Comprehensive stroke care is an interdisciplinary challenge. Close collaboration of cardiologists and stroke physicians is critical to ensure optimum utilisation of short- and long-term care and preventive measures in patients with stroke. Risk factor management is an important strategy that requires cardiologic involvement for primary and secondary stroke prevention. Treatment of stroke generally is led by stroke physicians, yet cardiologists need to be integrated care providers in stroke units to address all cardiovascular aspects of acute stroke care, including arrhythmia management, blood pressure control, elevated levels of cardiac troponins, valvular disease/endocarditis, and the general management of cardiovascular comorbidities. Despite substantial progress in stroke research and clinical care has been achieved, relevant gaps in clinical evidence remain and cause uncertainties in best practice for treatment and prevention of stroke. The Cardiovascular Round Table of the European Society of Cardiology together with the European Society of Cardiology Council on Stroke in cooperation with the European Stroke Organisation and partners from related scientific societies, regulatory authorities and industry conveyed a two-day workshop to discuss current and emerging concepts and apparent gaps in stroke care, including risk factor management, acute diagnostics, treatments and complications, and operational/logistic issues for health care systems and integrated networks. Joint initiatives of cardiologists and stroke physicians are needed in research and clinical care to target unresolved interdisciplinary problems and to promote the best possible outcomes for patients with stroke.

BCRT Berlin Institute of Health Center for Regenerative Therapies Berlin Germany

Berlin Institute of Health Germany

British Heart Foundation Centre of Research Excellence Oxford

Cardicenter Charles University 3rd Faculty of Medicine University Hospital Kralovske Vinohrady Prague Czech Republic

Cardiovascular and Cell Sciences Institute St George's University of London UK

Cardiovascular Division Harvard Medical School USA

Center for Stroke Research Berlin Charité Universitätsmedizin Berlin Germany

CTSU Nuffield Department of Population Health University of Oxford UK

Department of Cardiac Electrophysiology University of Leipzig Germany

Department of Cardiology Charité Universitätsmedizin Berlin Germany

Department of Cardiology partner site Berlin Universitätsmedizin Berlin Germany

Department of Internal Medicine and Cardiology Medical University of Warsaw Poland

Department of Medicine University of Thessaly Greece

Department of Neurology Charité Universitätsmedizin Berlin Germany

Department of Neurology Lariboisière Hospital University of Paris France

Department of Radiology Charles University and University Hospital Hradec Kralove Czech Republic

Deutsches Herzzentrum München Technische Universität München Germany

Division of Cardiovascular Medicine University of Oxford UK

Emergency Department University Hospital of Lille France

Faculty of Medicine University Duisburg Essen Germany

German Centre for Cardiovascular Research Partner site Berlin Germany

German Centre for Cardiovascular Research Partner site Munich Germany

Institute of Cardiovascular and Medical Sciences University of Glasgow UK

IRCCS San Raffaele Hospital Roma Italy

Kazimierz Pulaski University of Technology and Humanities Poland

Merck and Co Inc Kenilworth USA

Molecular and Clinical Sciences Research Institute St George's University of London UK

Neurology Clinic University of Belgrade Serbia

Nuffield Department of Surgical Sciences John Radcliffe Hospital UK

Population Health Research Institute McMaster University and Hamilton Health Sciences Canada

Santa Maria della Misericordia Hospital University of Perugia Italy

Service de Neuroradiology Hopital Purpan France

Siemens Healthcare GmbH Germany

Stroke Research Group University of Cambridge UK

Stroke Unit Emergency Department S Camillo Forlanini Hospital Italy

Stroke Unit Vall d'Hebron University Hospital Spain

Eur J Prev Cardiol. 2020 May;27(7):679-681. doi: 10.1177/2047487319877707. PubMed

Eur J Prev Cardiol. 2020 Aug;27(12):NP1. doi: 10.1177/2047487320940615. PubMed

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Shah R, Wilkins E, Nichols M, et al. Epidemiology report: Trends in sex-specific cerebrovascular disease mortality in Europe based on WHO mortality data. Eur Heart J 2019; 40: 755–764. PubMed PMC

Wilkins E, Wilson L, Wickramasinghe K, et al. European Cardiovascular Disease Statistics 2017. Brussels: European Heart Network, 2017.

