‘FAST’ Acronym Beats ‘BE-FAST’ for Prompt Stroke Response

The widely used FAST acronym remains the best tool for helping bystanders recognize stroke symptoms, despite efforts to expand it to BE-FAST.

A new study showed that adding Balance and Eye changes (BE) to FAST — Face drooping, Arm weakness, Speech difficulty, and Time to call 911 — does not significantly increase the likelihood of bystanders immediately calling emergency services when a stroke is suspected.

The study showed FAST performed significantly better than BE-FAST in terms of recalling key face, arm, and speech symptoms.

“Our desire to capture everything may actually overwhelm the general public,” study investigator Opeolu Adeoye, MD, chair, Department of Emergency Medicine, Washington University School of Medicine, St. Louis, and American Heart/Stroke Association volunteer, told Medscape Medical News. “In this case, I would suggest that perfect is the enemy of good.”

The findings were presented on February 5 at International Stroke Conference (ISC) 2025.

FAST More Effective for the Public?

FAST, which has been used in the stroke community for over 20 years, captures only about 80% of all strokes. This has led stroke neurologists to start using BE-FAST, “which allows us to capture those posterior circulation, or back of the brain, strokes that are missed somewhat by FAST,” said Adeoye.

Many stroke neurologists were under the impression that because BE-FAST includes more symptoms, it would be better at triggering emergency action by the general public.

The study included a representative sample of English-speaking US residents who completed a survey on their awareness of stroke symptoms. They were then randomly assigned to view a 1-minute educational video depicting FAST or a 1-minute video on BE-FAST.

Researchers assessed symptom knowledge and intent to call 911 among 1900 participants immediately after watching the video. They adjusted for age, stroke knowledge/experience, education level, and baseline familiarity with the mnemonic.

After viewing the video, the likelihood of calling 911 if a stroke was suspected increased in both groups (72% to 90% in FAST and 71% to 90% in BE-FAST; P

“It’s great to see that if people suspect a stroke, their inclination is to call 911, and that seems like a big win for us in terms of public awareness,” said Adeoye.

The ability of participants to identify what the letters F, A, and S represent was significantly higher immediately after seeing the video than at baseline for both groups (34% to 70% in FAST and 29% to 50% in BE-FAST; P

However, Adeoye noted the higher letter recognition in the FAST group than in the BE-FAST group (70% vs 50%). For awareness of stroke signs and symptoms, “that’s where I think BE-FAST loses ground relative to FAST,” he said.

Researchers also investigated symptom knowledge after 30 days among 1393 participants. Here, the likelihood of calling 911 had declined slightly in both groups but remained higher than at baseline with no between-group difference.

The ability of participants to recall what the letters mean declined for both groups but remained higher than at baseline. Again, FAST had significantly higher recognition than BE-FAST after 30-days (50% vs 40%; P .

The results suggest that for the general public, “something might be lost” by adding the two extra letters to FAST, said Adeoye.

The study’s findings suggest that FAST is the more effective approach for the general public, said Adeoye. However, the researcher noted that retaining BE-FAST may still be a reasonable choice for healthcare professionals, even though the study did not specifically assess that outcome.

FAST ‘Wins the Day’

Commenting for Medscape Medical News, William “B.J.” Hicks, MD, vice president, Neurosciences, Ohio Health, Columbus, Ohio, and American Stroke Association national volunteer expert, said the study provides useful information for stroke neurologists.

As FAST doesn’t encapsulate all possible stroke symptoms, “there was a concern in the stroke community that bystanders were not understanding that if you suddenly have an issue with vision, or an issue with balance, those are stroke-like symptoms,” said Hicks.

The idea was that adding these two symptoms would improve stroke symptom recognition, that “anything that builds off of something before is inherently better,” said Hicks.

He noted several stroke teams, and stroke centers have “started to gravitate toward” using BE-FAST.

However, the results of this new study suggest perhaps this may be too complicated for the general public. It’s “of paramount importance” that thestroke community has an acronym that’s “easily and readily identifiable” and that all Americans “can really grasp and understand. I think that’s where FAST wins the day,” said Hicks.

Adding the two extra letters — B and E — might interfere with providing “a clarifying, clear message” to the public, added Hicks. “Sometimes you pile on a little bit too much and it just becomes noise.”

He said some neurologists will likely be surprised that adding the BE to FAST doesn’t improve stroke symptom recognition, but “that’s the beauty of clinical trials.”

The study received funding support from the HCA Healthcare Foundation. Adeoye and Hicks reported no relevant disclosures.