HEART Score Calculator

What the HEART Score Assesses

HEART is a risk score for adults presenting to an emergency department with undifferentiated chest pain. It is designed to identify the large group of patients who can be safely discharged after a short evaluation, while flagging those who need admission and early investigation. Five components, each scored 0, 1 or 2, give a total from 0 to 10.

The Five Components

• H — History: slightly suspicious (0), moderately suspicious (1), highly suspicious (2)
• E — ECG: normal (0), non-specific repolarisation changes (1), significant ST deviation (2)
• A — Age: under 45 (0), 45 to 64 (1), 65 or older (2)
• R — Risk factors: none (0), one or two (1), three or more or known atherosclerotic disease (2)
• T — Troponin: normal (0), 1–3 times the upper limit of normal (1), more than 3 times (2)

Risk Bands and Six-Week MACE

• 0–3: low risk — roughly 1.7 % risk of a major adverse cardiac event within six weeks; discharge with follow-up is often appropriate
• 4–6: moderate risk — roughly 16.6 % — admission for observation, serial troponins and further testing
• 7–10: high risk — roughly 50 % — early invasive assessment and cardiology involvement

The percentages come from the original derivation and subsequent validation cohorts. They vary with the troponin assay used — high-sensitivity assays reclassify some patients downward — and with the population studied, so local pathways should be followed where they exist.

Where It Fits in Practice

• A single troponin is not enough. Serial sampling (or a validated high-sensitivity single-sample protocol) is required before any low-risk patient is discharged.
• The score complements, not replaces, ECG interpretation, which must be done by a competent reader and repeated if symptoms continue.
• It applies to undifferentiated chest pain in adults; it was not designed for ST-elevation myocardial infarction, where the pathway is immediate reperfusion.
• Alternative diagnoses still need excluding — pulmonary embolism, aortic dissection, pneumothorax and oesophageal or musculoskeletal causes. Scores such as PERC and the Wells score cover the thromboembolic ones.

Limitations

• “History” is subjective and is the component most likely to differ between clinicians.
• It was derived in emergency department populations and performs less predictably in primary care, in the very elderly, and in patients with chronic kidney disease or known coronary disease.
• It excludes some important groups from study populations, including those with haemodynamic instability, arrhythmia or clear non-cardiac causes.
• It estimates short-term risk of events, not the presence or absence of coronary disease.

Frequently Asked Questions