About the HEART Score
The HEART score is a bedside decision aid used in the emergency department to estimate the short-term risk of a major adverse cardiac event (MACE - death, myocardial infarction, or coronary revascularization) in a patient presenting with chest pain. Introduced by Backus, Six, and colleagues, it combines five simple, readily available elements into a single 0-to-10 score that separates patients into low, moderate, and high risk of a cardiac event within 6 weeks.
How the score is built
Each of five components scores 0, 1, or 2 points, and the five points are added together:
- History: how suspicious the reported symptoms and story are for acute coronary syndrome - slightly or non-suspicious (0), moderately suspicious (1), or highly suspicious (2).
- EKG (ECG): normal (0), a nonspecific repolarization disturbance (1), or significant ST-segment deviation not explained by another cause (2).
- Age: under 45 years (0), 45 to 64 years (1), or 65 years and older (2).
- Risk factors: no known risk factors (0), 1 to 2 risk factors such as hypertension, hypercholesterolemia, diabetes, obesity, smoking, family history, or known atherosclerotic disease (1), or 3 or more risk factors, or a known history of atherosclerotic disease, such as prior myocardial infarction, PCI, CABG, stroke, or peripheral artery disease (2).
- Troponin: at or below the local upper limit of normal (0), between 1 and 3 times that limit (1), or more than 3 times that limit (2).
Interpreting the result
Adding the five components gives a total from 0 to 10. In the original and follow-up validation studies, a score of 0-3 (low risk) was associated with roughly 0.9% to 1.7% 6-week MACE risk, 4-6 (moderate risk) with roughly 12% to 16.6%, and 7-10 (high risk) with roughly 50% to 65%. These bands describe average outcomes in the study populations, not a guarantee for any one patient, and clinical practice may translate them into different management pathways.
When to consult a professional
This tool performs the standard HEART score arithmetic for education and reference. It is not a diagnosis and does not replace clinical assessment. Any decision about discharge, observation, further testing, or invasive management should be made by a qualified clinician who has examined the patient and reviewed the full clinical picture.