Chest pain, shortness of breath, discomfort in the arms, neck or shoulders. Universally recognised heart attack warning signs, right?

Not so for up to four million Australians apparently.

New research shows one in five adults can't name a heart attack symptom and only about half know that chest pain is one of them.

The Monash University-led study examined the impact of a three-year Heart Foundation Warning Signs campaign designed to improve awareness and confidence to act.

It found heart attack patients who observed the initiative while it was running acted fast, but a cross-sectional comparison during and immediately after the campaign, between 2010 and 2014, and from 2015 until 2020, told a different story.

More than 100,000 adults were surveyed for the study, revealing a significant decline in awareness.

Recognition of chest pain as a heart attack symptom fell from 80 per cent in 2010 to 57 per cent in 2020, while the proportion of respondents who could not name a single heart symptom increased from four per cent to 20 per cent.

Lead author Associate Professor Janet Bray described the findings as "very alarming" and said new approaches were needed to ensure people act appropriately if symptoms occur.

"Every minute, more heart muscle dies and the chance of complications like cardiac arrest increases," she said.

"Every Australian should be able to recognise heart attack symptoms and the need to respond quickly and call triple zero for an ambulance."

The Heart Foundation's Dr Amanda Buttery said some Australians were at risk of serious illness or death due to their lack of knowledge, and awareness was unlikely to have improved since the study finished in 2020, as public health messaging had been focused on COVID-19.

"A heart attack occurs due to a blockage in an artery in the heart, which means blood and oxygen can't get to part of the heart and that part starts to die," she said.

"We have treatments in hospital that can reopen the blocked artery and the quicker this can be done the less heart muscle that dies. This is why we need the public to know heart attack symptoms and to call an ambulance."

The findings of the Monash study have already helped inspire a federally funded partnership to increase awareness involving Monash, the Heart Foundation, Ambulance Victoria and the Victorian Department of Health.

Dubbed Heart Matters, it focuses on eight high-risk local government areas which exhibit low warning sign recognition and ambulance use.

Almost 57,000 Australians have a heart attack or angina every year, equating to 155 events every day.

Twice as many men experience heart attacks as women and considerably more men die.

Hospital treatment is required by 157 people per day or one every nine minutes.