Public awareness of early symptoms of acute coronary syndrome and its association with anticipated prehospital delay: a cross-sectional study in Palestine

Background Timely recognition of acute coronary syndrome (ACS) symptoms is critical for early intervention and improved outcomes. This study assessed public awareness of ACS symptoms and its association with anticipated prehospital delay in Palestine. Methods A cross-sectional online survey was conducted between February and March 2026 among 1,293 Palestinian adults recruited through convenience sampling on social media platforms. A structured questionnaire assessed ACS symptom and risk-factor knowledge, anticipated help-seeking response to suspected ACS symptoms, and self-reported cardiovascular risk burden. Composite scores were pre-specified, and multivariable regression models were used to examine factors associated with knowledge and anticipated delay risk. Results The mean knowledge score was 7.91 ± 2.96, with 33.1% demonstrating high knowledge. A marked knowledge-action gap was observed: although 90.1% identified ambulance activation as the correct action, only 56.2% reported that they would call an ambulance for chest pain lasting more than 5 min. Higher knowledge was weakly associated with a more appropriate anticipated response ( β = 0.083, p < 0.001), whereas higher cardiovascular risk burden was associated with poorer anticipated response (OR = 1.22, 95% CI 1.01–1.48). Females had higher knowledge scores, while males reported more appropriate anticipated emergency responses. Conclusion This study identified suboptimal ACS knowledge and a gap between awareness and intended emergency response in an online convenience sample of Palestinian adults. Because the behavioral outcome was hypothetical, findings should be interpreted as anticipated response rather than actual prehospital delay. Interventions should combine symptom-awareness education with behavior-change strategies that promote immediate emergency medical service activation.