Ischemic stroke patients are at high risk for subsequent cardiovascular events. Despite this, an unacceptably high proportion of these patients do not receive treatment with evidence-based, guideline-recommended, vascular risk-reduction therapies when exposed to conventional care. The golden opportunity to most favorably influence the vascular future of stroke patients is at the initial encounter in the hospital or in the postdischarge setting. As such, there has been profound interest in identifying effective strategies and systems that increase the use of evidence-based therapies in the hospital and outpatient settings, to reduce the substantial morbidity and mortality that can result from recurrent vascular events after stroke. One strategy is the implementation of a stroke hospitalization quality-improvement program geared at optimizing appropriate drug therapy before discharge, intensifying patient education, and ensuring vigilant follow-up with early recognition and management of problems. Available evidence suggests that hospital-based systems can markedly improve medical care and education of hospitalized ischemic stroke patients, and increase longer-term patient adherence in the community.