Stroke Action Plan for Europe 2018-2030 (SAP-E): mid-term review and update.
Hanne Christensen, Francesca Romana Pezzella, Melinda Berg Roaldsen, Aleš Tomek, Arlene Wilkie, Louisa Christensen, Martin Dichgans, Avril Drummond, Tiina Laatikainen, Carlos A Molina, Katharina S Sunnerhagen, Danilo Toni, Sonia Abilleira, Diana Aguiar de Sousa, Anita Arsovska, Heinrich Audebert, Jelena Bartolovic, Yannick Béjot, Geert Jan Biessels, Juliet Bouverie, Hrvoje Budincevic, Barbara Casolla, Hugues Chabriat, Marina Charalambous, Jesse Dawson, Stephanie Debette, Frank-Erik de Leeuw, Adam Denes, Marina Diomedi, Diederik Dippel, Ulrich Dirnagl, Urs Fischer, Yuriy Flomin, Ana Catarina Fonseca, Birgitte Forchammer, Anne Forster, Giovanni Frisullo, Miquel Galofre, Zuzana Gdovinová, Christoph Gumbinger, Joseph Harbison, Richard Hobbs, Dalius Jatuzis, Hrvoje Jurlina, Mira Katan, Lisa Kidd, Stefan Kiechl, Janika Kõrv, Christina Kruuse, Wilfried Lang, Arthur Liesz, Svetlana Lorenzano, Andreas Luft, Grethe Lunde, Chris Macey, Hugh Stephan Markus, Gillian Mead, Patrik Michel, Serefnur Ozturk, Maurizio Paciaroni, Aleksandra Pavlovic, Carina U Persson, Terence J Quinn, Peter Rothwell, Luca Saba, Paola Santalucia, Gustavo Santo, Claus Simonsen, Thorsten Steiner, Katarzyna Stolarz-Skrzypek, Cristina Tiu, Alexander Tsiskaridze, Georgios Tsivgoulis, Jaakko Tuomilehto, Teresa Ulberg, Paolo Ursillo, Antonella Urso, Mia van Euler, Margus Viigimaa, Denis Vivien, Markus Wagner, Marion Walker, Alastair Webb, Diana Wong Ramos, Mauro Zampolini, Marialuisa Zedde, Gary Ford, Peter Kelly, Robert Mikulik, Bo Norrving, Hariklia Proios, Simona Sacco, Else Sandset, Joanna Wardlaw, Aleksandras Vilionskis, Valeria Caso
Journal: European stroke journal
2026;11(1):
PMID: 41614539
Abstract
OBJECTIVES
Implementation of the Stroke Action Plan for Europe (2018-2030) (SAP-E) was initiated in 2019. It is now updated at mid-term to reflect and respond to challenges for stroke care in Europe in 2025.
METHODS
The SAP-E covers the entire chain of stroke care. The sections (state of the art, current status and targets) were developed by working groups and finalised based on inputs from the Interim Review Committee and an open online meeting. Targets for 2030 were updated to reflect current knowledge, to prioritise and to increase accountability.
RESULTS
All sections have been updated based on the newest evidence to reflect the state of the art and current status in 2025.
CONCLUSION
Stroke remains a significant health issue in Europe, with notable incidence and inequities in access to care. Key interventions are strongly evidence-based, cost-effective and supported by World Health Organization and European Union recommendations. Despite improvements, gaps remain across the care pathway but particularly in terms of access to stroke units, rehabilitation and follow-up. To control and reduce the burden of stroke, the main action points are: (1) national stroke plans, which encompass the entire chain of care and are reflected in reimbursement systems, (2) quality and outcome control, where impact is measured at both individual and health care system level, (3) robust and resilient health care organisation covering the entire chain of care that promotes equal access to sustainable, timely and evidence-based stroke care and (4) effective national strategies to promote and facilitate a healthy lifestyle and risk factor control.
© The Author(s) 2026. Published by Oxford University Press on behalf of the European Stroke Organisation.
