Sustained impact of UK FAST-test public education on response to stroke: A population-based time-series study

Frank J. Wolters, Nicola L.M. Paul, on behalf of the Oxford Vascular Study, Linxin Li, Peter M. Rothwell*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

78 Citations (Scopus)
11 Downloads (Pure)

Abstract

Background: Urgent assessment is essential after stroke. Several countries have had public education campaigns, based on the FAST (Face-Arm-Speech-Time) test to reduce delays in seeking attention. However, the impact of these campaigns on patient behavior is uncertain. Methods: We prospectively determined patient behavior after incident major stroke (NIHSS>3) in a UK population based study (Oxford Vascular Study) before (2002-2008) and after (2009-2013) introduction of the FAST TV-campaign and assessed any sustained impact of campaign continuation. Results: Among 668 consecutive patients with major stroke, medical attention was sought by a bystander in 553 (89·6%). Patients were more likely to present directly to emergency services (OR=2·18, 95%CI:1·54-3·09, P<0·0001) after the campaign and to arrive at hospital within 3h (OR=2·18, 1·55-3·06, P<0·0001). Median [IQR] time to seeking attention fell from 53 [15-265] to 31 [7-120] minutes (P=0·005) and median time to hospital arrival from 185 [88-885] to 119 [78-256] minutes (P<0·0001). On time-series analysis improvements in hospital arrival within 3h and use of emergency medical services were significantly associated to initiation of the campaign (aOR=3·11, 1·53-6·29, P=0·002; and 2·22, 1·05-4·67, P=0·036, respectively), independent of trend, age, sex, ethnicity, educational level, social class, prior stroke and stroke severity, and have been sustained to 2013. Conclusion: Delays to seeking and receiving medical attention after major stroke in the UK. fell strikingly in 2009, coinciding with the start of the FAST TV campaign. That medical attention was sought by a bystander in nearly 90% of cases illustrates the importance of mass-media public education rather than focused programs in high-risk groups for major stroke.

Original languageEnglish
Pages (from-to)1108-1114
Number of pages7
JournalInternational Journal of Stroke
Volume10
Issue number7
DOIs
Publication statusPublished - 1 Oct 2015
Externally publishedYes

Bibliographical note

Funding:
The Oxford Vascular Study has been funded by the Wellcome
Trust, Wolfson Foundation, UK Stroke Association, British Heart Foundation, Dunhill Medical Trust, National Institute of Health Research
(NIHR), Medical Research Council, and the NIHR Oxford Biomedical
Research Centre.

Publisher Copyright:
© 2015 World Stroke Organization.

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