Stroke warning sign acronyms drive 911 calls, F.A.S.T. leads in symptom recall for public

(Press-News.org) Research Highlights:

Both F.A.S.T. and BE-FAST acronyms motivated people to call 911 right away for a possible stroke, and this impact lasted for 30 days. F.A.S.T. outperformed BE-FAST in the ability for people to remember key stroke warning signs (face, arm and speech), suggesting the additional letters of B and E hinder memory recall. Note: The study featured in this news release is a research abstract. Abstracts presented at the American Heart Association’s scientific meetings are not peer-reviewed, and the findings are considered preliminary until published as full manuscripts in a peer-reviewed scientific journal. This research was sponsored by the American Stroke Association with funding support from the HCA Healthcare Foundation. Embargoed until 4 a.m. CT/5 a.m. ET, Thursday, Jan. 30, 2025

DALLAS, Jan. 30, 2025 — When it comes to prompting people to call 911 at the first sign of stroke, both F.A.S.T. and BE-FAST stroke warning signs acronyms were equally effective. However, people remembered the key stroke warning signs (face, arm and speech) better with the F.A.S.T. acronym, according to a preliminary study to be presented at the American Stroke Association’s International Stroke Conference 2025. The meeting is in Los Angeles, Feb. 5-7, 2025, and is a world premier meeting for researchers and clinicians dedicated to the science of stroke and brain health.

Each year, approximately 800,000 people in the U.S. suffer a stroke, according to the American Heart Association’s 2025 Heart Disease and Stroke Statistics. Immediate treatment may minimize the long-term effects of a stroke and even prevent death. Awareness and recognition of stroke symptoms has improved over the last decade, yet more awareness is needed.

Both F.A.S.T. (Face, Arm, Speech, Time) and BE-FAST (Balance, Eye, Face, Arm, Speech, Time) are acronyms used as health communication mnemonics to help a person remember important warning signs of stroke.

The American Stroke Association, a division of the American Heart Association, currently utilizes the F.A.S.T. acronym. Some hospital and health care systems across the country have switched from using F.A.S.T. to BE-FAST in their consumer-facing stroke educational efforts. The belief is that adding additional symptoms, loss of balance and vision, to the acronym would result in greater identification of posterior circulation strokes, which represent approximately 20% of ischemic strokes and tend to be more disabling.

The Association convened a diverse group of researchers with expertise in stroke, epidemiology and market research to conduct a study, which focused on the general public, to assess whether F.A.S.T. or BE-FAST leads to better stroke symptom recall and whether either acronym is more likely to prompt calling 911. Assessments of stroke and symptom knowledge among the two acronym groups were taken at baseline, immediately after viewing a 1-minute educational video and 30 days later.

“This research was unique in that it blends health care terminology, methods and randomized approaches to identify how we can most effectively deliver messages to the public in a way that will allow us to reduce the burden of stroke,” said study lead author Opeolu Adeoye, M.D., M.S., FAHA, American Heart/Stroke Association volunteer and chair of the Department of Emergency Medicine at Washington University School of Medicine in St. Louis. “Historically, health care professionals want to provide the most comprehensive warning sign mnemonic to ensure no strokes are missed. What this research shows is, from a public point of view, adding two extra letters made it more challenging to recall the stroke warning signs.”

The study found:

Immediately after the educational video: The likelihood of calling 911 if a stroke was suspected increased in both acronym groups from approximately 70% before the educational video (baseline) to 90% immediately after the video, with no significant difference between the groups.  Participants’ ability to identify what symptoms the common letters F, A and S represent was similar for both acronym groups at baseline (34% for F.A.S.T. group and 29% for BE-FAST group) and significantly higher immediately after the video for both acronym groups (70% for F.A.S.T. group and 50% for BE-FAST group). The F.A.S.T. acronym had a significantly greater increase in common letter recall than BE-FAST immediately after viewing the video. At 30 days: The likelihood of calling 911 declined slightly at 30 days post-video compared to immediately after the video in both groups (86% for F.A.S.T. group and 87% for BE-FAST group) yet remained significantly increased compared to baseline with no difference between the two acronym groups. Participants’ ability to recall what symptoms the common letters F, A and S represent declined at 30 days post-video compared to immediately after the video for both groups (50% recall for F.A.S.T. group and 40% recall for BE-FAST group) yet remained significantly higher than at baseline. Again, F.A.S.T. had significantly higher common letter recall performance than BE-FAST after 30 days. “It is critically important that there is a recognition of stroke signs and symptoms by the general public. The more people are aware of the stroke warning signs, the better we may activate the processes needed to ensure patients get care as quickly as possible,” Adeoye said.

Study details, background or design:

A nationally representative online survey of English-speaking participants was used for this experimental design. Study data collection was conducted April 1 – May 15, 2024. Participants were randomly assigned to one of two acronym groups, either F.A.S.T. or BE-FAST, and shown a corresponding 1-minute education video. Assessments were made immediately after video viewing (1,900 total participants) and again 30 days later (1,393 participants; 73% recontact completion rate). Statistical analysis included T-tests to compare group means and ANOVA tests to compare the multiple groups over multiple time points, to estimate differences between groups on intent to call 911 and stroke symptom knowledge at baseline, immediately after the education and at 30 days. Analyses were adjusted for age, stroke knowledge/experience, education level and baseline familiarity with the acronyms. Co-authors, disclosures and funding sources are listed in the abstract. This research was sponsored by the American Stroke Association with funding support from the HCA Healthcare Foundation.

Statements and conclusions of studies that are presented at the American Heart Association’s scientific meetings are solely those of the study authors and do not necessarily reflect the Association’s policy or position. Abstracts presented at the Association’s scientific meetings are not peer-reviewed, rather, they are curated by independent review panels and are considered based on the potential to add to the diversity of scientific issues and views discussed at the meeting. The findings are considered preliminary until published as a full manuscript in a peer-reviewed scientific journal.

The Association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific Association programs and events. The Association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and biotech companies, device manufacturers and health insurance providers and the Association’s overall financial information are available here.

Additional Resources:

Multimedia is available on the right column of the release link Link to abstract WMP31 and ASA International Stroke Conference 2025 Online Program Planner AHA News release: New guideline: Preventing a first stroke may be possible with screening, lifestyle changes (October, 2024) AHA health information: Interactive F.A.S.T. Experience AHA health information: Clot in the brain illustration For more news at ASA International Stroke Conference 2025, follow us on X @HeartNews #ISC25 ###

About the American Stroke Association

The American Stroke Association is devoted to saving people from stroke — the No. 2 cause of death in the world and a leading cause of serious disability. We team with millions of volunteers to fund innovative research, fight for stronger public health policies and provide lifesaving tools and information to prevent and treat stroke. The Dallas-based association officially launched in 1998 as a division of the American Heart Association. To learn more or to get involved, call 1-888-4STROKE or visit stroke.org. Follow us on Facebook, X.

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