Success in boosting major stroke recognition doesn't trickle down to minor symptoms
- The Face, Arm, Speech, Time (FAST) public education campaign has not improved patient response to transient ischemic attack (TIA) and minor stroke, according to a prospective population-based study in England.
- Note that FAST teaches people how to recognize stroke, and the study shows that FAST has worked for major stroke, with people getting more urgent attention and access to acute stroke therapy.
The Face, Arm, Speech, Time (FAST) public education campaign has not improved transient ischemic attack (TIA) and minor stroke response in England, a prospective population-based study found.
In 5 years after the campaign launch, the percentage of people seeking medical attention within 3 hours of a TIA or minor stroke did not change, reported Peter Rothwell, MD, PhD, of John Radcliffe Hospital at University of Oxford, and co-authors.
The percentage of major strokes that were preceded by an unheeded TIA also remained unchanged.
"In contrast to major stroke, we found in this study that for TIA and minor stroke the U.K. nationwide televised FAST campaign has not improved patient use of EMS or patient delay in seeking medical attention," they wrote in JAMA Neurology. "This highlights the need for effective public education to be tailored to transient and minor stroke symptoms, as well as major stroke."
In Britain, the U.S., and other countries, FAST teaches people how to recognize stroke. "The FAST campaign has been around for some time in the U.S, continually reinforced by the American Heart Association and other organizations to increase awareness about stroke warning symptoms and urge people to call 911," said Ralph Sacco, MD, of the University of Miami and president of the American Academy of Neurology, who was not involved in the study.
"This study, which doesn't include U.S. patients, shows FAST has worked for major stroke, and people are getting more urgent attention and access to acute stroke therapy. That's a big improvement," Sacco told MedPage Today.
"But what this study implies is that we need to inform the public that sometimes minor symptoms that are transient and short can still mean big problems ahead. And we need to couple this with the reason to get urgent attention, which is acute stroke treatments. In TIA, if people get back to normal pretty fast, sometimes in minutes, they may not know they are still at risk of a major stroke."
In the U.K., the FAST public education television campaign started in February 2009 and continues to run on a yearly basis. From 2009 to 2013, its total advertising investment was £10.2 million (US $13.6 million).
For this analysis, researchers studied 2,243 consecutive patients with TIA or stroke from the Oxford Vascular Study cohort who visited 100 physicians in nine general practices in Oxfordshire between April 1, 2002, and March 31, 2014. Patients had an average age of 73.6 years; 50.2% were female and 96.3% were white; 36.8% were seen initially with TIA, 37.0% with minor stroke, and 26.2% with major stroke.
While 89.7% of the major stroke patients had one or more FAST symptom, only 63.1% of patients initially seen with TIA and 61.4% with minor stroke did.
Before April 1, 2009, 58.8% of major stroke patients used EMS; after April 1, 2009, 78.9% did (P<0.001). Medical attention within 3 hours occurred for 67.6% of major stroke patients before April 1, 2009 and 81.3% after that date (P<0.001). When the timing of the television spots and potential confounding variables were factored in, these changes largely coincided with the FAST campaign, the authors noted.
TIA and minor stroke patients also used EMS more frequently after April 1, 2009 (21.9% before April 1, 2009 versus 30.9% after April 1, 2009), but this was not significantly associated with the televised FAST campaign, the researchers indicated. Medical attention within 3 hours occurred for 40.4% of TIA and minor stroke patients after April 1, 2009, similar to the percentage (42.1%) before that date.
Within 90 days of an initial TIA or stroke, 188 patients had a stroke, of which 93 (49.5%) followed an unheeded TIA. This number was similar before (43/538; 8.0%) and after (50/615; 8.1%) the FAST campaign (P=0.93). , Rothwell et al wrote.
FAST has several strengths, observed Stephan Dombrowski, PhD, a University of Stirling health psychologist who has conducted surveys about the "Act FAST" message in England. The campaign's imagery and style are very recognizable and it focuses on witnesses, the main group that initiates medical attention, he pointed out.
But the FAST acronym does not capture all stroke symptoms, he said. And "the symptom strength shown in the Act FAST campaign might differ from the symptoms that people experience and witness, particularly milder stroke symptoms," Dombrowski told MedPage Today. "This can potentially lead to people dismissing stroke as a possible explanation for the symptoms."
The researchers noted several limitations to their research. Their retrospective diagnosis of unheeded TIAs before a stroke was subjective and may have been affected by recall bias, even though most TIAs had occurred in the previous week. They did not record the symptoms witnesses saw or ask about the FAST campaign. And results may not apply to racial and ethnic minorities, since 96% of patients in this study were white.
The Oxford Vascular Study is funded by the National Institute of Health Research (NIHR) Oxford Biomedical Research Centre (BRC), the Wellcome Trust, the Wolfson Foundation, and the British Heart Foundation.
Rothwell reported relationships with Bayer. No other relationships were reported.
Source Reference: Wolters F, et al "Medical attention seeking after transient ischemic attack and minor stroke before and after the UK Face, Arm, Speech, Time (FAST) public education campaign: Results from the Oxford Vascular Study" JAMA Neurology 2018;DOI:10.1001/jamaneurol.2018.1603.
Read the original article on Medpage Today:FAST Fails to Improve TIA, Minor Stroke Response in Britain