title: Sustained impact of UK FAST-test public education on response to stroke: a population-based time-series study.
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 3 h (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 3 h 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.
  
  
  CONCLUSIONS
  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.
authors: Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, UK.
authors: Frank J
authors: FJ
authors: Wolters
authors: Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, UK.
authors: Nicola L M
authors: NL
authors: Paul
authors: Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, UK.
authors: Linxin
authors: L
authors: Li
authors: Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, UK.
authors: Peter M
authors: PM
authors: Rothwell
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001364:Awareness; D016009:Chi-Square Distribution; D018672:Community Health Planning; D004632:Emergency Medical Services; D005260:Female; D006266:Health Education; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008402:Mass Media; D008875:Middle Aged; D020521:Stroke / Q000453:epidemiology / Q000517:prevention & control / Q000523:psychology*; D013997:Time Factors; D006113:United Kingdom / Q000453:epidemiology
keywords: FAST; patient behavior; public education; stroke