Adams HP, Jr, Bendixen BH, Kappelle LJ, et al. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke 1993; 24: 35–41. PubMed

Widimsky P, Doehner W, Diener HC, et al. on behalf of the ESC Council on Stroke. The role of cardiologists in stroke prevention and treatment: Position paper of the European Society of Cardiology Council on Stroke. Eur Heart J 2018; 39: 1567–1573. PubMed

European Society of Cardiology. Cardiovascular round table, https://www.escardio.org/The-ESC/What-we-do/Initiatives/Cardiovascular-Round-Table (2019, accessed 20 August 2019).

Bonaccio M, Di Castelnuovo A, Costanzo S, et al. Moli-sani Study Investigators. Health-related quality of life and risk of composite coronary heart disease and cerebrovascular events in the Moli-sani study cohort. Eur J Prev Cardiol 2018; 25: 287–297. PubMed

Ferrieres J, Lautsch D, Ambegaonkar BM, et al. Use of guideline-recommended management in established coronary heart disease in the observational DYSIS II study. Int J Cardiol 2018; 270: 21–27. PubMed

Zeller T, Schnabel RB, Appelbaum S, et al. Low testosterone levels are predictive for incident atrial fibrillation and ischaemic stroke in men, but protective in women – results from the FINRISK study. Eur J Prev Cardiol 2018; 25: 1133–1139. PubMed

O'Donnell MJ, Chin SL, Rangarajan S, et al. Global and regional effects of potentially modifiable risk factors associated with acute stroke in 32 countries (INTERSTROKE): A case-control study. Lancet 2016; 388: 761–775. PubMed

Law MR, Morris JK, Wald NJ. Use of blood pressure lowering drugs in the prevention of cardiovascular disease: Meta-analysis of 147 randomised trials in the context of expectations from prospective epidemiological studies. BMJ 2009; 338: b1665. PubMed PMC

Williams B, Mancia G, Spiering W, et al. 2018 ESC/ESH guidelines for the management of arterial hypertension. Eur Heart J 2018; 39: 3021–3104. PubMed

Muntner P, Whelton PK. Using predicted cardiovascular disease risk in conjunction with blood pressure to guide antihypertensive medication treatment. J Am Coll Cardiol 2017; 69: 2446–2456. PubMed PMC

Chang TI, Reboussin DM, Chertow GM, et al. SPRINT Research Group. Visit-to-visit office blood pressure variability and cardiovascular outcomes in SPRINT (Systolic Blood Pressure Intervention Trial). Hypertension 2017; 70: 751–758. PubMed PMC

Lewington S, Whitlock G, Clarke R, et al. Blood cholesterol and vascular mortality by age, sex, and blood pressure: A meta-analysis of individual data from 61 prospective studies with 55,000 vascular deaths. Lancet 2007; 370: 1829–1839. PubMed

Hindy G, Engstrom G, Larsson SC, et al. Role of blood lipids in the development of ischemic stroke and its subtypes: A Mendelian randomization study. Stroke 2018; 49: 820–827. PubMed PMC

Osawa K, Trejo MEP, Nakanishi R, et al. Coronary artery calcium and carotid artery intima-media thickness for the prediction of stroke and benefit from statins. Eur J Prev Cardiol 2018; 25: 1980–1987. PubMed

Cottel D, Montaye M, Marécaux N, et al. Comparison of the rates of stroke and acute coronary events in northern France. Eur J Prev Cardiol 2018; 25: 1534–1542. PubMed

Halliday A, Harrison M, Hayter E, et al. 10-Year stroke prevention after successful carotid endarterectomy for asymptomatic stenosis (ACST-1): A multicentre randomised trial. Lancet 2010; 376: 1074–1084. PubMed PMC

Bonaca MP, Goto S, Bhatt DL, et al. Prevention of stroke with ticagrelor in patients with prior myocardial infarction: Insights from PEGASUS-TIMI 54 (Prevention of Cardiovascular Events in Patients With Prior Heart Attack Using Ticagrelor Compared to Placebo on a Background of Aspirin-Thrombolysis in Myocardial Infarction 54). Circulation 2016; 134: 861–871. PubMed

Ganesan AN, Chew DP, Hartshorne T, et al. The impact of atrial fibrillation type on the risk of thromboembolism, mortality, and bleeding: A systematic review and meta-analysis. Eur Heart J 2016; 37: 1591–1602. PubMed

Wachter R, Groschel K, Gelbrich G, et al. Holter-electrocardiogram-monitoring in patients with acute ischaemic stroke (Find-AFRANDOMISED): An open-label randomised controlled trial. Lancet Neurol 2017; 16: 282–290. PubMed

