Background Fast medical assessment is essential after TIA and stroke. Several countries have had out public education campaigns to increase symptom recognition and reduce delays in seeking medical attention. However, since campaigns tend to focus on symptoms and signs of major stroke, individuals with TIA or minor stroke might be falsely reassured.

Methods We determined patient perception and behaviour after TIA, minor stroke (NIHSS≤5) and major stroke in the community from 2002 to 2012 in a population based study (Oxford Vascular Study) before and after the 2009 FAST (Face-Arm-Speech-Time) media campaign.

Results Among 2251 consecutive patients (817 TIA, 968 minor stroke, 466 major stroke), those with major stroke were slightly more likely to correctly diagnose their symptoms after the FAST campaign (52.4% vs. 43.0%, OR 1.5 [0.7–3.0], p=0.30) and to present directly to emergency services (OR 2.6 [1.6–4.2], p<0.001), with an improvement in time to calling help in the early hours following symptom onset (log-rank test, p=0.02). Amongst patients with TIA or minor stroke, those who correctly diagnosed their symptoms sought medical attention more quickly (median delay [IQR] in hours–2.5 [0.5–18.3] vs. 7.0 [1.0–41.0], p<0.001), but correct self-diagnosis declined after the FAST campaign from 38.4% to 29.6% (OR 0.67, 0.53–0.85, p=0.001), although delay in seeking medical attention was unchanged (log-rank test, p=0.82). Correct self-diagnosis was still lowest for TIA and stroke with non-FAST symptoms, particularly isolated visual symptoms (11.4%) and isolated vertigo (15.6%).

Conclusion The U.K. FAST campaign appears to have improved recognition and behaviour after major stroke, but symptom recognition remains poor in TIA and minor stroke and may have been adversely affected. Public education campaigns should consider potential unintended consequences of focussing only on FAST-test symptoms and on major stroke.