OBJECTIVE: To describe the benefits and pitfalls of educational campaigns designed to reduce the delay between the onset of acute myocardial infarction (AMI) and its treatment. METHODS: All seven educational campaigns reported between 1982 and 1994 were evaluated. RESULTS: The impact on delay time ranged from a reduction of patient decision time by 35% to no reduction. One study reported a sustained reduction that resulted in the delay time being halved during the three years after the campaign. The use of ambulances did not increase. Only one study reported that survival was unaffected. There was a temporary increase in the numbers of patients admitted to the emergency department with non-cardiac chest pain in the initial phase of educational campaigns. CONCLUSION: The challenge of shortening the delay between the onset of infarction and the start of treatment remains. The campaigns so far have not been proved to be worthwhile and it is not certain that further campaigns will do better. New media campaigns should be run to establish whether a different type of message is more likely to change the behaviour of people in this life-threatening situation.