Address:
Department of Neurology, Copenhagen University Hospital, Bispebjerg, Copenhagen, Denmark.; Department of Neuroscience, San Camillo-Forlanini Hospital, Rome, Italy.; Clinical Research Department, University Hospital of North Norway, Tromsø, Norway.; Department of Clinical Medicine, UiT, The Arctic University of Norway, Tromsø, Norway.; Neurology Department, Second Medical Faculty of Charles University and University Hospital Motol, Prague, Czech Republic.; Stroke Alliance for Europe, London, United Kingdom.; LMU Clinic, Institute for Stroke and Dementia Research, Munich, Germany.; School of Health Sciences, University of Nottingham, Nottingham, United Kingdom.; Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.; Hospital Vall d'Hebron, Barcelona, Catalonia.; Department of Rehabilitation Medicine, University of Gothenburg, Gothenburg, Sweden.; University La Sapienza, Rome, Italy.; Ministry of Health, Stroke Programme for Catalonia, Fundació TIC Salut Social, Bracelona, Catalonia.; Lisbon Central University Hospital, ULS São José, Lisbon, Portugal.; Faculdade de Medicina, Universidade de Lisboa, Gunbenkian Institute for Molecular Medicine, Lisbon, Portugal.; Stroke Center, University Clinic of Neurology, University "Ss. Cyril and Methodius," Faculty of Medicine, Skopje, North Macedonia.; Department of Neurology and Center for Stroke Research, Charité Universitaetsmedizin, Berlin, Germany.; University Hospital Sveti Duh, Zagreb, Croatia.; Department of Neurology, Dijon University Hospital, Dijon, France.; Department of Neurology, UMC Utrecht, Utrecht, The Netherlands.; Stroke Association, London, United Kingdom.; Department of Neurology, Sveti Duh University Hospital, Zagreb, Croatia.; Department of Neurology, Université Cote d'Azur UR2CA-URRIS, CHU Hôpital Pasteur 2, Nice, France.; Department of Neurology, CNVT (APHP) and INSERM, University of Paris Cité, Paris, France.; Department of Rehabilitation Sciences, Cyprus University of Technology, Limassol, Cyprus.; School of Cardiovascular and Metabolic Health College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, United Kingdom.; Department of Epidemiology and Neurology, University of Bordeaux, Bordeaux University Hospital, Inserm, Bordeaux, France.; Department of Neurology, Research Institute for Medical Innovation, Radboudumc, Nijmegen, The Netherlands.; HUN-REN Institute of Experimental Medicine, Budapest, Hungary.; University Hospital of Rome Tor Vergata, Rome, Italy.; Department of Neurology, Erasmus MC Stroke Center Erasmus MC University Medical Center, Rotterdam, The Netherlands.; Department of Experimental Neurology, Charite Universitätsmedizin Berlin and Berlin Institute of Health, Berlin, Germany.; Department of Neurology, University Hospital Bern and University of Bern, Bern, Switzerland.; Department of Neurology, Shupyk National University of Healthcare of Ukraine and Medical Center "Universal Clinic 'Oberig'", Kyiv, Ukraine.; Department of Neurology, Hospital de Santa Maria, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.; Danish Stroke Association, Copenhagen, Denmark.; University of Leeds, Leeds, United Kingdom.; Department of Neurology, Fondazione Policlinico Agostino Gemelli, IRCCS - Department of Neuroscience, Catholic University of the Sacred Heart, Rome, Italy.; Faculty of Medicine and Health, Department of Neurology and Rehabilitation, Örebro University, Örebro, Sweden.; Department of Neurology, P.J. Safarik University Kosice, Faculty of Medince and University Hospital L. Pasteur Kosice, Slovakia.; Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany.; Department of Medical Gerontology, Trinity College Dublin and Irish National Audit of Stroke, Dublin, Ireland.; University of Oxford, Oxford, United Kingdom.; Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.; Stroke Survivor, Stroke Alliance for Europe, Faculty of Family medicine, Zagreb Medical School, Zagreb, Croatia.; Department of Neurology, University Hospital of Basel, Basel, Switzerland.; Department of Nursing, School of Health & Life Sciences, Glasgow Caledonian University, Glasgow, United Kingdom.; Department of Neurology, Medical University of Innsbruck, , VASCage, Innsbruck, Austria.; Department of Neurology and Neurosurgery, University of Tartu, Tartu, Estonia.; Department of Brain and Spinal Cord Injury, Neuroscience Center, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark.; Department Neurology, Neurovascular Research Unit, University Hospital - Herlev Gentofte, Herlev, Denmark.; Medical Faculty, Sigmund Freud Private University, Vienna, Austria.; Department of Neurology, LMU Hospital, Munich, Germany.; Department of Human Neurosciences, Sapienza, University of Rome, Rome, Italy.; Cereneo Center for Neurology and Rehabilitation, University