Introduction
Early hospital arrival is essential for a patient with acute ischemic stroke, to be eligible for acute reperfusion therapies. We evaluated the effectiveness of a national public stroke-awareness campaign in Singapore in improving onset-to-door time (OTD), and the factors associated with short OTD.  

Method
A national ‘FAST’ stroke-awareness campaign was conducted in 2016. We prospectively recruited consecutive patients admitted for acute ischemic stroke to two large tertiary hospitals over 2-month periods before and after the campaign. 

Results
Of the 229 patients included, 154 were recruited pre-campaign and 75 post-campaign. In the post-campaign group, 34.6% reported having been exposed to the campaign. The proportion of patients with OTD within 3.5 hours was 31.8% pre-campaign and 41.3% post-campaign (p = 0.16); that for OTD within 6 hours was 42.2% pre-campaign and 57.3% post-campaign (p = 0.03). Multivariate analysis showed that factors associated with OTD within 3.5 hours were education level (in years) (OR 1.13, p 0.01), NIHSS score (OR 1.09, p = 0.02), ambulance use (OR 2.88, p = 0.004), and awareness that treatment for acute stroke is time-sensitive (OR 2.51, p = 0.04). Seeking medical attention from primary care first reduced the odds of short OTD time (OR 0.092, p <0.001).   

Conclusion
These findings show that exposure to the ‘FAST’ stroke campaign did influence the likelihood of arriving early to hospital after onset of stroke symptoms. There is a need to emphasize the use of ambulance services and to avoid seeking medical attention at the primary care level in the event of stroke.

INSIGHTS FROM A NATIONAL PUBLIC STROKE-AWARENESS CAMPAIGN IN SINGAPORE TO INCREASE EARLY HOSPITAL ARRIVAL IN ACUTE ISCHEMIC STROKE