Berntsson J, Smith JG, Nilsson PM, et al. Pro-atrial natriuretic peptide and prediction of atrial fibrillation and stroke: The Malmö Preventive Project. Eur J Prev Cardiol 2017; 24: 788–795. PubMed

Sulzgruber P, Wassmann S, Semb AG, et al. Oral anticoagulation in patients with non-valvular atrial fibrillation and a CHA2DS2-VASc score of 1: A current opinion of the European Society of Cardiology Working Group on Cardiovascular Pharmacotherapy and European Society of Cardiology Council on Stroke. Eur Heart J Cardiovasc Pharmacother 2019; 5: 171–180. PubMed

Hankey GJ, Jamrozik K, Broadhurst RJ, et al. Five-year survival after first-ever stroke and related prognostic factors in the Perth Community Stroke Study. Stroke 2000; 31: 2080–2086. PubMed

European Stroke Organisation. Action plan for stroke in Europe 2018–2030, https://eso-stroke.org/action-plan-stroke-europe-2018-2030-2/ (2019, accessed 20 August 2019).

Rothwell PM, Algra A, Chen Z, et al. Effects of aspirin on risk and severity of early recurrent stroke after transient ischaemic attack and ischaemic stroke: Time-course analysis of randomised trials. Lancet 2016; 388: 365–375. PubMed PMC

Ulvenstam A, Henriksson R, Söderström L, et al. Ischemic stroke rates decrease with increased ticagrelor use after acute myocardial infarction in patients treated with percutaneous coronary intervention. Eur J Prev Cardiol 2018; 25: 1219–1230. PubMed

Johnston SC, Easton JD, Farrant M, et al. Clinical Research Collaboration, Neurological Emergencies Treatment Trials Network, and the POINT Investigators. Clopidogrel and aspirin in acute ischemic stroke and high-risk TIA. N Engl J Med 2018; 379: 215–225. PubMed PMC

Sharma M, Hart RG, Connolly SJ, et al. Stroke outcomes in the COMPASS trial. Circulation 2019; 139: 1134–1145. PubMed

Amarenco P, Albers GW, Denison H, et al. Efficacy and safety of ticagrelor versus aspirin in acute stroke or transient ischaemic attack of atherosclerotic origin: A subgroup analysis of SOCRATES, a randomised, double-blind, controlled trial. Lancet Neurol 2017; 16: 301–310. PubMed

Benavente OR, Hart RG, McClure LA, et al. Effects of clopidogrel added to aspirin in patients with recent lacunar stroke. N Engl J Med 2012; 367: 817–825. PubMed PMC

Hart RG, Sharma M, Mundl H, et al. NAVIGATE ESUS Investigators. Rivaroxaban for stroke prevention after embolic stroke of undetermined source. N Engl J Med 2018; 378: 2191–2201. PubMed

Diener HC, Sacco RL, Easton JD, et al. RE-SPECT ESUS Steering Committee and Investigators. Dabigatran for prevention of stroke after embolic stroke of undetermined source. N Engl J Med 2019; 380: 1906–1917. PubMed

Zannad F, Anker SD, Byra WM, et al. COMMANDER HF Investigators. Rivaroxaban in patients with heart failure, sinus rhythm, and coronary disease. N Engl J Med 2018; 379: 1332–1342. PubMed

Kirchhof P, Benussi S, Kotecha D, et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J 2016; 37: 2893–2962. PubMed

Goyal M, Menon BK, van Zwam WH, et al. Hermes Collaborators. Endovascular thrombectomy after large-vessel ischaemic stroke: A meta-analysis of individual patient data from five randomised trials. Lancet 2016; 387: 1723–1731. PubMed

Scheitz JF, Nolte CH, Doehner W, et al. The stroke-heart syndrome: Clinical presentation and underlying mechanisms. Lancet Neurol 2018; 17: 1109–1120. PubMed

Doehner W, Ural D, Haeusler KG, et al. Heart and brain interaction in patients with heart failure: Overview and proposal for a taxonomy. A position paper from the Study Group on Heart and Brain Interaction of the Heart Failure Association. Eur J Heart Fail 2018; 20: 199–215. PubMed

Psychogios MN, Behme D, Schregel K, et al. One-stop management of acute stroke patients: Minimizing door-to-reperfusion times. Stroke 2017; 48: 3152–3155. PubMed

Aguiar de Sousa D, Von Martial R, Abilleira S, et al. Access to and delivery of acute ischaemic stroke treatments: A survey of national scientific societies and stroke experts in 44 European countries. Eur Stroke J 2019; 4: 13–28. PubMed PMC