How is the HEART score interpreted?

Score 0–3: Low risk (~2% MACE rate at 6 weeks), candidates for early discharge. Score 4–6: Moderate risk (~13% MACE), admission and further workup recommended. Score 7–10: High risk (~50% MACE), early invasive management indicated.

When should the HEART score be used?

The HEART score should be used in emergency department patients presenting with acute chest pain when acute coronary syndrome is in the differential diagnosis. It is not validated for use in STEMI (where immediate intervention is needed regardless of score) or for patients with clearly non-cardiac chest pain.

How does the HEART score compare to TIMI?

HEART was specifically designed for ED chest pain evaluation and includes clinical gestalt (History component), making it more practical in undifferentiated chest pain. TIMI was developed for known ACS patients. HEART better identifies low-risk patients safe for discharge; TIMI better stratifies patients with confirmed ACS.

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HEART Score for Chest Pain

Stratify risk of major adverse cardiac events (MACE) at 6 weeks in emergency department chest pain patients to guide disposition.

Eingaben

History Typicality of chest pain presentation.

ECG ECG findings at presentation.

Age

Risk factors HTN, DM, hyperlipidemia, smoking, obesity, family Hx CAD.

Troponin Initial troponin relative to the 99th percentile URL.

HEART Score. Select criteria above.

Low risk

MACE Risk (6 wk)—

Disposition guidance—

Haftungsausschluss: Nur zu Bildungszwecken. Kein Ersatz für klinisches Urteil. Always integrate with clinical assessment, serial troponins, and local protocols.

Scoring criteria

History: 0 = slightly suspicious, 1 = moderately, 2 = highly suspicious
ECG: 0 = normal, 1 = non-specific changes, 2 = significant ST deviation
Age: 0 = <45, 1 = 45–64, 2 = ≥65
Risk factors: 0 = none, 1 = 1–2, 2 = ≥3 or known atherosclerotic disease
Troponin: 0 = ≤ normal, 1 = 1–3× normal, 2 = >3× normal

MACE risk by score

0–3 (Low): ~1.6% MACE at 6 weeks
4–6 (Moderate): ~12–16.6% MACE at 6 weeks
7–10 (High): ~50–65% MACE at 6 weeks

Clinical pearls

Low-risk patients (0–3) may be candidates for early discharge with outpatient follow-up.
Moderate-risk patients (4–6) should be admitted for observation and further workup.
High-risk patients (7–10) warrant early invasive strategy.
Use high-sensitivity troponin assays and apply institutional cutoffs.

References

Six AJ, et al. Chest pain in the emergency room: value of the HEART score. Neth Heart J. 2008;16(6):191–196.
Backus BE, et al. A prospective validation of the HEART score for chest pain patients at the emergency department. Int J Cardiol. 2013;168(3):2153–2158.

Related tools

Über dieses Tool

What Is the HEART Score?

The HEART score is a clinical decision tool designed to risk-stratify emergency department patients presenting with acute chest pain for major adverse cardiac events (MACE) within 6 weeks. Developed by Six et al. in 2008 in the Netherlands, it incorporates five elements: History, ECG, Age, Risk factors, and Troponin — each scored 0–2 for a total range of 0–10. The HEART score was designed specifically to identify low-risk patients who can be safely discharged early, reducing unnecessary admissions and costly workups.

When to Use the HEART Score

Apply the HEART score to adult patients presenting to the ED with chest pain where acute coronary syndrome (ACS) is in the differential. It is most useful for identifying the large proportion of ED chest pain patients who are at low risk (score 0–3) and may be candidates for early discharge with outpatient follow-up, potentially avoiding observation unit admission and stress testing.

Interpreting HEART Score Results

Patients with HEART scores of 0–3 have approximately 1.6% risk of MACE at 6 weeks and are generally considered safe for early discharge. Scores of 4–6 indicate moderate risk (~12–16.6% MACE) warranting admission for observation and serial troponins. Scores of 7–10 indicate high risk (~50–65% MACE) and should prompt early invasive strategy consideration.

🔑 Klinische Hinweise

The HEART Pathway (HEART score + 0/3-hour high-sensitivity troponin) has been prospectively validated to safely reduce admissions by ~20% without missing MACE events.
The "History" component is the most subjective. Highly suspicious = typical anginal chest pain (substernal pressure, exertional, relieved by rest/nitroglycerin). Slightly suspicious = clearly non-cardiac features.
Use high-sensitivity troponin assays and apply your institution's 99th percentile URL for the troponin component.
The HEART score was not designed to diagnose ACS — it predicts 6-week MACE risk to guide disposition. STEMI should be identified by ECG before applying any risk score.

Schlüsselreferenzen

Six AJ, et al. Chest pain in the emergency room: value of the HEART score. Neth Heart J. 2008;16(6):191–196.
Backus BE, et al. A prospective validation of the HEART score for chest pain patients at the emergency department. Int J Cardiol. 2013;168(3):2153–2158.
Mahler SA, et al. The HEART Pathway randomized trial: identifying emergency department patients with acute chest pain for early discharge. Circ Cardiovasc Qual Outcomes. 2015;8(2):195–203.

Formel zuletzt überprüft: Februar 2026