Pre-hospital delay remains a significant obstacle to improving treatment for ACS. Further work investigating how patients and their relatives appraise symptoms in the two component phases of delay may help in the development of more effectively targeted interventions. Interventions aimed at helping patients and their families appraise symptoms more accurately and seek help more quickly are likely to reduce delay times here. The pattern of symptoms, including both pain and non-pain symptoms played an important part in reducing delay in the home-to-hospital component, suggesting that wider educational interventions aimed at the general public as well as clinical staff in recognizing the atypical symptoms of ACS may help to improve the rapidity of hospital admission. Interventions should focus on challenging unhelpful illness beliefs, and providing information and education concerning atypical patterns of symptoms in relation to ACS and be made more widely available to include patients' families, health care professionals and the general public.