ABSTRACT NUMBER: ESOC2026A778 STROKE LITERACY IN ITALY: AN ICEBERG MODEL REVEALING DOMAIN-SPECIFIC GAPS BEYOND APPARENT EMERGENCY AWARENESS

Abstract Background and aims Despite public campaigns, pre-hospital delays in acute ischemic stroke remain substantial, with only modest improvement in onset-to-door times. Methods We ran a nationwide cross-sectional survey on ischemic stroke knowledge across four domains: conceptual knowledge, symptom recognition, awareness of time-dependent treatment, and intended emergency action (immediate EMS/118 call). A composite score (≥3 correct) was analysed using contingency tests and multivariable logistic regression. Results Among 1,769 participants, 71% were female, 60% held a university degree, 9% worked in healthcare, and 47% reported a family history of stroke. Only 25% identified “cerebral stroke” and “cerebral ischemia” as synonyms, and 52% rated stroke as severe but ischemia as milder; accuracy was higher in healthcare workers (45% vs 23%, p<0.001) and higher education (29% vs 22%, p=0.002). One quarter failed to identify unilateral paralysis as the cardinal symptom, with lower recognition in those aged ≥41 years (70–73% vs ~77–79%, p=0.019). Treatment awareness was high (84%) and associated with higher education/healthcare-related exposure (p=0.007). Intended EMS/118 call was reported by 85% and associated with younger age (p=0.004) and indirect stroke-care exposure (p=0.001). Overall, 65% achieved a high composite score; healthcare employment independently predicted a high score (OR 2.02, 95% CI 1.28–3.19), whereas age and educational level were not independently associated. Conclusions Findings support an iceberg model of stroke literacy, with surface awareness masking deeper, phase-specific gaps requiring targeted education. Conflict of interest MR Bagnato has nothing to disclose Figure 1 - belongs to Conclusions