Moser et al. [1] have argued that social and proximal factors such as being married, having a bystander present and location at symptom onset play an important role in the cognitive aspects of symptom appraisal. Our findings support this, showing that both being married and the presence of a bystander predicted short pre-hospital delay, and are associated specifically with the decision time component. Perhaps not surprisingly, a bystander is more likely to be present if patients are married. Previous studies have shown conflicting findings concerning the role and relationship of the bystander in pre-hospital delay, since although patients tend to have a short decision time if a bystander is present, this is not the case if the bystander is a relative because family members, particularly spouses, often recommend strategies that increase delay [6,8]. Our results support previous findings showing that patients who are at home when symptoms begin are likely to have longer pre-hospital delays [8,23], indicating that the relationship between the context in which cardiac symptoms occur and pre-hospital delay is complicated and warrants detailed investigation. Educational and counseling interventions aimed at reducing decision delay have been found to increase patients knowledge of ACS [24] but it may be useful if future interventions were to incorporate ways of optimizing bystander assistance, particularly among relatives of patients previously identified as at risk of ACS.