title: Comparison of Acute Stroke Preparedness Strategies to Decrease Emergency Department Arrival Time in a Multiethnic Cohort: The Stroke Warning Information and Faster Treatment Study.
abstract: OBJECTIVE
  Less than 25% of stroke patients arrive to an emergency department within the 3-hour treatment window. Stroke Warning Information and Faster Treatment (SWIFT) compared an interactive intervention (II) with enhanced educational (EE) materials on recurrent stroke arrival times in a prospective cohort of multiethnic stroke/transient ischemic attack survivors.
  
  
  METHODS
  A single-center randomized controlled trial (2005-2011) randomized participants to EE (bilingual stroke preparedness materials) or II (EE plus in-hospital sessions). We assessed differences by randomization in the proportion arriving to emergency department <3 hours, prepost intervention arrival <3 hours, incidence rate ratio for total events, and stroke knowledge and preparedness capacity.
  
  
  RESULTS
  SWIFT randomized 1193 participants (592 EE, 601 II): mean age 63 years; 50% female, 17% black, 51% Hispanic, 26% white. At baseline, 28% arrived to emergency department <3 hours. Over 5 years, first recurrent stroke (n=133), transient ischemic attacks (n=54), or stroke mimics (n=37) were documented in 224 participants. Incidence rate ratio=1.31 (95% confidence interval=1.05-1.63; II to EE). Among II, 40% arrived <3 hours versus 46% EE (P=0.33). In prepost analysis, there was a 49% increase in the proportion arriving <3 hours (P=0.001), greatest among Hispanics (63%, P<0.003). II had greater stroke knowledge at 1 month (odds ratio=1.63; 1.23-2.15). II had higher preparedness capacity at 1 month (odds ratio=3.36; 1.86, 6.10) and 12 months (odds ratio=7.64; 2.49, 23.49).
  
  
  CONCLUSIONS
  There was no difference in arrival <3 hours overall between II and EE; the proportion arriving <3 hours increased in both groups and in race-ethnic minorities.
  
