Stroke is a brain attack, affecting 17 million people  worldwide  each  year.  It  is  the second most common cause of death[1] and a leading cause of adult physical disability[2].

Stroke survivors can experience a wide range of outcomes that are long-lasting, including problems with mobility, vision, speech and memory; personality changes; fatigue; and depression[3, 4].

SAFE commissioned King’s College London to produce a white paper describing the burden of stroke globally for publication in 2007. At the time of writing that report, there was no up to date, comprehensive assessment of the numbers of people having stroke, dying from stroke or living with disability as a result of stroke in most European  Union  countries.  Since  then,  a large global and regional study of these numbers has been undertaken as part of the Global Burden of Diseases, Injuries, and Risk Factors Study[5]. The present study uses the most recent available data to describe stroke epidemiology, prevention and care across the EU.

Scope of the study and methods

In order to frame the study and enable comparisons across countries and regions, SAFE required the inclusion of a number of indicators of stroke care quality. There are potentially many such indicators that could have been included; to keep the study manageable in the available time, a shortlist of 12 indicators was chosen (Appendix 2.1) in discussion with colleagues at King’s College London and SAFE to reference different parts of the stroke care ‘pathway’, from prevention to long-term care and support.

Information on these indicators and the epidemiology of stroke in each country was gathered through reviewing the scientific literature and by consulting with stroke researchers, clinicians and stroke support organisation representatives.

Structure of the report

The report is structured to reflect the stroke care pathway, and focuses on the 12 stroke care quality indicators. Each chapter starts with a brief, accessible introduction to the content.
Chapter 1 describes variations across Europe in the number of people who have strokes, and explains some of the key terminology and data sources. It estimates the future epidemiological picture for stroke in Europe.
Chapter 2 focuses on stroke prevention. It considers the provision of educational campaigns for the public, and describes how well (or inadequately) important stroke risk factors are being managed at population level.
Chapter 3 focuses on stroke as a medical emergency. It summarises evidence from different European countries of the level of public awareness of acute stroke symptoms, the existence of relevant training for healthcare professionals, and the impact of pre-hospital notification systems.
Chapter 4 describes the availability of organised acute stroke care, i.e. stroke unit care, and delivery of thrombolysis. It highlights the significant variation in availability and standardisation of stroke unit care across Europe, and explores some of the barriers to delivering thrombolysis.
Chapter 5 summarises the available data on hospital-based and community rehabilitation in the different countries, and longer term support for stroke survivors and their families from statutory and voluntary agencies.
The Recommendations section consolidates a number of action points proposed by SAFE board members, based on the evidence in this report and prioritised according to the advocacy interests of SAFE’s member organisations.

A summary of stroke epidemiology and data on the 12 stroke care quality indicators is provided for each EU and SAFE member country in a separate publication. Click here for data per country comparison.