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HEART Score

Select the descriptor that best matches each HEART score component (History, ECG, Age, Risk factors, Troponin).

History

ECG

Age

Risk factors

Risk factors include hyperlipidaemia, hypertension, diabetes, current smoking, obesity, positive family history, or established atherosclerotic disease.

Troponin (relative to upper limit of normal)

HEART score

4

Risk category

Moderate risk

≈12–16% 6-week MACE risk

Observation with serial ECGs/troponins and possible functional or anatomical testing is recommended prior to disposition.

How to Use This Calculator

1

Assess the chest pain history

Determine how suspicious the presentation is for acute coronary syndrome based on features and risk profile.

2

Evaluate ECG and troponin

Use the worst ECG finding and the highest troponin relative to the 99th percentile upper limit of normal.

3

Combine with clinical judgement

HEART complements—not replaces—clinical evaluation. Consider serial testing, alternative diagnoses, and patient preference.

Formula

HEART Score = History (0–2) + ECG (0–2) + Age (0–2) + Risk factors (0–2) + Troponin (0–2).

Score 0–3: low risk, 4–6: moderate risk, 7–10: high risk of 6-week major adverse cardiac events.

Full Description

The HEART score stratifies emergency department chest pain patients for near-term risk of myocardial infarction, revascularisation, or death. It improves decision-making about discharge versus observation and has been validated across diverse populations. Integrate serial troponins and consider HEART Pathway protocols for safe early discharge.

Frequently Asked Questions

How do I count risk factors?

Include hypertension, hyperlipidaemia, diabetes, current smoking, obesity, positive family history, and known atherosclerotic disease.

Can I use high-sensitivity troponin?

Yes. Compare the value to the assay-specific 99th percentile upper reference limit to assign troponin points.

What if serial troponins change the score?

Update the troponin component with the highest value obtained during serial testing.

Does HEART apply to patients with known CAD?

Yes, but risk may be higher. Use HEART in conjunction with clinician expertise and guideline-based management of known coronary disease.