  
  BACKGROUND
  URL: http://www.clinicaltrials.gov. Unique identifier: NCT00415389.
authors.affiliation: From the Division of Social Epidemiology, Global Institute of Public Health (B.B.-A., E.T.R., L.W.Q., V.T.), Department of Neurology, Langone Medical Center (B.B.-A.), and Department of Epidemiology, College of Dentistry (B.B.-A.), New York University, NY; Department of Emergency Medicine (J.S.), and Department of Neurology (H.M.), Columbia University, New York, NY; Department of Epidemiology and Biostatistics, University of California at San Francisco (M.M.G.); Center for Biostatistics, Department of Population Health, Icahn School of Medicine at Mount Sinai, New York, NY (M.C.P.); and Department of Neurology, Weill Cornell Medical College, New York, NY (J.C.). bb109@nyu.edu.
authors.forename: Bernadette
authors.initials: B
authors.lastname: Boden-Albala
authors.affiliation: From the Division of Social Epidemiology, Global Institute of Public Health (B.B.-A., E.T.R., L.W.Q., V.T.), Department of Neurology, Langone Medical Center (B.B.-A.), and Department of Epidemiology, College of Dentistry (B.B.-A.), New York University, NY; Department of Emergency Medicine (J.S.), and Department of Neurology (H.M.), Columbia University, New York, NY; Department of Epidemiology and Biostatistics, University of California at San Francisco (M.M.G.); Center for Biostatistics, Department of Population Health, Icahn School of Medicine at Mount Sinai, New York, NY (M.C.P.); and Department of Neurology, Weill Cornell Medical College, New York, NY (J.C.).
authors.forename: Joshua
authors.initials: J
authors.lastname: Stillman
authors.affiliation: From the Division of Social Epidemiology, Global Institute of Public Health (B.B.-A., E.T.R., L.W.Q., V.T.), Department of Neurology, Langone Medical Center (B.B.-A.), and Department of Epidemiology, College of Dentistry (B.B.-A.), New York University, NY; Department of Emergency Medicine (J.S.), and Department of Neurology (H.M.), Columbia University, New York, NY; Department of Epidemiology and Biostatistics, University of California at San Francisco (M.M.G.); Center for Biostatistics, Department of Population Health, Icahn School of Medicine at Mount Sinai, New York, NY (M.C.P.); and Department of Neurology, Weill Cornell Medical College, New York, NY (J.C.).
authors.forename: Eric T
authors.initials: ET
authors.lastname: Roberts
authors.affiliation: From the Division of Social Epidemiology, Global Institute of Public Health (B.B.-A., E.T.R., L.W.Q., V.T.), Department of Neurology, Langone Medical Center (B.B.-A.), and Department of Epidemiology, College of Dentistry (B.B.-A.), New York University, NY; Department of Emergency Medicine (J.S.), and Department of Neurology (H.M.), Columbia University, New York, NY; Department of Epidemiology and Biostatistics, University of California at San Francisco (M.M.G.); Center for Biostatistics, Department of Population Health, Icahn School of Medicine at Mount Sinai, New York, NY (M.C.P.); and Department of Neurology, Weill Cornell Medical College, New York, NY (J.C.).
authors.forename: Leigh W
authors.initials: LW
authors.lastname: Quarles
authors.affiliation: From the Division of Social Epidemiology, Global Institute of Public Health (B.B.-A., E.T.R., L.W.Q., V.T.), Department of Neurology, Langone Medical Center (B.B.-A.), and Department of Epidemiology, College of Dentistry (B.B.-A.), New York University, NY; Department of Emergency Medicine (J.S.), and Department of Neurology (H.M.), Columbia University, New York, NY; Department of Epidemiology and Biostatistics, University of California at San Francisco (M.M.G.); Center for Biostatistics, Department of Population Health, Icahn School of Medicine at Mount Sinai, New York, NY (M.C.P.); and Department of Neurology, Weill Cornell Medical College, New York, NY (J.C.).
authors.forename: M Maria
authors.initials: MM
authors.lastname: Glymour
authors.affiliation: From the Division of Social Epidemiology, Global Institute of Public Health (B.B.-A., E.T.R., L.W.Q., V.T.), Department of Neurology, Langone Medical Center (B.B.-A.), and Department of Epidemiology, College of Dentistry (B.B.-A.), New York University, NY; Department of Emergency Medicine (J.S.), and Department of Neurology (H.M.), Columbia University, New York, NY; Department of Epidemiology and Biostatistics, University of California at San Francisco (M.M.G.); Center for Biostatistics, Department of Population Health, Icahn School of Medicine at Mount Sinai, New York, NY (M.C.P.); and Department of Neurology, Weill Cornell Medical College, New York, NY (J.C.).
authors.forename: Ji
authors.initials: J
authors.lastname: Chong
authors.affiliation: From the Division of Social Epidemiology, Global Institute of Public Health (B.B.-A., E.T.R., L.W.Q., V.T.), Department of Neurology, Langone Medical Center (B.B.-A.), and Department of Epidemiology, College of Dentistry (B.B.-A.), New York University, NY; Department of Emergency Medicine (J.S.), and Department of Neurology (H.M.), Columbia University, New York, NY; Department of Epidemiology and Biostatistics, University of California at San Francisco (M.M.G.); Center for Biostatistics, Department of Population Health, Icahn School of Medicine at Mount Sinai, New York, NY (M.C.P.); and Department of Neurology, Weill Cornell Medical College, New York, NY (J.C.).
authors.forename: Harmon
authors.initials: H
authors.lastname: Moats
authors.affiliation: From the Division of Social Epidemiology, Global Institute of Public Health (B.B.-A., E.T.R., L.W.Q., V.T.), Department of Neurology, Langone Medical Center (B.B.-A.), and Department of Epidemiology, College of Dentistry (B.B.-A.), New York University, NY; Department of Emergency Medicine (J.S.), and Department of Neurology (H.M.), Columbia University, New York, NY; Department of Epidemiology and Biostatistics, University of California at San Francisco (M.M.G.); Center for Biostatistics, Department of Population Health, Icahn School of Medicine at Mount Sinai, New York, NY (M.C.P.); and Department of Neurology, Weill Cornell Medical College, New York, NY (J.C.).
authors.forename: Veronica
authors.initials: V
authors.lastname: Torrico
authors.affiliation: From the Division of Social Epidemiology, Global Institute of Public Health (B.B.-A., E.T.R., L.W.Q., V.T.), Department of Neurology, Langone Medical Center (B.B.-A.), and Department of Epidemiology, College of Dentistry (B.B.-A.), New York University, NY; Department of Emergency Medicine (J.S.), and Department of Neurology (H.M.), Columbia University, New York, NY; Department of Epidemiology and Biostatistics, University of California at San Francisco (M.M.G.); Center for Biostatistics, Department of Population Health, Icahn School of Medicine at Mount Sinai, New York, NY (M.C.P.); and Department of Neurology, Weill Cornell Medical College, New York, NY (J.C.).
authors.forename: Michael C
authors.initials: MC
authors.lastname: Parides
mesh_terms: D000368:Aged; D015331:Cohort Studies; D004636:Emergency Service, Hospital / Q000592:standards*; D005006:Ethnicity / Q000208:ethnology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D020521:Stroke / Q000175:diagnosis / Q000208:ethnology* / Q000628:therapy*; D013997:Time Factors; D061665:Time-to-Treatment / Q000592:standards*; D016896:Treatment Outcome
keywords: acute stroke; health literacy; patient education; patient-centered outcomes research; preparedness