A 'scandalous' shortage of stroke treatment units spells lower level of care in Wales.
People who suffer a stroke are more likely to die or experience life-long disabilities in Wales than in England because of a lack of expert care.
An annual audit of stroke services has again exposed the "scandalous" shortage of dedicated stroke units in Wales.
Just nine Welsh hospitals - fewer than 50% - have a stroke unit, compared to 97% in England.
As a result only about a quarter of people who suffer a stroke - one of Wales' biggest killers - will be admitted to or treated on a stroke unit.
Patients who are managed on stroke units have much better results than patients looked after in other settings.
Experts last night said the late introduction of key guidelines for older people's health services in Wales had "handicapped" stroke care.
Dr Tony Rudd, chairman of the Intercollegiate Stroke Network and associate director of the Royal College of Physicians' (RCP) clinical effectiveness and evaluation unit, said, "The failure of the majority of hospitals in Wales to offer stroke unit care is scandalous and needs urgent action.
"People need to realise how they get treated and how the health service responds to stroke can make a big difference in the long term.
"If it can be done in England, it should be feasible anywhere."
And Dr Hamsaraj Shetty, a consultant physician with an interest in stroke treatment, at the University Hospital of Wales, said, "This is not the first time that Wales has come bottom of the league table.
"What is disappointing is that in spite of repeated reports from the RCP that Wales is not doing well, nothing seems to have changed.
"Over the last 15 years a number of important advances in terms of diagnosis, prevention of stroke have taken place but they have not been translated to Welsh patients."
The 2006 National Sentinel Audit for Stroke, funded by the Healthcare Commission and carried out by the RCP, also found that only 38% of patients had brain imaging to confirm their diagnosis within 24 hours of the onset of symptoms.
The report said this figure is "unacceptably low and must be improved".
Patients need a brain scan to determine if it is appropriate to prescribe aspirin - if given within 48 hours of a stroke it can save lives and reduce disability.
The introduction of the National Service Framework for older people in England in 2001, which set targets for stroke care, has been credited with improving stroke services.
But in Wales a similar NSF was introduced only in 2006 - it has been described by stroke experts as "a bit toothless" with no targets or imperatives.
Joe Korner, director of communications for the Stroke Association, said, "Radical improvements in stroke care are within our reach. The government has the chance to do for stroke what has been achieved for heart disease in the last 10 years.
"It is vital that stroke gets the priority and investment needed - without investment hundreds will die needlessly."
A spokesman for the Welsh Assembly Government said, "The 2006 RCP audit report demonstrates that health services in Wales for people who have suffered a stroke require improvement.
"The Welsh Assembly Government's strategy for improving the quality of stroke services is through the progressive implementation of the standards set out in the National Service Framework for Older People published in March 2006.
"Over the last year, NHS organisations in Wales have been required to develop more appropriate models of care for patients suffering with strokes. From 2007-2008, local health boards must improve their commissioning of stroke services.
"Officials at the Welsh Assembly Government will work with the NHS to develop clear national priorities for action."