World Stroke Organization Brain & hEart globAl iniTiative Program

Luciano A Sposato^{1

2

3

4}, Sheila Martins^{5

6}, Jan F Scheitz^{7

8}, Sara Aspberg⁹, M Edip Gurol¹⁰, Mohamed Abdalla¹¹, Antonio Arauz¹², Vanessa Cano-Nigenda¹², Paul Fiorilli¹³, Carsten Israel¹⁴, Kengo Kusano¹⁵, Ossama Mansour¹⁶, Steven R Messé¹⁷, Arthur Pille^{6

18}, Thaís Secchi^{5

6}, Carisi A Polanczyk, Andreia Biolo^{5

18}, Ismail Ramadan¹⁹, Ashraf Sallam²⁰, Wolf Schäbitz²¹, Kazunori Toyoda²², Sharon Valencia²³, Shang Wang²⁴, Yunyun Xiong²⁵, Amr Zaki²⁶, Gustavo Saposnik²⁷, Marc Fisher²⁸, M Cecilia Bahit²⁹

Affiliations

¹ Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
² Heart and Brain Laboratory, Western University, London, Ontario, Canada.
³ Robarts Research Institute, Western University, London, Ontario, Canada.
⁴ Lawson Health Research Institute, London, Ontario, Canada.
⁵ Hospital Moinhos de Vento, Neurology Service and Postgraduate in Stroke Neurology, Porto Alegre, Brazil.
⁶ Brazilian Stroke Network, Porto Alegre, Brazil.
⁷ Klinik für Neurologie mit Experimenteller Neurologie and Center for Stroke Research Berlin, Charité Universitätsmedizin Berlin, Berlin, Germany.
⁸ DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany.
⁹ Department of Clinical Sciences, Division of Cardiovascular Medicine, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
¹⁰ Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
¹¹ Neurology Department, Armed Forces Medical Institute in Alexandria, Alexandria, Egypt.
¹² Stroke Clinic, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico.
¹³ Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
¹⁴ Department of Cardiology, Evangelisches Klinikum Bethel, University Hospital OWL, University Bielefeld, Campus Bielefeld-Bethel, Bielefeld, Germany.
¹⁵ Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.
¹⁶ Stroke and Neurointerventional Center, Alexandria University School of Medicine, Alexandria, Egypt.
¹⁷ Department of Neurology, Hospital of the University of Pennsylvania., Philadelphia, Pennsylvania, USA.
¹⁸ Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
¹⁹ Neurology Department, Alexandria University School of Medicine, Alexandria, Egypt.
²⁰ Cardiology and Angiology Department, Armed Forces Medical Institute, Alexandria, Egypt.
²¹ Department of Neurology, Evangelisches Klinikum Bethel, University Hospital OWL, University Bielefeld, Campus Bielefeld-Bethel, Bielefeld, Germany.
²² Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.
²³ Cardiology and Echocardiography Department, Instituto Nacional de Neurología y Neurocirugia Manuel Velasco Suárez, Mexico City, Mexico.
²⁴ Department of Neurocardiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
²⁵ Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
²⁶ Cardiology Department, Alexandria University School of Medicine, Alexandria, Egypt.
²⁷ Department of Medicine (Neurology), Stroke Outcomes & Decision Neuroscience Research Unit, University of Toronto, Toronto, Canada.
²⁸ Division of Stroke and Cerebrovascular Diseases, Department of Neurology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA.
²⁹ Department of Cardiology, INECO Neurociencias Rosario, Rosario, Argentina.

PMID: 37276846
DOI: 10.1159/000530471

World Stroke Organization Brain & hEart globAl iniTiative Program

Luciano A Sposato et al. Cerebrovasc Dis. 2024.

. 2024;53(1):115-124.

doi: 10.1159/000530471. Epub 2023 Jun 5.

