Supplementary Material for: World Stroke Organization Brain and hEart globAl iniTiative Program

Introduction. The World Stroke Organization (WSO) Brain & Heart Task Force developed The Brain & hEart globAl iniTiative (BEAT), a pilot feasibility implementation program aimed at establishing 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 post-stroke 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 pre-specified 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. Discussion/Conclusion. The WSO BEAT pilot program showed 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.