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HEART Score for Major Cardiac Events in Chest Pain

The HEART score (0–10) risk-stratifies emergency department chest pain for 6-week major adverse cardiac events: 0–3 low (MACE ~1.7%, candidate for early discharge), 4–6 moderate (~16.6%, observe/investigate), 7–10 high (~50%, early invasive strategy).

  • History: Slightly suspicious (0); Moderately suspicious (1); Highly suspicious (2)
  • ECG: Normal (0); Non-specific repolarization disturbance (LBBB, LVH, paced, repolarization changes) (1); Significant ST deviation (2)
  • Age (years)
  • Risk factors: No known risk factors (0); 1–2 risk factors (1); ≥ 3 risk factors or known atherosclerotic disease (2)
  • Initial troponin: ≤ normal limit (0); 1–3× normal limit (1); > 3× normal limit (2)
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Interpretation

ResultMeaning
0–3Low risk (MACE 1.7%)
4–6Moderate (16.6%)
7–10High (50.1%)

Formula

History 0–2 · ECG 0–2 · Age (< 45: 0, 45–64: 1, ≥ 65: 2) · Risk factors (none 0, 1–2: 1, ≥ 3 or known atherosclerosis 2) · Troponin (≤ ULN 0, 1–3×: 1, > 3×: 2). Risk factors: hypertension, hypercholesterolemia, diabetes, obesity (BMI > 30), current or recent smoking, family history.

Clinical pearls

  • Low HEART score supports discharge only together with serial negative troponins (HEART Pathway).
  • Do not use for STEMI or patients with obvious alternative diagnoses; it is for undifferentiated chest pain.

Examples

heart score 58M moderately suspicious history, normal ecg, 2 risk factors, negative troponinheart score for a 70 year old woman with typical angina, st depression and troponin 5 times normalchest pain risk 40F atypical pain normal ekg no risk factors trop negative

FAQ

What HEART score is safe to discharge?

A HEART score of 0–3 is low risk (about 1–2% six-week MACE) and, with negative serial troponins, supports early discharge.

What counts as a risk factor in HEART?

Hypertension, hypercholesterolemia, diabetes, obesity, current or recent smoking, and family history of premature CAD; known atherosclerotic disease scores 2.

Evidence

  1. Six AJ, Backus BE, Kelder JC. Chest pain in the emergency room: value of the HEART score. Neth Heart J 2008;16:191–6.
  2. Backus BE et al. A prospective validation of the HEART score for chest pain patients at the emergency department. Int J Cardiol 2013;168:2153–8.

Cardiology · Reviewed 2026-10-14 · Methodology