HEART Score Calculator

A validated clinical decision tool for risk stratification of chest pain patients in the emergency department. Predicts 6-week risk of major adverse cardiac events (MACE).

Important Clinical Disclaimer: The HEART Score is intended for use by qualified healthcare professionals only. It is for educational and informational purposes and should not replace clinical judgement. Always interpret results alongside the full clinical picture and follow your local guidelines and protocols.
HEART Score Assessment

Is the patient's history highly suspicious for acute coronary syndrome (ACS)?

Evaluate the 12-lead ECG for signs of ischaemia.

Patient's age in years.

Risk factors: hypertension, hypercholesterolaemia, diabetes, obesity (BMI >30), smoking (current or quit ≤3 months), family history of CAD (1st degree relative <65 years), atherosclerotic disease (prior MI, PCI/CABG, CVA/TIA, peripheral arterial disease).

Initial troponin level (use your laboratory's normal reference range).

About the HEART Score

The HEART Score (History, ECG, Age, Risk factors, Troponin) is a clinical decision tool developed to stratify risk in patients presenting to the emergency department with chest pain.

Key Features:
  • Developed specifically for emergency department chest pain assessment
  • Predicts 6-week MACE (Major Adverse Cardiac Events): death, MI, or coronary revascularisation
  • Validated in multiple international cohorts
  • Helps guide disposition decisions (discharge vs observation vs admission)
  • Simple to calculate at the bedside
When to Use:
  • Adult patients presenting with chest pain or anginal equivalent
  • After initial troponin result is available
  • To guide decision-making regarding discharge vs further workup

HEART Score Interpretation

HEART Score Risk Category 6-Week MACE Risk Recommended Management
0-3 Low Risk 0.9-1.7%
  • Consider early discharge with outpatient follow-up
  • GP follow-up within 72 hours
  • Provide clear safety-netting advice
  • Consider stress testing as outpatient if appropriate
4-6 Moderate Risk 12-16.6%
  • Admission for observation recommended
  • Serial troponins (e.g., 3-6 hours)
  • Consider non-invasive testing (stress test, CT coronary angiography)
  • Cardiology review may be appropriate
7-10 High Risk 50-65%
  • Admission to coronary care unit
  • Urgent cardiology consultation
  • Consider early invasive strategy (angiography)
  • Initiate ACS protocol and antiplatelet therapy
Important Notes:
  • MACE = Major Adverse Cardiac Events (death, myocardial infarction, coronary revascularisation)
  • The HEART Score should be used alongside clinical judgement, not as a replacement
  • Patients with STEMI or clear high-risk features should receive immediate treatment regardless of score
  • Local protocols and pathways should take precedence

Limitations

When NOT to Use
  • STEMI - patients with ST-elevation MI require immediate reperfusion, not risk stratification
  • Haemodynamic instability - hypotensive or shocked patients
  • Obvious non-cardiac chest pain - trauma, clear musculoskeletal cause
  • Patients already diagnosed with ACS - HEART Score is for undifferentiated chest pain
  • Paediatric patients - validated only in adults
Score Limitations
  • History scoring is subjective and depends on clinician interpretation
  • Troponin assays vary between laboratories - use local reference ranges
  • High-sensitivity troponin may affect scoring thresholds
  • Does not account for symptom duration or timing
  • Risk factors definition may vary between studies
  • Not validated for serial assessment over time

Frequently Asked Questions

HEART is an acronym for the five components of the score:

  • H - History
  • E - ECG
  • A - Age
  • R - Risk factors
  • T - Troponin

Each component is scored 0, 1, or 2 points, giving a total score range of 0-10.

A HEART Score of 0-3 identifies patients at low risk (approximately 1-2% MACE risk at 6 weeks). Studies have shown that early discharge of these patients is safe, provided:

  • Troponin is negative (at an appropriate time point)
  • Clinical judgement supports discharge
  • Appropriate safety-netting is provided
  • Follow-up is arranged (e.g., GP within 72 hours)

However, the score should supplement, not replace, clinical judgement. If you have concerns despite a low score, further investigation is appropriate.

The History component is the most subjective element. Consider:

  • Highly suspicious (2 points): Classic anginal symptoms - central/left chest pain, crushing/pressure-like, radiating to arm/jaw/neck, associated with diaphoresis, nausea, dyspnoea, worse with exertion
  • Moderately suspicious (1 point): Some features of ACS but mixed or atypical - e.g., chest pain with some classic features but lacking others
  • Slightly suspicious (0 points): Non-specific symptoms, clearly atypical presentation, pain that is sharp/positional/pleuritic/reproducible

When in doubt, score higher (more conservative approach).

The original HEART Score was validated with conventional troponin assays. With high-sensitivity troponin (hs-cTn):

  • The score can still be used, but be aware that hs-cTn may detect smaller troponin elevations
  • Use your laboratory's 99th percentile upper reference limit as the "normal limit"
  • Some centres use modified HEART pathways incorporating hs-cTn protocols (e.g., 0/1 hour or 0/3 hour pathways)
  • Consider combining with delta troponin values if available

Follow your local ACS pathway guidance for troponin interpretation.

The HEART Score has been extensively validated:

  • Derivation: Six et al. (2008) - developed in the Netherlands
  • Validation: Multiple international studies including the HEART Pathway trial (2015)
  • Meta-analyses: Confirm good discrimination for MACE prediction
  • Implementation studies: Show safe reduction in admissions and testing

The score has been shown to reduce unnecessary admissions and testing while maintaining patient safety when applied appropriately.

Disclaimer

This calculator is provided for educational and informational purposes only. It is not intended to be a substitute for professional medical advice, diagnosis, or treatment.

  • Always seek the advice of a qualified healthcare provider with any questions regarding a medical condition.
  • Never disregard professional medical advice or delay seeking it because of information from this tool.
  • Clinical decision-making should always incorporate the full clinical context, patient preferences, and local protocols.
  • The creators of this tool accept no liability for decisions made based on its output.

If you are a patient: please discuss any results with your healthcare provider. This tool is designed for use by medical professionals and may not be appropriate for self-assessment.

References

  1. Six AJ, Backus BE, Kelder JC. (2008). Chest pain in the emergency room: value of the HEART score. Netherlands Heart Journal, 16(6), 191-196.
  2. Backus BE, et al. (2013). A prospective validation of the HEART score for chest pain patients at the emergency department. International Journal of Cardiology, 168(3), 2153-2158.
  3. Mahler SA, et al. (2015). The HEART Pathway randomized trial: identifying emergency department patients with acute chest pain for early discharge. Circulation: Cardiovascular Quality and Outcomes, 8(2), 195-203.
  4. Poldervaart JM, et al. (2017). Effect of using the HEART score in patients with chest pain in the emergency department: a stepped-wedge, cluster randomized trial. Annals of Internal Medicine, 166(10), 689-697.
  5. NICE (2024). Acute coronary syndromes (NG185). National Institute for Health and Care Excellence.