Both the F.A.S.T. and BE-FAST acronyms effectively encouraged prompt calls to 911 for potential stroke cases, and this effect persisted for 30 days. However, a preliminary study set to be presented at the American Stroke Association’s International Stroke Conference 2025 indicates that individuals were better able to recall key stroke warning signs (specifically, face, arm, and speech) when using the F.A.S.T. acronym. This conference will take place in Los Angeles from February 5 to 7, 2025, serving as a leading meeting for researchers and health professionals focused on stroke and brain health.
According to the American Heart Association’s 2025 Heart Disease and Stroke Statistics, about 800,000 people in the United States experience a stroke each year. Timely medical intervention can significantly reduce the long-term consequences of a stroke and may even save lives. Awareness of stroke symptoms has improved in the past decade, but more needs to be done.
The acronyms F.A.S.T. (Face, Arm, Speech, Time) and BE-FAST (Balance, Eye, Face, Arm, Speech, Time) serve as memory aids to help people remember vital stroke warning signs.
The American Stroke Association, part of the American Heart Association, currently promotes the F.A.S.T. acronym. However, some hospitals and healthcare systems have transitioned to using BE-FAST in their public education campaigns. They believe that including additional symptoms, such as balance and vision problems, will lead to better recognition of posterior circulation strokes, which account for around 20% of ischemic strokes and can be more debilitating.
A diverse team of researchers with expertise in stroke, epidemiology, and market research conducted a study to evaluate whether F.A.S.T. or BE-FAST aids the public in better recalling stroke symptoms and whether either acronym increases the likelihood of calling 911. Participants’ knowledge of stroke symptoms was assessed at the start, immediately after viewing a brief educational video, and again 30 days later.
“This study is distinctive because it combines healthcare language and methods with a randomized approach to find out how we can most effectively convey messages to the public to help reduce the impact of stroke,” explained study lead author Opeolu Adeoye, M.D., M.S., FAHA, a volunteer for the American Heart/Stroke Association and chair of the Department of Emergency Medicine at Washington University School of Medicine in St. Louis. “In the past, healthcare professionals aimed to present the most comprehensive mnemonic for stroke warning signs to avoid missing any cases. This research indicates that from the public’s perspective, the addition of two letters made it harder to remember the warning signs.”
Key findings of the study include:
- Immediately after watching the educational video:
- In both acronym groups, the likelihood of calling 911 if a stroke was suspected jumped from about 70% before the video (baseline) to 90% right after viewing it, with no significant differences between the groups.
- At the beginning, both groups had similar recall rates for the signs represented by the letters F, A, and S (34% for F.A.S.T. and 29% for BE-FAST). However, recall rates increased significantly for both groups after the video (70% for F.A.S.T. and 50% for BE-FAST), with F.A.S.T. showing a more substantial increase in recall.
- At 30 days:
- The willingness to call 911 saw a slight drop 30 days post-video, with 86% for the F.A.S.T. group and 87% for the BE-FAST group, but this was still significantly higher than baseline levels, with no notable difference between the two groups.
- Participants’ ability to remember what the letters F, A, and S referred to dropped to 50% for F.A.S.T. and 40% for BE-FAST after 30 days, although both were still significantly above baseline. Once again, F.A.S.T. outperformed BE-FAST in recall.
“It is crucial for the general public to recognize stroke signs and symptoms. The more people understand these warning signs, the better we can activate the necessary processes to ensure patients receive timely care,” said Adeoye.
Details about the study’s design include:
- A nationally representative online survey involving English-speaking participants was implemented in this experimental study. Data collection took place from April 1 to May 15, 2024.
- Participants were randomly assigned to either the F.A.S.T. or BE-FAST group and shown a specific 1-minute educational video. Assessments occurred immediately after watching the video (1,900 total participants) and again 30 days later (1,393 participants; a 73% response rate).
- Statistical analyses included T-tests to compare group averages and ANOVA tests to assess differences across multiple groups and time points concerning intentions to call 911 and knowledge of stroke symptoms at baseline, immediately after viewing the educational material, and at 30 days. The analyses were adjusted for factors such as age, stroke knowledge, education level, and prior familiarity with the acronyms.