Authors

Affiliations

¹ Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
² Heart and Brain Laboratory, Western University, London, Ontario, Canada.
³ Robarts Research Institute, Western University, London, Ontario, Canada.
⁴ Lawson Health Research Institute, London, Ontario, Canada.
⁵ Hospital Moinhos de Vento, Neurology Service and Postgraduate in Stroke Neurology, Porto Alegre, Brazil.
⁶ Brazilian Stroke Network, Porto Alegre, Brazil.
⁷ Klinik für Neurologie mit Experimenteller Neurologie and Center for Stroke Research Berlin, Charité Universitätsmedizin Berlin, Berlin, Germany.
⁸ DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany.
⁹ Department of Clinical Sciences, Division of Cardiovascular Medicine, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
¹⁰ Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
¹¹ Neurology Department, Armed Forces Medical Institute in Alexandria, Alexandria, Egypt.
¹² Stroke Clinic, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico.
¹³ Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
¹⁴ Department of Cardiology, Evangelisches Klinikum Bethel, University Hospital OWL, University Bielefeld, Campus Bielefeld-Bethel, Bielefeld, Germany.
¹⁵ Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.
¹⁶ Stroke and Neurointerventional Center, Alexandria University School of Medicine, Alexandria, Egypt.
¹⁷ Department of Neurology, Hospital of the University of Pennsylvania., Philadelphia, Pennsylvania, USA.
¹⁸ Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
¹⁹ Neurology Department, Alexandria University School of Medicine, Alexandria, Egypt.
²⁰ Cardiology and Angiology Department, Armed Forces Medical Institute, Alexandria, Egypt.
²¹ Department of Neurology, Evangelisches Klinikum Bethel, University Hospital OWL, University Bielefeld, Campus Bielefeld-Bethel, Bielefeld, Germany.
²² Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.
²³ Cardiology and Echocardiography Department, Instituto Nacional de Neurología y Neurocirugia Manuel Velasco Suárez, Mexico City, Mexico.
²⁴ Department of Neurocardiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
²⁵ Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
²⁶ Cardiology Department, Alexandria University School of Medicine, Alexandria, Egypt.
²⁷ Department of Medicine (Neurology), Stroke Outcomes & Decision Neuroscience Research Unit, University of Toronto, Toronto, Canada.
²⁸ Division of Stroke and Cerebrovascular Diseases, Department of Neurology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA.
²⁹ Department of Cardiology, INECO Neurociencias Rosario, Rosario, Argentina.

PMID: 37276846
DOI: 10.1159/000530471

Abstract

Introduction: The World Stroke Organization (WSO) Brain & Heart Task Force developed the Brain & hEart globAl iniTiative (BEAT), a pilot feasibility implementation program to establish clinical collaborations between cardiologists and stroke physicians who work at large healthcare facilities.

Methods: The WSO BEAT pilot project focused on atrial fibrillation (AF) and patent foramen ovale (PFO) detection and management, and poststroke cardiovascular complications known as the stroke-heart syndrome. The program included 10 sites from 8 countries: Brazil, China, Egypt, Germany, Japan, Mexico, Romania, and the USA The primary composite feasibility outcome was the achievement of the following 3 implementation metrics (1) developing site-specific clinical pathways for the diagnosis and management of AF, PFO, and the stroke-heart syndrome; (2) establishing regular Neurocardiology rounds (e.g., monthly); and (3) incorporating a cardiologist to the stroke team. The secondary objectives were (1) to identify implementation challenges to guide a larger program and (2) to describe qualitative improvements.

Results: The WSO BEAT pilot feasibility program achieved the prespecified primary composite outcome in 9 of 10 (90%) sites. The most common challenges were the limited access to specific medications (e.g., direct oral anticoagulants) and diagnostic (e.g., prolonged cardiac monitoring) or therapeutic (e.g., PFO closure devices) technologies. The most relevant qualitative improvement was the achievement of a more homogeneous diagnostic and therapeutic approach.

Conclusion: The WSO BEAT pilot program suggests that developing neurocardiology collaborations is feasible. The long-term sustainability of the WSO BEAT program and its impact on quality of stroke care and clinical outcomes needs to be tested in a larger and longer duration program.

Keywords: Atrial fibrillation; Implementation; Neurocardiology; Patent foramen ovale; Quality improvement; Stroke.

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World Stroke Organization Brain & hEart globAl iniTiative Program

Affiliations

World Stroke Organization Brain & hEart globAl iniTiative Program

Authors

Affiliations

Abstract

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