Across Europe over the last two decades there has been a welcome reduction in the proportion of people having a stroke (when taking age into account). And people’s chance of recovering from their stroke has greatly improved. Europe boasts some of the best stroke care in the world, has pioneered important developments in the prevention and treatment of stroke, has an active stroke research community and has patient advocacy organisations in almost every country.

But, despite this progress, the numbers of strokes are set to rise because the proportion of Europeans over 70 is increasing. The projections in this report indicate that between 2015 and 2035, overall there will be a 34% increase in total number of stroke events in the EU from 613,148 in 2015 to 819,771 in 2035. Stroke prevention should, therefore, be a high priority. Despite most European countries having guidelines for risk factors such as high blood pressure and atrial fibrillation, there is significant under-treatment. And well below half of all people treated for high blood pressure, for example, are actually on enough medication to get their blood pressure below the desired target level.

While death rates from stroke have been falling over the last twenty years, your chance of dying from a stroke varies greatly according to where in Europe you live. Currently, rates of deaths from stroke in different countries range from 30 per 100,000 of the population to 170 per 100,000 of the population. Falling death rates due to better and quicker treatment mean that there will be more people surviving their strokes and living with the consequences. So the estimated total cost of stroke in Europe (healthcare and non-healthcare costs) of an estimated 45 billion euros in 2015 is set to rise.

When it comes to stroke care, the inequalities across the continent are apparent. For example, in some European countries we are concerned about how effective public education campaigns to encourage an emergency response to stroke are. But in many places across Europe emergency services specialised in stroke simply do not exist. Thrombolysis (clot-busting treatment) rates vary from less than 1% of patients to 16%.

Despite over thirty years of evidence showing the difference stroke units make, only about 30% of patients receive stroke unit care across Europe. The proportion of people who get treated on a stroke unit varies from less than 10% to over 80%, depending on where you live. Existing European Stroke Organisation guidelines are not consistently applied and a continent- wide, evidence-based system of specialist stroke care is yet to be realised.

Access to rehabilitation and long-term support is also a significant issue in many parts of Europe. Provision of rehabilitation is not widely monitored in many parts of Europe and even where there are audits, people often receive therapies during only brief periods of each day in hospital. In several countries there is very limited access to therapies once people are at home. There are no outpatient therapy services in two out of every five EU countries.

SAFE commissioned the Burden of Stroke study to show each EU country where it stands in terms of the stroke burden and how well it is meeting the need for acute and follow-up care, including examples of good practice. The research findings for this report have led SAFE to generate a number of action points for EU policy makers, national health service representatives and stroke support organisations.

SAFE is a non-profit-making organisation that represents a range of stroke patient groups from across Europe whose mutual goal is to drive stroke prevention and care up the European and national political agendas, prevent the incidence of stroke through education and support stroke care and patient centred research. SAFE aims to raise awareness of the major impact stroke has on individuals and on the health and economy of Europe.

Jon Barrick, SAFE President