BE FAST Versus FAST: A Randomized Pilot Trial Comparing Retention of Stroke Symptoms Between 2 Mnemonics

Background Balance, Eye, Face, Arm, Speech, Time (BE FAST) was proposed to increase the public's ability to recognize more signs of stroke by adding balance (B) and eyesight changes (E) to the stroke acronym FAST (Face, Arm, Speech, Time). Previous prospective studies suggested these additions did not result in increased stroke detection. Methods and Results A randomized, assessor blinded prospective pilot study assessed retention of BE FAST and FAST. The 174 participants were randomized to 1 of 2 education arms, educated similarly visually and auditorily, and retention was tested at 3 time points. Mnemonic recall was similar at 30 days (79.5% versus 69.8%, P =0.104). Significantly lower retention was seen in the BE FAST group's ability to recall all symptoms at 3 to 5 minutes (75% versus 30.2%, P <0.001), 60 minutes (70.5% versus 41.9%, P <0.001), and 30 days (51.1% versus 24.4%, P <0.001). Significantly higher retention was observed in the FAST group for partial recall at 3 to 5 minutes (94.3% versus 84.9%, P =0.041), 60 minutes (86.4% versus 77.9%, P =0.045), and 30 days (76.1% versus 59.3%, P =0.012). For BE FAST, retention of more common symptoms at 30 days was lower for face (78.4% versus 60.5%, P =0.010), speech (65.9% versus 47.7%, P =0.015), and arm (63.6% versus 52.3%, P =0.131). Conclusion Significantly higher retention and ability to recall stroke symptoms, fully or partially, was found with FAST. Adding B and E to FAST resulted in lower retention of more common symptoms. Registration URL: https://www.clinicaltrials.gov ; Unique identifier: NCT06152016.