HEART Score Calculator

The HEART Score is a clinical decision tool used in emergency departments to stratify chest pain patients by their risk of a major adverse cardiac event (MACE) within 6 weeks. It evaluates five factors: History, ECG findings, Age, Risk Factors, and Troponin level, each scored 0–2 for a maximum total of 10.

MACE refers to serious cardiac outcomes including acute myocardial infarction (heart attack), percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG), or death. The HEART Score predicts the likelihood of experiencing any of these events within 6 weeks of an ED presentation for chest pain.

A score of 0–3 indicates low risk (approximately 1–2% MACE), suggesting the patient may be safely discharged with outpatient follow-up. A score of 4–6 indicates moderate risk (~12–17% MACE), warranting further observation and testing. A score of 7–10 indicates high risk (~50–65% MACE), requiring urgent cardiology consultation and likely invasive management.

The HEART Score was developed by Dr. Barbra Backus and colleagues in the Netherlands and first published in 2010. It was validated in multiple large prospective studies and has since become one of the most widely used chest pain risk stratification tools in emergency medicine worldwide.

Multiple studies have shown the HEART Score outperforms both the TIMI and GRACE scores for risk stratification of undifferentiated chest pain in the ED. It is simpler to calculate, doesn't require laboratory values beyond troponin, and has been shown to identify a larger proportion of truly low-risk patients who can be safely discharged.

The HEART Score is validated for adults presenting to the ED with chest pain of possible cardiac origin. It should not be used for patients with a clearly non-cardiac cause of chest pain, those with ST-elevation MI (STEMI), or patients with new left bundle branch block (LBBB), as these require immediate intervention regardless of score.

The Troponin component is assessed relative to the laboratory's normal upper limit for the specific assay used (conventional or high-sensitivity troponin). A result ≤ the normal limit scores 0, a result 1–3× the normal limit scores 1, and a result > 3× the normal limit scores 2.

A low HEART Score (0–3) is associated with a very low MACE rate (~1.9%) and supports early discharge in most cases. However, clinical judgment should always be applied — the score is a decision support tool, not a replacement for individualized clinical assessment. Shared decision-making with the patient is recommended.