Analysis of 425,675 stroke patients across England revealed standardized annual stroke incidence increased from 227.6 to 244.8 per 100,000 between 2020-2023. Electronic health record linkage uncovered that 10.8% of non-fatal ischemic strokes were recorded exclusively in primary care, while 19.4% of fatal strokes appeared only in death records. Among ischemic stroke survivors, 89.1% received antiplatelet or anticoagulant therapy, but only 44.5% received antihypertensive medications despite hypertension being a major stroke risk factor. This comprehensive surveillance approach represents a significant advance in stroke care monitoring, particularly revealing how pandemic-related healthcare disruptions affected both stroke recognition and outcomes. The study introduces 'home-time' as a disability proxy, showing patients averaged 166.6 days at home within 180 days post-stroke, declining with age and stroke severity. However, this preprint awaits peer review, and the observational design cannot establish whether medication gaps directly impact outcomes. The findings suggest substantial opportunities to improve secondary prevention, especially blood pressure management, which could prevent thousands of recurrent strokes annually across England's healthcare system.