Abstract
Background/Objective: Stroke survivors are at high-risk for recurrent stroke. Stroke education attempts to reduce this risk by emphasizing stroke warning signs and need to call 911. Long-term stroke awareness has been under-studied in stroke survivors. We aimed to assess stroke awareness at 1 year among stroke survivors and identify factors associated with poor performance. Methods: From a single center prospective cohort study of consecutive patients diagnosed with acute ischemic stroke or transient ischemic stroke (TIA), we identified stroke survivors able to complete telephone interviews at 1 year. All patients were provided standardized educational materials during index hospitalization. We used the validated Stroke Action Test (STAT) to assess stroke knowledge at 1 year. The STAT is a 28-item questionnaire that asks respondents to choose 1 of 4 answers to each scenario (call 911, call doctor, wait 1 hour, or wait 1 day). We also assessed cognitive status at 1 year using the validated telephone interview for Cognitive Status (TICS). We identified factors associated with STAT score (number of correct responses) using univariate and multivariate regression. Results: Among 254 patients who completed 1 year follow-up (65.8 years; 55.5% male; 68.5% white; 94.1% modified Rankin 0-1 at 1 year), the median STAT score was 57.1% (range 2.1-75.0%). In multivariate regression, TICS score (B=0.533; p<0.001) and ethnicity (B=-2.357, p=0.006) were independently associated with STAT score. Age, race, insurance, arrival by ambulance at time of index hospitalization, stroke unit admission, length of stay, discharge to rehabilitation, post-stroke hospital/clinic visits were not associated with STAT score. Conclusion: Despite hospitalization and standardized education at time of index event, most stroke survivors are unaware of stroke warning signs at 1 year. Besides cognitive status and Hispanic ethnicity, no other factors were identified that predicted STAT score performance. Future studies should focus on improving hospital-based stroke educational programs and consider novel strategies in patients with cognitive impairment and differing language/cultural backgrounds.
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