Home / HEART Score

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.

Inputs

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—

Disclaimer: For educational purposes only. Not a substitute for clinical judgment. 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.