The per capita spending on health ranged from RM 636 (USD 233) to RM 1,303 (USD 426). The health spending of GDP in Malaysia is similar to the other countries in Asi