Clinical Calculators

HEART Score

Risk of major adverse cardiac events in emergency department patients with chest pain

5 items left

History (chest pain history)
ECG

Examples of repolarization abnormalities: bundle branch block, left ventricular hypertrophy, digoxin effect, an implanted right-ventricular pacemaker, a past myocardial infarction (including repolarization abnormalities that are unchanged). Patients with ST-elevation myocardial infarction (STEMI) are outside the scope of this score

18 to 100
years
Risk factors

Risk factors: diabetes, hypertension and hypercholesterolemia (count only those diagnosed before the visit, not those the patient merely suspects without a physician’s diagnosis); smoking (recent; the time window is 1 month in some reports and 90 days in others, so sources differ); obesity; a family history of coronary artery disease (may be counted or not). Atherosclerotic disease: peripheral artery disease, myocardial infarction, or a past coronary revascularization (stroke may also be counted)

Troponin

Use the hospital’s own standard (its discriminative level) to decide what is abnormal

Cautions

  • A score for patients who come to the emergency department with chest pain
  • The score was developed without patients who have ST-elevation myocardial infarction (STEMI): Six 2008 states that they were not part of the study, and Brady 2018 that they were excluded from the original development of the score. Do not use it for a patient with STEMI
  • For the ECG item, a significant ST deviation means significant ST depression or ST elevation (Six 2008, Methods; Brady 2018, body text), so a patient with ST elevation alone scores 2 points on this item
  • For what counts as an abnormal troponin, use the hospital’s own discriminative level (the paper also advises this). Assays differ, and so do their discriminative levels
  • In the first report (Six 2008) the troponin cut-offs were 1 to 2 times the discriminative level for 1 point and more than 2 times for 2 points. The cut-offs on this screen (1 to 3 times, more than 3 times) are from Table 1 of the review Brady 2018, so the boundary differs from the first report
  • In a validation of 2440 chest pain patients in 10 hospitals in the Netherlands (Backus 2013), 1.7% of the patients with 0 to 3 points, 16.6% of those with 4 to 6 points and 50.1% of those with 7 to 10 points had a major adverse cardiac event within 6 weeks. Even at 0 to 3 points the risk is not zero

References

  1. 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. (Table 1, Methods) PMID: 18665203, DOI: 10.1007/BF03086144, https://pmc.ncbi.nlm.nih.gov/articles/PMC2442661/[Original article]
  2. 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. (Abstract) (original not seen) PMID: 23465250, DOI: 10.1016/j.ijcard.2013.01.255[Original article]
  3. Brady W, de Souza K. The HEART score: A guide to its application in the emergency department. Turk J Emerg Med. 2018;18(2):47-51. (Table 1, section 5 (Electrocardiogram)) PMID: 29922729, DOI: 10.1016/j.tjem.2018.04.004, https://pmc.ncbi.nlm.nih.gov/articles/PMC6005932/[Review article]

Checked on: 2026-11-07

Disclaimer

This calculation is intended to support the judgment of healthcare professionals. Results are for reference only; decisions about diagnosis and treatment must be made by the responsible healthcare professional. The values you enter never leave your device.