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The ‘Act FAST’ public education campaign was introduced to reduce the time to presentation of patients with stroke, and thereby increase the opportunity for thrombolysis and rapid initiation of secondary prevention. The campaign was launched in the UK in February 2009 and has subsequently been adopted in a number of other countries, including the USA and Australia. One significant limitation of the ‘Act FAST’ campaign, however, is that the acronym excludes any reference to the symptoms of sudden visual loss, which may be a manifestation of embolic disease either in the anterior or posterior circulation. One solution would be to modify the acronym to include vision: ‘Act VFAST’ (act very fast).
FAST has been shown to have good diagnostic sensitivity (>75%) when used by ambulance staff,1 and other authors have suggested alternative acronyms to further increase this sensitivity.2 However, these study designs involve patients who have already been presented to hospital and it is therefore not possible to determine false-negative rates: in the case of vision, it is not known how many patients with embolic visual changes do not make it to acute services for review. If patients with vision loss are not aware that this can be a symptom of stroke, they may not present in the first place. One potential way to improve this is to increase recognition within the community that vision loss can be a manifestation of stroke. Interestingly, there is also evidence that when matching descriptions of stroke symptoms to patient experience of those symptoms, ‘loss of vision’ or ‘sudden decrease in vision’ had much higher rates of patients identifying that this description exactly …
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