Stroke remains one of the leading causes of morbidity and mortality in Germany and worldwide. Within this position paper by the Commission Health Services Research and Quality Assurance of the German Stroke Society, we summarize current data on stroke epidemiology, healthcare delivery, and quality assurance of stroke in Germany, identify evidence and knowledge gaps across the stroke care pathway, and derive priorities for future health services research and quality assurance. Based on registry and routine administrative data, approximately 253,000 incident and recurrent strokes were estimated to occur in Germany in 2023. Although age-standardized stroke mortality rates had declined substantially since the 1980s, this trend has reached a plateau since 2018. Acute care is predominantly administered in certified stroke units, characterized by high process and outcome quality. However, areas for improvement remain in post-acute care and in structured outpatient aftercare, particularly regarding appropriate care for patients with persistent functional impairments and unmet needs. Future research priorities include for example the utilization of real-world data to document long-term outcomes, the expansion of quality assurance to specific entities such as subarachnoid hemorrhage, and the evaluation of telemedical frameworks in pre-hospital settings. Systematic implementation of Patient-Reported Outcome Measures (PROMs) in research and clinical practice could facilitate the identification of unmet needs and the development of patient-centered care models. In light of recent legislative advancements (e.g., the Health Data Use Act, European Health Data Space) and technological innovations (e.g., AI-driven applications), new opportunities are emerging to bolster health services research and further optimize the management of stroke patients.
Although Germany has a strong history of stroke research, it currently lacks a national harmonised infrastructure for clinical stroke research. To address this gap, the stroke-specific Specialty Network (SN Stroke) of the Network University Medicine (NUM) was established as a comprehensive research platform. Hereby we present the protocol of the Stroke-CORE cohort (COhort for REsearch in Stroke) within SN Stroke enrolling a large representative cohort of patients with acute ischeamic stroke or intracerebral haemorrhage in Germany. Stroke-CORE is a national, prospective, longitudinal, multi-centre cohort study with a decentralised biobank, structured as a modular umbrella protocol. Adult patients with acute ischaemic stroke or intracerebral haemorrhage, and paediatric stroke patients are enrolled at participating hospitals. Data collection follows four adaptive levels, ranging from a core clinical data set (Level 1) to modules covering the whole stroke care pathway (Level 2), biosamples (Level 3), and voluntary additional modules (Level 4), with follow-up at discharge, 90 days, 180 days (optional), and annually. Enrolment started in August 2026 across 12 initial sites, with a target of 12,750 patients being recruited by 2030. Stroke-CORE represents a nationally harmonised cohort spanning prehospital care, acute treatment, rehabilitation, prevention, aftercare, and paediatric stroke. Its adaptive modular design allows continuous expansion with new modules, data streams, and biobanking initiatives without protocol revision. As a sustainable national research platform, Stroke-CORE aims to address key knowledge gaps, facilitate recruitment for clinical trials, and accelerate translational, clinical and outcomes research. The protocol is registered at German Clinical Trials Register (DRKS00039775, July 8th, 2026).
Abstract Background Ischemic stroke is a common and serious complication of infective bacterial endocarditis. This study aimed to characterize the frequency, clinical and pathological features, treatment strategies, and outcomes of patients with stroke due to infective endocarditis. Methods We systematically searched PubMed from database inception to October 2022 for studies reporting on stroke in patients with infective endocarditis and performed a meta-analysis. Results A total of 122 studies comprising 270,211 patients with infective endocarditis were included. Ischemic stroke occurred in 21% and hemorrhagic stroke in 5% of patients. Stroke was observed in 32% of patients with mitral valve endocarditis, 25% with aortic valve, and 11% with tricuspid valve endocarditis. Stroke was associated with significantly higher mortality (OR 2.35; 95%CI 1.74–3.16). Staphylococcus and Streptococcus species were most frequently associated with stroke (33% and 25%, respectively). The risk of stroke did not differ significantly between patients with and without pre-existing antithrombotic therapy (37% vs. 24%; OR 1.24, 95%CI 0.75–2.06). Successful reperfusion was achieved in 80% of patients undergoing mechanical thrombectomy, although mortality remained high at 49%. Conclusions Stroke is a common complication of infective bacterial endocarditis and has a substantial impact on patient outcomes. It occurs most frequently in patients with mitral valve endocarditis and in those with infections caused by staphylococcal pathogens. Stroke risk was not reduced in patients with pre-existing antithrombotic therapy, supporting discontinuation where no other indication exists. Mechanical thrombectomy in patients with endocarditis-related large vessel occlusion achieves high recanalization rates; however, overall clinical outcomes remain poor in this population.
