Prevent, treat and support: An EU election manifesto for stroke survivors

The Stroke Alliance for Europe (SAFE) and the European Stroke Organisation (ESO) today launch their joint EU MEP Election Manifesto 2024. For the elections in June we are asking MEP candidates to support improving health across the EU with a focus on improving prevention, care and support of those affected by stroke across Europe. 

Every year, nearly 1.5 million people suffer a stroke in 32 European countries1. Stroke can be devastating – leading to death or life-long disability2, shattering the lives of victims and their loved ones. Those who survive will join the more than 9 million European stroke survivors who live with long term health, social, and financial impacts3. 

The EU Non-Communicable Disease Initiative, Healthier Together, launched by the European Commission in 2022, provides opportunities for policy action that both EU-level and national policymakers should build on. We call upon all EU level policymakers, to prioritise stroke in health policies, to support member states to develop national stroke plans and lead research into the under-examined areas of stroke. 

Following the principles of the Stroke Action Plan for Europe, SAFE and ESO are calling for the implementation of the following policy proposals:  

  1. Prior to a stroke
    1. Primary prevention and risk factor control 
    2. Implement legislation for public health interventions 
    3. Implement risk factor screening and treatment programmes 
  2.   Amidst the stroke
    1. Quality of care and stroke management 
    2. Ensure equal access to acute stroke care 
    3. Establish a quality improvement system for stroke services 
  3. Life after stroke 
    1. Prevent further stroke and take care of those who had one 
    2. Implement post-rehabilitation personal care plans that offer non-medical support 
    3. Provide sufficient secondary prevention services 
    4. Guarantee equitable access to rehabilitation prior and post discharge  
    5. Develop a European framework of reference for stroke care quality 
    6. Empower a dignified life after stroke 
  4. Understanding stroke 
    1. Provide sufficient research funding 
    2. Improve stroke services with better data 
    3. Encourage research into under-examined areas of stroke 

Click here for the full manifesto: 



  1. At what cost: The economic impact of stroke in Europe. University of Oxford for the Stroke Alliance for Europe (SAFE).  
  2. Sudharsanan, N., Deshmukh, M., & Kalkonde, Y. (2019). Direct estimates of disability-adjusted life years lost due to stroke : a cross-sectional observational study in a demographic surveillance site in rural Gadchiroli, India. BMJ open, 9(11), e028695. 
  3. Wafa, H. A., Wolfe, C. D. A., Emmett, E., Roth, G. A., Johnson, C. O., & Wang, Y. (2020). Burden of Stroke in Europe: Thirty-Year Projections of Incidence, Prevalence, Deaths, and Disability-Adjusted Life Years. Stroke, 51(8), 2418–2427. 

The Czech Republic signs the Stroke Action Plan for Europe declaration


We are very pleased to announce that the Czech Republic is the 13th country to endorse the Declaration for Action on Stroke and enact the Stroke Action Plan for Europe, bringing the country another step closer to guaranteeing the highest standard of care and support for stroke patients.

The document summarises the aims of the implementation of the Stroke Action Plan for Europe and by signing it, the governmental bodies in each country manifest their commitment to

  • acknowledge that cerebrovascular diseases, including stroke, are among the major causes of premature death long term disability, and cognitive decline
    in the adult population of Europe, and that many strokes are preventable and treatable with evidence-based and cost-effective strategies ;
  • support the Stroke Action Plan for Europe with the four overarching targets for 2030: (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
  • align with the WHO Global Action Plan for Prevention and Control of Noncommunicable Diseases 2013-2020 that aims for a 25% relative reduction in
    premature mortality from cardiovascular diseases, cancer, diabetes, or chronic respiratory diseases by 2025.

Fint out more about the Declaration on this page.

2023 SAP-E Annual Status Report

The 2023 Status Report emphasizing this years Stroke Action Plan-Europe achievements by the European Stroke Organisation (ESO) and Stroke Alliance for Europe (SAFE) is now available.

With the participation of 42 delegates representing 34 countries, the first on-site SAP-E National Coordinators’ meeting in Riga, Estonia in March has been one of the highlights of the year. The two-day programme included sharing experiences, workshops’ discussions and introduction of the new leadership structure, including regional spokespersons.

The SAP-E Steering Committee maintains its momentum by extending the successes attained in the present year:

The end of 2023 will be dedicated to strengthening our presence and advocacy activities at the EU level, starting the 2022 data collection for the SST and preparing the second on-site National Coordinators meeting in January 2024.

View the full status report here.

Stories of Stroke by Euan Haig

Having a Stroke

Saturday, 11th July 2015

A slightly late breakfast, my right hand suddenly refused to wrap its fingers round my coffee cup.  Puzzled, I stood up to go into my kitchen and found my right foot did not seem to know what to do.  Alarms rang.  I used my iPad to see what came up for ‘weak right hand and foot’.  Loads of entries about stroke.  I rang NHS 24.  Maybe a minute and a half into the conversation the chap on the other end said ‘You’re having a stroke.  You are going into the Edinburgh RI.  An ambulance is on its way and will be with you in less than 8 minutes.”

