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Norrving B, Barrick J, Davalos A, Dichgans M, Cordonnier C, Guekht A, Kutluk K, Mikulik R, Wardlaw J, Richard E, Nabavi D, Molina C, Bath PM, Stibrant Sunnerhagen K, Rudd A, Drummond A, Planas A, Caso V. Action Plan for Stroke in Europe 2018-2030. Eur Stroke J 2018; 3:309-336. [PMID: 31236480 PMCID: PMC6571507 DOI: 10.1177/2396987318808719] [Citation(s) in RCA: 274] [Impact Index Per Article: 45.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Accepted: 10/01/2018] [Indexed: 12/21/2022] Open
Abstract
Two previous pan-European consensus meetings, the 1995 and 2006 Helsingborg meetings, were convened to review the scientific evidence and the state of current services to identify priorities for research and development and to set targets for the development of stroke care for the decade to follow. Adhering to the same format, the European Stroke Organisation (ESO) prepared a European Stroke Action Plan (ESAP) for the years 2018 to 2030, in cooperation with the Stroke Alliance for Europe (SAFE). The ESAP included seven domains: primary prevention, organisation of stroke services, management of acute stroke, secondary prevention, rehabilitation, evaluation of stroke outcome and quality assessment and life after stroke. Research priorities for translational stroke research were also identified. Documents were prepared by a working group and were open to public comments. The final document was prepared after a workshop in Munich on 21-23 March 2018. Four overarching targets for 2030 were identified: (1) to reduce the absolute number of strokes in Europe by 10%, (2) to treat 90% or more of all patients with stroke in Europe in a dedicated stroke unit as the first level of care, (3) to have national plans for stroke encompassing the entire chain of care, (4) to fully implement national strategies for multisector public health interventions. Overall, 30 targets and 72 research priorities were identified for the seven domains. The ESAP provides a basic road map and sets targets for the implementation of evidence-based preventive actions and stroke services to 2030.
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Affiliation(s)
- Bo Norrving
- Department of Clinical Sciences Lund, Neurology, Skåne
University Hospital, Lund University, Lund, Sweden
| | | | - Antoni Davalos
- Department of Neurosciences, Hospital Universitari Germans Trias
i Pujol, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Martin Dichgans
- Institute for Stroke and Dementia Research, University Hospital,
Ludwig-Maximilians University, Munich, and Munich Cluster of Systems Neurology
(SyNergy), Munich, Germany
| | | | - Alla Guekht
- Clinical Center for Neuropsychiatry, Russian National Research
Medical University, Moscow, Russia
| | - Kursad Kutluk
- Department of Neurology, Stroke Unit, University of Dokuz Eylul,
Izmir, Turkey
| | - Robert Mikulik
- International Clinical Research Center and Neurology Department,
St Anne's University Hospital Brno and Masaryk University Brno, Czech
Republic
| | - Joanna Wardlaw
- Centre for Clinical Neurosciences, Edinburgh Imaging and UK
Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | - Edo Richard
- Department of Neurology, Radboud University Medical Centre,
Nijmegen, and Department of Neurology, Academic Medical Centre, Amsterdam, the
Netherlands
| | - Darius Nabavi
- Department of Neurology with Stroke Unit, Vivantes Hospital
Neukölln, Berlin, Germany
| | - Carlos Molina
- Stroke Unit, Department of Neurology, Hospital Vall d´Hebron
Barcelona, Spain
| | - Philip M Bath
- Stroke Trials Unit, Division of Clinical Neuroscience,
University of Nottingham, Nottingham, UK
| | | | - Anthony Rudd
- Guy's and St Thomas' NHS Foundation Trust, Stroke NHS England
and Royal College of Physicians, London, UK
| | - Avril Drummond
- School of Health Sciences, University of Nottingham,
Nottingham, UK
| | - Anna Planas
- Institut d'Investigacions Biomèdiques de Barcelona (IIBB),
Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona,
Spain
| | - Valeria Caso
- Stroke Unit, Department of Medicine and Cardiovascular
Medicine, University of Perugia, Perugia, Italy
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Webb A, Heldner MR, Aguiar de Sousa D, Sandset EC, Randall G, Bejot Y, van der Worp B, Caso V, Fischer U. Availability of secondary prevention services after stroke in Europe: An ESO/SAFE survey of national scientific societies and stroke experts. Eur Stroke J 2018; 4:110-118. [PMID: 31259259 PMCID: PMC6572590 DOI: 10.1177/2396987318816136] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Accepted: 11/01/2018] [Indexed: 11/15/2022] Open
Abstract
Background Recurrent stroke is associated with increased disability and cognitive impairment, but the availability of secondary prevention measures after transient ischaemic attack (TIA) or stroke in Europe is uncertain. This limits prioritisation of investment and development of national stroke strategies. Methods National stroke representatives throughout Europe were surveyed. Consensus panels reported national data if available, or else expert opinion, estimating the availability of each intervention by quintiles of patients, dichotomised for analysis at 60%. Countries were classified into tertiles of gross domestic product per capita. Results Of 50 countries, 46 responded; 14/45 (31%) had national stroke registries and 25/46 (54.3%) had national stroke strategies incorporating secondary prevention. Respondents reported that the majority of TIA patients were assessed by specialist services within 48 hours in 74.4% of countries, but in nine countries more than 20% of patients were seen after more than seven days and usually assessed by non-specialists (7/46 countries). Eighty percent of countries deferred blood pressure assessment to primary care, whilst lifestyle management programmes were commonly available in only 46% of countries. Although basic interventions were widely available, interventions frequently not available to more than 60% of patients included: ambulatory cardiac monitoring (40% countries); prescription (26%) and continuation (46%) of statins; blood pressure control at follow-up (44%); carotid endarterectomy within one month (15%); face-to-face follow-up in hospital (33%); direct oral anticoagulants (21%). Gross domestic product per capita and reimbursement of interventions were the commonest predictors of availability of interventions. Conclusions Provision of secondary prevention varied, with gaps in care prevalent throughout Europe, particularly in lower income countries.
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Affiliation(s)
- A Webb
- Centre for Prevention of Stroke and Dementia, University of Oxford, Oxford, UK
| | - M R Heldner
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - D Aguiar de Sousa
- Department of Neurosciences and Mental Health (Neurology), Hospital de Santa Maria, University of Lisbon, Lisbon, Portugal
| | - E C Sandset
- Department of Neurology, Oslo University Hospital, Oslo, Norway.,Department of Research and Development, the Norwegian Air Ambulance Foundation, Oslo, Norway
| | - G Randall
- Stroke Alliance for Europe, Brussels, Belgium
| | - Y Bejot
- Dijon Stroke Registry, EA7460, Pathophysiology and Epidemiology of Cerebro-Cardiovascular diseases (PEC2), University Hospital of Dijon, University of Burgundy, Dijon, France
| | - B van der Worp
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - V Caso
- Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - U Fischer
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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