How it's calculated
The HEART Score adds points (0-2) across five categories — History, ECG, Age, Risk factors, and Troponin — for a total of 0-10, stratifying patients with chest pain into low, moderate, or high risk of a major adverse cardiac event (MACE) within 6 weeks.
Score interpretation
| Score | Risk | 6-week MACE |
|---|---|---|
| 0 – 3 | Low | ~1.7% |
| 4 – 6 | Moderate | ~16.6% |
| 7 – 10 | High | ~50.1% |
Clinical use
- The HEART Score was developed specifically for undifferentiated chest pain in the emergency department, unlike scores derived from confirmed acute coronary syndrome populations.
- Low-risk patients (score ≤3) with a negative troponin are often considered for early discharge without further inpatient testing, per local protocol.
- The HEART Pathway (HEART score plus serial troponins at 0 and 3 hours) is a widely validated accelerated diagnostic protocol built around this score.
- Like all risk scores, it supports rather than replaces clinical judgement — a low score in a patient with a highly convincing history may still warrant further caution.
Frequently asked questions
What is the HEART Score used for?
It stratifies patients presenting with chest pain into low, moderate, or high risk of a major adverse cardiac event within 6 weeks, helping guide decisions about further testing, observation, or early discharge.
What counts as a low HEART Score?
A score of 0-3 is considered low risk (around 1.7% 6-week MACE), and such patients — especially with a negative troponin — are often considered for early discharge without further inpatient cardiac testing.
Is the HEART Score better than troponin alone?
The HEART Score combines history, ECG, age, risk factors, and troponin into a single risk estimate, which has been shown to outperform troponin alone or clinician gestalt for risk-stratifying chest pain.
What is the HEART Pathway?
It's an accelerated diagnostic protocol combining the HEART Score with troponin measurements at presentation and again at 3 hours, used to safely identify patients suitable for early discharge.
References
- Six AJ, Backus BE, Kelder JC. Chest pain in the emergency room: value of the HEART score. Neth Heart J. 2008;16:191-196.
- Mahler SA, et al. The HEART Pathway randomized trial. Circ Cardiovasc Qual Outcomes. 2015;8:195-203.
- Backus BE, et al. A prospective validation of the HEART score. Int J Cardiol. 2013;168:2153-2158.