A pilot comparison of the retention rates of FAST and BEFAST stroke warning-sign mnemonics
BackgroundSeveral pre-hospital delays prevent stroke patients from arriving within the optimal 4.5-h therapeutic window, including failure to recognize stroke symptoms and lack of urgency in perceiving them as requiring immediate medical attention. Community stroke education is critical in reducing...
Saved in:
| Main Authors: | , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2025-07-01
|
| Series: | Frontiers in Neurology |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fneur.2025.1624800/full |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849716004812226560 |
|---|---|
| author | Shujing Guo Jeffrey L. Saver |
| author_facet | Shujing Guo Jeffrey L. Saver |
| author_sort | Shujing Guo |
| collection | DOAJ |
| description | BackgroundSeveral pre-hospital delays prevent stroke patients from arriving within the optimal 4.5-h therapeutic window, including failure to recognize stroke symptoms and lack of urgency in perceiving them as requiring immediate medical attention. Community stroke education is critical in reducing pre-hospital delays. The Face-Arm-Speech-Time (FAST) mnemonic has been the AHA/ASA’s official stroke warning-signs public education message since 2013. Recently, a more inclusive but potentially harder to remember mnemonic, adding Balance-Eyes (BEFAST), has been proposed to increase the sensitivity of warning-sign messaging in detecting strokes. We undertook a pilot randomized trial to assess the feasibility of, refine methods for, and provide information regarding required sample size for a larger, pivotal randomized trial comparing the retention rate of FAST versus BEFAST.MethodsThis study randomized adult participants without history of stroke to a comprehensive community stroke education intervention that included the definition of a stroke, its risk factors, outcomes, and either FAST or BEFAST mnemonics and assessed retention after 14–21 days. The primary endpoint was retention of mnemonic letter and warning-sign knowledge. The secondary outcome was improvement at 14–21 days in participant knowledge of stroke definition, risk factors, and outcomes.ResultsAmong the 50 adult participants, mean age was 37.2 (±14.8) and 30 (60%) participants were women. Study procedures were completed in all participants. At initiation, 23 (46%) participants knew the definition of stroke and could describe a mean 1.6 signs, 0.98 risk factors, and 0.74 outcomes. Full mnemonic recall rates at 14–21 days were 68% for FAST and 56% for the BEFAST cohorts (p = 0.39). Secondary paired analysis found significant improvements in participant knowledge of stroke signs (to 2.72), risk factors (to 3.30), and outcomes (to 2.24) with p = 0.007 or smaller.DiscussionThis pilot trial demonstrated the feasibility of performing a large, pivotal trial and indicates a sample size of 512 participants is needed to provide sufficient power. The preliminary pilot data suggest a generally higher recall performance in the FAST group. Regardless of the mnemonic taught, participants had significant improvements in their knowledge of stroke signs, risk factors, and outcomes. |
| format | Article |
| id | doaj-art-45b072478ae54ee09b3510b8a0409dcc |
| institution | DOAJ |
| issn | 1664-2295 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Neurology |
| spelling | doaj-art-45b072478ae54ee09b3510b8a0409dcc2025-08-20T03:13:10ZengFrontiers Media S.A.Frontiers in Neurology1664-22952025-07-011610.3389/fneur.2025.16248001624800A pilot comparison of the retention rates of FAST and BEFAST stroke warning-sign mnemonicsShujing GuoJeffrey L. SaverBackgroundSeveral pre-hospital delays prevent stroke patients from arriving within the optimal 4.5-h therapeutic window, including failure to recognize stroke symptoms and lack of urgency in perceiving them as requiring immediate medical attention. Community stroke education is critical in reducing pre-hospital delays. The Face-Arm-Speech-Time (FAST) mnemonic has been the AHA/ASA’s official stroke warning-signs public education message since 2013. Recently, a more inclusive but potentially harder to remember mnemonic, adding Balance-Eyes (BEFAST), has been proposed to increase the sensitivity of warning-sign messaging in detecting strokes. We undertook a pilot randomized trial to assess the feasibility of, refine methods for, and provide information regarding required sample size for a larger, pivotal randomized trial comparing the retention rate of FAST versus BEFAST.MethodsThis study randomized adult participants without history of stroke to a comprehensive community stroke education intervention that included the definition of a stroke, its risk factors, outcomes, and either FAST or BEFAST mnemonics and assessed retention after 14–21 days. The primary endpoint was retention of mnemonic letter and warning-sign knowledge. The secondary outcome was improvement at 14–21 days in participant knowledge of stroke definition, risk factors, and outcomes.ResultsAmong the 50 adult participants, mean age was 37.2 (±14.8) and 30 (60%) participants were women. Study procedures were completed in all participants. At initiation, 23 (46%) participants knew the definition of stroke and could describe a mean 1.6 signs, 0.98 risk factors, and 0.74 outcomes. Full mnemonic recall rates at 14–21 days were 68% for FAST and 56% for the BEFAST cohorts (p = 0.39). Secondary paired analysis found significant improvements in participant knowledge of stroke signs (to 2.72), risk factors (to 3.30), and outcomes (to 2.24) with p = 0.007 or smaller.DiscussionThis pilot trial demonstrated the feasibility of performing a large, pivotal trial and indicates a sample size of 512 participants is needed to provide sufficient power. The preliminary pilot data suggest a generally higher recall performance in the FAST group. Regardless of the mnemonic taught, participants had significant improvements in their knowledge of stroke signs, risk factors, and outcomes.https://www.frontiersin.org/articles/10.3389/fneur.2025.1624800/fullstrokewarning-sign mnemonicsBEFASTFASTpublic health education |
| spellingShingle | Shujing Guo Jeffrey L. Saver A pilot comparison of the retention rates of FAST and BEFAST stroke warning-sign mnemonics Frontiers in Neurology stroke warning-sign mnemonics BEFAST FAST public health education |
| title | A pilot comparison of the retention rates of FAST and BEFAST stroke warning-sign mnemonics |
| title_full | A pilot comparison of the retention rates of FAST and BEFAST stroke warning-sign mnemonics |
| title_fullStr | A pilot comparison of the retention rates of FAST and BEFAST stroke warning-sign mnemonics |
| title_full_unstemmed | A pilot comparison of the retention rates of FAST and BEFAST stroke warning-sign mnemonics |
| title_short | A pilot comparison of the retention rates of FAST and BEFAST stroke warning-sign mnemonics |
| title_sort | pilot comparison of the retention rates of fast and befast stroke warning sign mnemonics |
| topic | stroke warning-sign mnemonics BEFAST FAST public health education |
| url | https://www.frontiersin.org/articles/10.3389/fneur.2025.1624800/full |
| work_keys_str_mv | AT shujingguo apilotcomparisonoftheretentionratesoffastandbefaststrokewarningsignmnemonics AT jeffreylsaver apilotcomparisonoftheretentionratesoffastandbefaststrokewarningsignmnemonics AT shujingguo pilotcomparisonoftheretentionratesoffastandbefaststrokewarningsignmnemonics AT jeffreylsaver pilotcomparisonoftheretentionratesoffastandbefaststrokewarningsignmnemonics |