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ORIGINAL RESEARCH article

Front. Neurol.

Sec. Stroke

Volume 16 - 2025 | doi: 10.3389/fneur.2025.1624800

A Pilot Comparison of the Retention Rates of FAST and BEFAST Stroke Warning-Sign Mnemonics

Provisionally accepted
Shujing  GuoShujing GuoJeffrey  L SaverJeffrey L Saver*
  • University of California, Los Angeles, Los Angeles, United States

The final, formatted version of the article will be published soon.

Background: Several pre-hospital delays prevent stroke patients from arriving within the optimal 4.5-hour therapeutic window, including failure to recognize stroke symptoms and lack of urgency in perceiving them as requiring immediate medical attention. Community stroke education is critical in reducing pre-hospital delays. The Face-Arm-Speech-Time (FAST) mnemonic has been the AHA/ASA's official stroke warning-signs public education message since 2013. Recently, a more inclusive but potentially harder to remember mnemonic, adding Balance-Eyes (BEFAST), has been proposed to increase the sensitivity of warning-sign messaging in detecting strokes. We undertook a pilot randomized trial to assess the feasibility of, refine methods for, and provide information regarding required sample size for a larger, pivotal randomized trial comparing the retention rate of FAST versus BEFAST. Methods: This study randomized adult participants without history of stroke to a comprehensive community stroke education intervention that included the definition of a stroke, its risk factors, outcomes, and either FAST or BEFAST mnemonics and assessed retention after 14-21 days. The primary endpoint was retention of mnemonic letter and warning-sign knowledge. The secondary outcome was improvement at 14-21 days in participant knowledge of stroke definition, risk factors, and outcomes. Results: Among the 50 adult participants, mean age was 37.2 (±14.8) and 30 (60%) participants were women. Study procedures were completed in all participants. At initiation, 23 (46%) participants knew the definition of stroke and could describe a mean 1.6 signs, 0.98 risk factors, and 0.74 outcomes. Full mnemonic recall rates at 14-21 days were 68% for FAST and 56% for the BEFAST cohorts (P=0.39). Secondary paired analysis found significant improvements in participant knowledge of stroke signs (to 2.72), risk factors (to 3.30), and outcomes (to 2.24) with P=0.007 or smaller. Discussion: This pilot trial demonstrated the feasibility of performing a large, pivotal trial and indicates a sample size of 512 participants is needed to provide sufficient power. The preliminary pilot data suggest a generally higher recall performance in the FAST group. Regardless of the mnemonic taught, participants had significant improvements in their knowledge of stroke signs, risk factors, and outcomes.

Keywords: Stroke, Warning sign mnemonics, BEFAST, FAST, public health education

Received: 07 May 2025; Accepted: 01 Jul 2025.

Copyright: © 2025 Guo and Saver. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Jeffrey L Saver, University of California, Los Angeles, Los Angeles, United States

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