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Kathleen Dracup had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis 2 Background. The effectiveness of therapy for an acute coronary syndrome (ACS) is dependent on patients ’ quick decision to seek treatment. We surveyed level of knowledge about heart disease and self-perceived risk for a future acute myocardial infarction (AMI) in patients with documented ischemic heart disease. Methods. Patients (N = 3522) were mean age 67 years, 68 % male and all had a history of AMI or invasive cardiac procedure for ischemic heart disease. Data were gathered using a 26-item instrument focusing on ACS symptoms and appropriate steps to seeking treatment. Patients were asked to identify their level of perceived risk for a future AMI. Results. Forty-six percent of patients had low knowledge levels (i.e., <70 % correct). The mean score was 71%. Higher knowledge scores were significantly related to female gender, younger age, higher education, participation in cardiac rehabilitation, an