United Stroke Alliance Patient Survey Questions

The following online survey includes a short series of questions related to patient experiences with stroke. It will take no more than 5 minutes of your time. Your responses will help inform the development of patient and caregiver resources. If you are filling this out for a stroke survivor who is unable to complete the survey, please answer from their perspective. Thank you for your time.

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* 1. What is your gender?

Male

Female

Prefer not to answer

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* 2. What is your age?

Under 40 years old

40-49 years old

50-59 years old

60-69 years old

70-79 years old

80+ years old

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* 3. What best describes where you live?

Rural (country)

Suburban (just outside a city or town)

Urban (city)

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* 4. How long ago did you experience a stroke?

Less than 1 year ago

1 to 2 years ago

3 to 5 years ago

More than 5 years ago

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* 5. What kind of stroke did you have?

Ischemic Stroke (Clot or Blocked Artery)

I can’t remember

Hemorrhagic Stroke (Bleeding in the Brain)

N/A

I don't know

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* 6. If you suffered an ischemic stroke, were you given a cause/diagnosis of your stroke?

Yes

I Can't Remember

N/A

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* 7. As someone who has experienced a stroke, how concerned are you about having another stroke (recurrent stroke)?

Very Concerned

Somewhat Concerned

Not at all Concerned

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* 8. How informed do you feel about recurrent stroke risk and actions you can take to prevent another stroke?

Very informed

Somewhat informed

Not at all informed

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* 9. How are you currently managing your recurrent stroke risk? (select all that apply)

I’m not managing my stroke risk factors

Exercise

Diet

Heart Monitoring

Medication

Reduced or quit smoking

Managing blood pressure, diabetes and/or cholesterol

In-office visits with my doctor every 6-12 months

Other

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* 10. Are you aware of the connection between atrial fibrillation, an irregular heart rhythm, and stroke?

Yes

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* 11. Atrial fibrillation is a risk factor for stroke. What type of heart monitoring have you received after your stroke? (select all that apply)

Short-term monitor (Holter monitor or sticky patch placed on the outside of your chest)

Insertable heart monitor (Small device placed just under the skin)

App or personal health monitoring device (i.e., iPhone)

No heart monitoring following my stroke

I’m not sure

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* 12. What information or resources would you find helpful to learn more about atrial fibrillation and heart monitoring? (select all that apply)

Talking to a heart doctor (cardiologist or electrophysiologist)

Talking with/hearing from other stroke survivors who received heart monitoring after their stroke

Participating in a stroke survivor patient group

Using Online tools (videos, graphics, questions to ask your doctor checklists)

Other (please specify)

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* 13. Did your stroke doctor refer you to a heart doctor (cardiologist or electrophysiologist) following your stroke?

Yes

I don’t remember