A Survey Of Chinese Public Stroke Awareness And Coping Styles (FAST-RIGHT Study)

Stroke is the leading cause of death in China.Stroke healthy education is crucial to prevention,diagnosis,and treatment of stroke.Multiple campaigns of stroke healthy education have been implemented in China,such as FAST campaigns on early recognition of stroke and proper delivery,but their effectiveness remains unknown.Thus,we conducted FAST-RIGHT study to determine the public awareness and response to stroke in China,aiming at providing baseline and specific information for further stroke education on improving public knowledge of stroke recognition and proper response.Part 1.Public awareness of stroke and the appropriate responses in ChinaBackground and Purpose:Early presentation is critical for receiving effective reperfusion therapy for acute ischemic stroke.Early recognition of stroke and activation of emergency medical services could reduce prehospital delay.However,the public awareness of stroke remained unknown in china,thus,we undertook a national survey of awareness and responses to acute stroke symptoms in China.Methods:We undertook a cross-sectional community-based study of 1 87723 adults(age≥40 years)presenting to 69 administrative areas across China between January 201 7 and May 2017 to determine the national stroke recognition rate and the correct action rate.Multivariable logistic regression models were used to identify factors associated with stroke recognition and intention-to-avail emergency medical services.Results:Estimates of stroke recognition rate and correct action rate were 81.9%(153675/187723)and 60.9%(114380/187723),respectively,but these rates varied widely by sociodemographic status,region,and stroke risk.Approximately one-third of participants who recognized a stroke failed to call emergency medical service.Low likelihood of emergency medical service use was associated with younger age(40-59 years),being male,rural location,(regions of east,south,and northwest China),high body mass index(≥24),low education(primary school or below),low personal income(<US $731 per annum),living with immediate family,having multiple children(≥2),having a friend with stroke,exposure to less avenues to learn about stroke(1),nonsmoking,regular exercise,unknown family history,and no history of cardiovascular disease.Intention of calling emergency medical service was strongly related to awareness of stroke(odds ratio 2.05;95%CI,2.00-2.10;P<0.001).Conclusions:Substantial discrepancies exist between stroke recognition and correct action and not all stroke patients know the appropriate responses.Further,national stroke educational programs with specific plans targeting different groups are needed,which do not solely focus on stroke recognition,but also on the appropriate responses at the time of a stroke.Part 2.Subgroup analysis:Differences of barriers from calling ambulance after recognizing stroke in different age groupsBackground and Purpose:Utilization of emergency medical services(EMS)could reduce prehospital delay and increase thrombolysis rate,but only a part of individuals recognizing stroke onset would call EMS.As health behavior varies with increasing age,we aimed to examine the potential barriers in calling emergency medical services(EMS)after recognizing a stroke among 40-74-and 75-99-year-old adults.Methods:Data were obtained from a cross-sectional community-based study(FAST-RIGHT)that was conducted from January 2017 to May 201 7 and involved adults(age≥ 40 years)across 69 administrative areas in China.A subgroup of residents(153675)who recognized stroke symptoms was analyzed.Multivariable logistic regression models were performed in the 40-74 and 75-99 age groups,separately,to determine the factors associated with wait-and-see behaviors at the onset of a stroke.Results:In the 40-74 and 75-99 age groups,the rates of participants who chose"Self-observation at home" were 3.0%(3912)and 3.5%(738),respectively；the rates of"Wait for family,then go to hospital" were 31.7%(42071)and 33.1%(6957),respectively.Rural residence,living with one’s spouse,low income(<731 US $ per annum),having a single avenue to learn about stroke,and having friends with stroke were factors associated with waiting for one’s family in both groups.However,unlike in the 40-74 age group,sex,number of children,family history.and stroke history did not influence the behaviors at stroke onset in the 75-99 age group.Conclusions:Different barriers from recognizing stroke and calling an ambulance exist in the 40-74 and 75-99 age groups in this specific population.Different strategies that mainly focus on changing the "Wait for family" behavior and emphasize on immediately calling EMS are recommended for both age groups.Part 3.Subgroup analysis:Association between response to stroke and recurrent stroke risk among cerebral vascular disease survivorsBackground and Purpose:Cerebrovascular disease(CVD)survivors are at a high risk of recurrent stroke.Although it is thought that survivors with higher risk of stroke respond better to stroke onset,to date,no study has been able to demonstrate that.Thus,we investigated whether the intent to call emergency medical services(EMS)increased with recurrent stroke risk among CVD survivors.Methods:Data were derived from FAST-RIGHT study,and a CVD survivor population of 6,290 was analyzed.According to the stroke risk score based on Essen Stroke Risk Score,CVD survivors were divided into three subgroups:low-(0),middle-(1-3)and high-(4-7)recurrent risk groups.Multivariable logistic regression models were used to identify the association between the stroke risk and stroke recognition,as well as stroke risk and EMS calling.Results:The estimated stroke recognition rate in CVD survivors with low,middle,and high risk was 89.0%(503/565),85.2%(3841/4509),and 82.5%(1001/1213),respectively,while the rate of calling EMS was 66.7%(377/565),64.3%(2897/4509),and 69.3%(840/1213),respectively.The CVD survivors’knowledge of recognizing stroke and intent to call EMS did not improve with recurrent stroke risk,even after adjustment for multiple socio-demographic factors.Conclusions:Despite being at a higher risk of recurrent stroke,Chinese CVD survivors showed poor knowledge of stroke,and their intent to call EMS did not increase with recurrent stroke risk.Enhanced and stroke risk-orientated education on stroke recognition and proper response is needed for all CVD survivors.