Hospital Zurich, Vitznau, Switzerland.; Stroke Survivor, Stroke Alliance for Europe, Norway.; University of Cambridge, Cambridge, United Kingdom.; Stroke and Elderly Care Medicine, University of Edinburgh and NHS Lothian, Edinburgh, United Kingdom.; Department of Neurology Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.; Department of Neurology, Selcuk University Faculty of Medicine, Konya, Turkey.; Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy.; Department of Neurology, Faculty of Special Education and Rehabilitation, University of Belgrade, Belgrade, Serbia.; Department of Neuroscience and Physiology, Rehabilitation Medicine, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.; Department of Medicine, University of Gothenburg and Department of Medicine, Geriatrics and Emergency Medicine, Centre for Lifestyle Intervention, Sahlgrenska University Hospital/Östra, Gothenburg, Region Västra Götaland, Sweden.; Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital/Östra, Gothenburg, Region Västra Götaland, Sweden.; Department of Geriatric Medicine, University of Glasgow, Glasgow, United Kingdom.; Department of Neurology, University of Oxford, Oxford, United Kingdom.; Department of Radiology, AOU Cagliari, Cagliari, Italy.; Department of Neurology, Staff Direzione Strategica, AOSGA, Roma, Italy.; Department of Neurology, Hospitais da Universidade de Coimbra, Unidade Local de Saúde, Coimbra, Portugal.; Department of Neurology, Aarhus University Hospital, Aarhus, Denmark.; Department of Neurology, Varisano Krankenhaus Frankfurt Höchst, Frankfurt, Germany.; Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany.; First Department of Cardiology and Hypertension, Jagiellonian University Medical College, Krakow, Poland.; Department of Clinical Neurosciences, University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania.; Ivane Javakhishvili Tbilisi State University, Pineo Medical Ecosystem, Tbilisi, Georgia.; Second Department of Neurology, "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.; Department of Public Health, University of Helsinki, Helsinki, Finland.; Department of Neurology, Skåne University Hospital in Malmö/Lund, Malmö, Sweden.; Department of Clinical Sciences, Neurology, Lund University, Lund, Sweden.; Department of Hygiene and Public Health, Agenas-Italian Agency for Regional Health Services, Rome, Italy.; Department of Health Economics, Health Department of the Lazio Region, Rome, Italy.; Clinical Research Department, University Hospital of Northern Norway, Tromsø, Norway.; Department of Clinical Medicine, UiT, The Arctic University of Norway, Tromsø, Norway.; Center of Cardiology, Tallinn University of Technology, North Estonia Medical Centre, Tallinn, Estonia.; Department of Neurobiology, Centre Hospitalier Universitaire Caen Normandie, Caen, France.; German Stroke Foundation, Gladbeck, Germany.; Department of Stroke Rehabilitation, University of Nottingham, Nottingham, United Kingdom.; Department of Stroke Medicine, Department of Brain Sciences, Imperial College London, London, United Kingdom.; Portugal AVC-União de Sobreviventes, Familiares e Amigos, Lisbon, Portugal.; Department of Neurology and Physical and Rehabilitation Medicine, Department of Rehabilitation, USLUMBRIA2, Foligno, Italy.; Stroke Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy.; Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom.; Department of Stroke Service, Mater University Hospital, Dublin, Ireland.; Department of Neurology, University College Dublin, Dublin, Ireland.; Department of HRB Stroke, Clinical Trials Network Ireland, Dublin, Ireland.; Department of Mater Misericordiae, University Hospital, Dublin, Ireland.; School of Medicine, University College Dublin, Dublin, Ireland.; Health Research Board, Stroke Clinical Trials, Network Ireland, Dublin, Ireland.; Department of Neurology, International Clinical Research Center, St Anne's University Hospital, Masaryk University Brno, Brno, Czech Republic.; Neurology Department, Tomas Bata Hospital, Zlín, Czech Republic.; Department of Neurology, Lund University Department of Clinical Sciences Lund, Skåne University Hospital, Lund, Sweden.; Department of Neurocognitive Disorders and Rehabilitation, Department of Educational and Social Policy, University of Macedonia, Thessaloniki, Greece.; Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.; Department of Neurology, Oslo University Hospital, Oslo, Norway.; Centre for Clinical Brain Sciences, University of Edinburgh, UK and UK Dementia Research Institute Centre, University of Edinburgh, Edinburgh, United Kingdom.; Stroke Center, Republican Vilnius University hospital, Vilnius, Lithuania.; Department of Emergency and Cardiovascular Medicine, Santa Maria Della Misericordia, Perugia, Italy.