Table 1.

2021–30 primary stroke prevention roadmap

	Goals	Targets	Recommendations and actions	Assessment methods
Scarcity of funding for primary stroke prevention across all countries, particularly in LMICs	To provide sufficient funding for primary and secondary stroke prevention	Governments and politicians	Encourage all governments and politicians to reinvest revenues from taxation on unhealthy products (eg, tobacco, sugary drinks, alcohol, and salt in processed foods, aimed at reducing consumption) back into health services and preventive strategies; all health-care policy makers should be aware that, for every US$1 spent on prevention of stroke and cardiovascular disease, there are over $10 returns on investment	The proportion of funding allocated to primary stroke prevention
Few countries or regions have established action plans for stroke prevention	To establish country-specific action plans and stroke prevention guidelines for every country	The whole population for population-wide prevention strategies and individuals at any level of risk for individual prevention strategies	All governments should allocate sufficient funding for the development and implementation of primary stroke prevention strategies, have financially sustainable action plans for primary and secondary stroke prevention, and should have culturally appropriate guidelines for primary and secondary stroke prevention; adults are encouraged to use freely available and validated mobile phone apps for managing their risk factors (eg, WSO, World Heart Federation, World Federation of Neurology, and European Stroke Organisation recommended Stroke Riskometer app); transferring and sharing tasks of primary stroke prevention from highly trained health professionals to less qualified health-care workers after training; culturally appropriate education about healthy lifestyles should be incorporated into standard education curricula and started early in life, with reinforcement across the lifespan	Stroke incidence, mortality, and disability; prevalence of risk factors; 5 or 10 year risk of cardiovascular disease and stroke; availability of stroke and transient ischaemic attack and stroke prevention clinics; proportion of people at risk of stroke and people who have had a stroke or transient ischaemic attack managed in clinics; proportion of evidence-based decisions in stroke prevention
Absence of an integrative approach in primary stroke prevention, particularly in LMICs	To establish collaboration between different national and international agencies and organisations involved in primary prevention of non-communicable disease	National and international agencies and organisations	Include nationally and internationally recognised stroke experts in all relevant national and international agencies and organisations involved in primary prevention of non-communicable diseases; prioritise primary stroke prevention strategies to reduce exposure to cardiovascular disease risk factors in the whole population across the life course, including intrauterine life, with a focus on optimal maternal and child health care, behavioural, and lifestyle risk factors, which would enable an integrative approach that also targets other non-communicable diseases (eg, dementia, diabetes, cancer, and pulmonary diseases)	Checklist of representation of stroke experts in all relevant national and international agencies and organisations involved in primary prevention of non-communicable diseases
Little stroke awareness across all countries	To establish national ongoing stroke awareness campaigns about stroke, its warning signs, and its prevention	The whole population	All national and regional stroke organisations should conduct ongoing stroke awareness campaigns about stroke, its warning signs, and its prevention, coordinated by the WSO; regular television programmes are the preferred channel of media for such campaigns	Stroke awareness surveys
Absence of monitoring systems for evaluation of the effectiveness of preventive strategies	To establish national and subnational (for large countries) monitoring frameworks	Whole population and people at risk of stroke	All countries should have monitoring systems to evaluate the effects of primary and secondary prevention strategies; in the absence of sufficient quality country-specific epidemiological data on burden of stroke and risk factors, health-care policy makers should be encouraged to use relevant Global Burden of Disease estimates; regular use of accurate data to support decision making	Changes in the 5 year or 10 year absolute risk of stroke and cardiovascular disease of outpatients; strengthening surveillance for key stroke risk factors (eg, increased blood pressure, smoking, alcohol, obesity, and excessive salt consumption) with use of regular (eg, once in 2–5 years) inexpensive population-based surveys (eg, WHO STEPwise survey) would provide policy makers with accurate estimates of prevalence of stroke risk factors to prioritise investments to reduce exposure to the risk factors and reduce the incidence and burden of stroke; ongoing or regular (eg, once in 2–5 years) registries of strokes morbidity and mortality
Insufficient funding of stroke prevention research across all countries, particularly in LMICs	To study determinants of stroke occurrence and outcomes and the best strategies to reduce stroke burden	Health research funding agencies	In consultation with recognised regional experts on stroke and public health, allocate sufficient funding for research in primary and secondary stroke prevention	Proportion of research funding allocated to primary stroke prevention (compared with the total health research funding)

LMICs=low-income and middle-income countries. WSO=World Stroke Organization.