Ischemic Stroke Burden in Cardiology PracticeIschemic Stroke Burden in Cardiology Practice: Prevalence, Trends, and Unmet Needs in North Africa

Ischemic stroke, responsible for 87% of stroke cases globally, imposes a significant burden on healthcare systems, particularly in under-resourced regions. This multicenter retrospective cohort study analyzed ischemic stroke (AVCi) prevalence across four North African cardiology centers (2017–2025) to delineate demographic and regional risk patterns. Utilizing harmonized electronic health record (EHR) data from 7,298 adults with cardiovascular risk factors, we identified AVCi cases via ICD-10 codes (I63) and radiologic confirmation, validated through natural language processing (NLP) and adjudication. The overall AVCi prevalence was 1.59% (95% CI 1.32–1.91%), with exponential increases in older adults (4.55% in ≥90 years; adjusted OR 9.01, *p*<0.001). Males exhibited 49% higher odds of AVCi than females (p*=0.038), while tobacco use showed a non-significant 18% elevated risk (*p*=0.452), potentially confounded by younger smoker demographics. Hypertension (2.3-fold increased prevalence) and atrial fibrillation (38.8% prevalence in AVCi cases) emerged as dominant modifiable drivers, yet only 63.8% of high-risk patients received guideline-directed anticoagulation, with marked inter-center variability (52–78%, *p*=0.012). These findings underscore critical gaps in secondary prevention and highlight the imperative for age- and sex-tailored interventions in cardiology populations. The study further emphasizes the role of region-specific epidemiological data in addressing disparities, particularly in low- and middle-income countries where stroke burden is escalating. Limitations include retrospective design and potential EHR misclassification, necessitating future prospective cohorts with biomarker integration. This work provides actionable insights for optimizing stroke prevention strategies and standardizing care protocols in resource-limited settings