Not a lot to say except ‘thanks’.  I thought I’d better use what time was left whilst I still had mobility so I made sure my front door was unlocked and rang my son.  “I don’t wish to cause undue alarm but I am having a stroke.  An ambulance is on the way.”

“I’ll come now.”

“No point coming here, I’ll be in the RI by the time you arrive.”

“I’ll go there.”

I picked up my mobile phone, its charger, and some change.  The ambulance arrived.  I was chaired into it and had a fast drive about four miles to the RI.

I was chaired straight into ‘treatment’.  By then my right side was completely paralysed below my chin.  I had no facial droop.  In retrospect that might have caused clinicians to underestimate severity.
The admission process was very fast; a doctor gave me four Clopidogrel tablets as I sat and then I was put in bed.  I later found I had the tablets 38 minutes after I phoned NHS 24.

Thought “I am in the best place now.”  I had no fear of dying.  My son arrived.

A good hour passed.  The paralysis and I regained full mobility.  I felt fine.  I was examined again.  The doctor said I had had a TIA.  It had felt anything but transient but was nothing I could debate.  Later judgement was that the doctor had made a good call that I had had an aeschemic stroke rather than haemorrhagic stroke in which case Clopidogrel might have worsened the bleed.

I was discharged.  My son took me to meet friends that afternoon.  The paralysis slowly returned.  My long-suffering son took me home.  I ‘phoned the hospital number I’d been given and once again an ambulance appeared.  By around six pm I was back in a hospital bed.

This time I felt deeply tired.  There had been no pain, no headache, no muscle stiffness or aches.  Just complete immobility in my right side as before.

I fell asleep thinking again I was in the best place.  I did not fear it would kill me; rather I thought “It hasn’t killed me so far, so it probably wouldn’t”.

And that was the end of the first day of the rest of my life.


If You wish to Get Moving, Get Moving!

Sunday, 12th July 2015

The hospital woke me the way hospitals usually do.  I realised I wasn’t dead – I hadn’t expected anything else.  My left half could move but doing it all on its own meant nothing was fast or easy.  Somewhere after a difficult breakfast (and a long, heavy nap) the ward nurse told me the Consultant would see me on Monday morning and that would get the recovery organisation into action.  What’s the difference between God and a Consultant?  God doesn’t think he’s a Consultant!  (Sorry Fergus – I’m sure you have heard it!).  I had another long heavy nap, and a sort of wash in bed. One-armed, one-handed, and not very conscientious.

Then began a long day.  Even turning over in bed was difficult.  It seemed to take at least 5 minutes of great effort.  Jamming my good foot into the fence at the side of the bed gave me something to lever with or lever against, and lots of shoving with good arm, elbow and hand did the rest.  And once I was over I found I was better off where I’d been.  I thought I’d better make a good job of recovery.

Several long heavy naps before and after lunch.  The least effort required heavy rest after.  I was too knackered to be bored, I just slept.  I knew I had exactly the same musculature as 24 hours before and it was not they that had to recover, it was my brain.  It needed major retraining but I needed to know how to do it.  I was well aware of what I could not move.  Right arm and leg were utterly immobile.  I could feel things with them just as before but nothing moved, nothing responded.

I did not think where in my musculature was the dividing line between mobility and its absence?  I was too concerned with the very obvious fact of paralysis of my arm and leg to think about it.  If I had I would have realised the right half of my torso was just as paralysed as my arm and leg.  That was why it was so hard to turn over in bed.  The muscles that do all the arching of the back and all the bending of the body had lost interest, but it took fully a year to work it out.  Try turning over without arching your back or bending your body.  There are surprises there, I think, in the mechanics of the act.

The body needs all its bits to work for good overall motion.  I didn’t have that and didn’t know it’s full extent or importance.  Getting it all working is another story.

Open Call for Chief Operations Officer of SAP-E

To support SAP-E and ensure its success, we are looking for a motivated stroke care professional to take on the role of Chief Operations Officer (COO) within the SAP-E Steering Committee.

The COO will have a key role in the overall success of SAP-E by supporting and driving the implementation of SAP-E within Europe.

Interested candidates can download the call document for more information.

The application deadline is 14 November.

Annual Status Report reveals big strides for stroke in 2022

The European Stroke Organisation (ESO) and Stroke Alliance for Europe (SAFE) have published the 2022 status report highlighting progress made in the past year for the SAP-E.

One major achievement in the first half of 2022 has been the inclusion of stroke as a priority in the recent EU Non-Communicable Diseases Initiative – Healthier Together. SAFE and ESO worked closely with DG Sante, the EU Commission department responsible for their policies on health and food safety, in the co-creation process for the EU NCD initiative.

With this important collaboration, the SAP-E Steering Committee continues to build on its achievements from the current year:

• Establishment of a network of over 90 National Coordinators
• Translation of the Stroke Action Plan for Europe document in 12 languages
• Launch of the Declaration for Action on Stroke, with 8 countries currently signed
• Publication of the Essentials of Stroke Care guidelines
• Development of a National Stroke Plan Template
• Initiation of the yearly Stroke Service Tracker (SST) survey among 52 countries

Project plans for the second half of 2022 include further advocacy on the EU level, continued support in preparing actionable tools for National Coordinators, consolidation and publishing of the data from the 2020 SST, and awareness campaigns for stroke physicians, stroke survivors, and the general public.

