Free tool · Scored assessment · ER / Cardiac
HEART Score for Chest Pain.
Risk-stratify a patient with chest pain in the ED for a major adverse cardiac event (MACE) over the next ~6 weeks. Score the five elements — History, ECG, Age, Risk factors, Troponin — for a total of 0 to 10, and get the low / moderate / high band with its published MACE rate and the usual disposition framing. Built from Six (2008) and the Backus (2013) validation. The score supports the workup; the provider’s evaluation drives disposition.
Score the five elements
Use the clinical picture at the time of evaluation. Troponin is scored as multiples of your assay’s upper reference limit.
Score all five elements to see the risk band.
HEART scoring & risk bands [1][2]
| Element | 0 | 1 | 2 |
|---|---|---|---|
| History | Slightly suspicious | Moderately suspicious | Highly suspicious |
| ECG | Normal | Non-specific repolarization | Significant ST deviation |
| Age | <45 | 45–64 | ≥65 |
| Risk factors | None | 1–2 | ≥3 or known atherosclerotic dz |
| Troponin | ≤ normal | 1–3× normal | >3× normal |
Risk factors = HTN, hypercholesterolemia, diabetes, obesity (BMI >30), smoking (current or cessation ≤3 months), and family history of premature coronary disease. A history of significant atherosclerotic disease (prior MI, PCI/CABG, stroke/TIA, or peripheral arterial disease) automatically scores 2. Bands: 0–3 low (~1.7% MACE), 4–6 moderate (~12–17% MACE), 7–10 high (~50–65% MACE) at 6 weeks. The HEART score does not, by itself, rule out ACS — serial troponin and provider judgment apply.
References
- Six AJ, Backus BE, Kelder JC. Chest pain in the emergency room: value of the HEART score. Neth Heart J. 2008;16(6):191–196. PMID: 18665203. (Original HEART score derivation.)
- Backus BE, Six AJ, Kelder JC, 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. PMID: 23465250. (Multicenter validation; 6-week MACE 0–3 ≈1.7%, 4–6 ≈16.6%, 7–10 ≈50.1%.)
- Mahler SA, et al. The HEART Pathway (HEART score + 0- and 3-hour troponin). Circ Cardiovasc Qual Outcomes. 2015. (Accelerated-diagnostic-protocol use of the score.)
Element definitions and MACE rates transcribed from the cited derivation and validation studies. Disposition is individualized by the care team and local pathway.
Pairs well with