View the full media statement here.

View the full status report here.

ESO and SAFE welcome the publication of the EU Healthier Together plan

The European Commission recently launched the EU Non-Communicable Diseases Initiative – Healthier Together to reduce the burden of non-communicable diseases (NCD), including stroke, and improve health and wellbeing.

From December 2021 to May 2022, the Stroke Alliance for Europe (SAFE) and the European Stroke Organisation (ESO) worked closely together with DG Sante, the EU Commission department responsible for their policies on health and food safety, in the co-creation process for the EU NCD initiative.

This has resulted in the publication of a toolkit to guide Member states and EU policymakers towards a holistic and coordinated approach for health promotion and disease prevention, treatment and care, for diseases including stroke.

The plan covers the period from 2022-2027 and prioritises four disease groups including diabetes, cardiovascular diseases, chronic respiratory diseases, mental health and neurological disorders and health determinants for all major NCDs. Recognising its significant health burden and opportunities for improvement, we are delighted to see that stroke is specifically drawn out as a priority area under mental health and neurological disorders.

The initiative underlines the vital importance of implementing a national stroke plan, increasing public awareness, and improving screening, encompassing the entire chain of care from primary prevention to life after stroke.

This builds on the Stroke Action Plan for Europe (SAP-E), prepared by ESO and SAFE for the years 2018 to 2030.

We look forward to working with DG Sante and the European Commission in implementing the initiative to improve stroke prevention, care and life after stroke for all affected by stroke in Europe.

Harriet Priois, SAFE President added:

“We welcome this response by the European Commission to the ongoing efforts of the health community to prioritise non-communicable diseases (NCDs) on the EU agenda. We worked together with the European Stroke Organisation on a joint response to the consultation which was based on the Stroke Action Plan for Europe and the Essentials of Stroke care guideline.

We are delighted that stroke is drawn out as a priority area and that the Stroke Action Plan must be implemented across Europe. This initiative gives us a strong opportunity to raise the profile of stroke within our countries and we hope it will contribute to reducing the stroke burden, and improve the quality of life of those living with stroke in Europe.”

Download the full report

Highlighting SAP-E successes on European Stroke Awareness Day

On the occasion of European Stroke Awareness Day 2022, the European Stroke Organisation (ESO) and Stroke Alliance for Europe (SAFE) are pleased to share the progress made toward reaching the 4 overarching targets of the Stroke Action Plan for Europe (SAP-E).

Over the past year, SAP-E has made great strides in reaching the goals set out in the Action Plan. As of today and thanks to the advocacy of the SAP-E National Coordinators, these achievements include:

  • Establishment of a network of National Coordinators
  • Translation of the Stroke Action Plan for Europe document in 12 languages
  • Launch of the Declaration for Action on Stroke
    • 8 countries currently signed
  • Publication of the Essentials of Stroke Care guidelines
  • Development of a National Stroke Plan Template
  • Initiation of the Stroke Service Tracker (SST) survey

Prof. Hanne Christensen, Professor of Neurology and Chair of the Stroke Action Plan for Europe says, “Stroke can be prevented and treated, but there is still a significant gap between knowledge and the delivery of stroke services. In early 2022 we [the SAP-E Steering Committee] launched the SST. This survey will enable us to monitor the progress of quality of care and outcomes. The yearly data collected from the SST will allow for benchmarking both over time and within countries, providing each country with the knowledge and data to facilitate the implementation of its national plan.”

Dr. Francesca Romana Pezzella, Stroke Neurologist and Stroke Action Plan for Europe Co-Chair adds, “The recent successes of our National Coordinators is extremely encouraging. SAP-E gives us a unified approach for stroke treatment and management to help us tackle inequalities in stroke care across European countries. We have developed tools such as the National Stroke Plan Template, which will help National Coordinators support the development of country-specific care plans.”

Arlene Wilkie, SAFE Director General and SAP-E implementation Co-Chair says, “Stroke is the biggest cause of adult disability in Europe with impacts on all aspects of life – economic, social, medical, physical and mental health. Together with ESO we have developed a number of documents and tools to improve stroke care, including an illustrated Fact Sheet on the basics of stroke and the Essentials of Stroke Care guidelines that give an overview of evidence-based interventions covering the entire chain of stroke care.”

Download the full media release

Ukraine signs the Stroke Action Plan for Europe Declaration

On 19 May 2021, Ukraine announced that the Ministry of Health of Ukraine along with the National Health Service of Ukraine support and have signed the Declaration for Action on Stroke.

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Declaration for Action on Stroke launches on European Stroke Awareness Day

An appeal is launched today (11 May 2021) for Health Ministries across Europe to sign the Declaration for Action on the Stroke Action Plan for Europe to tackle one of the leading causes of death and disability.

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