HEART Score for Major Cardiac Events

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HEART Score for Major Cardiac Events

Estimates risk of major cardiac events in chest pain patients

All tools /

HEART Score for Major Cardiac Events

Estimates risk of major cardiac events in chest pain patients

History (H)

Overall suspicion based on story/exam.

ECG (E)

Most abnormal ECG in current visit.

Age (years)

Age points: 1 (<45 = 0 · 45–64 = 1 · ≥65 = 2)

Risk factors (R)

Select all that apply. Known atherosclerotic disease (CAD/MI/PCI/CABG/PAD/stroke/TIA) ⇒ 2 pts regardless of count.

HypertensionHyperlipidemiaDiabetesSmokingObesityFamily history of CADKnown atherosclerotic disease (forces 2 pts)

Selected: 0 · Risk-factor points: 0

Troponin (T)

Relative to your lab's upper limit of normal (ULN).

Troponin value

ULN

Entering value + ULN auto-suggests a category; you can still choose manually.

HEART 2 — Low (0–3)

Estimated 4–6 week MACE: ~1.7% (4–6 wk) · H1 · E0 · A1 · R0 · T0

Instructions

The HEART Score is a validated risk stratification tool for patients presenting to the emergency department with chest pain. It predicts the risk of major adverse cardiac events (MACE) within 6 weeks, including myocardial infarction, percutaneous coronary intervention, coronary artery bypass grafting, and death.

HEART stands for:

History
ECG
Age
Risk factors
Troponin

Each component is scored 0, 1, or 2 points. The total score determines the patient’s short-term cardiac risk and guides management decisions.

Overview

When to use

Why use

Evidences

Interpretation

HEART Score Table

Component	0	1	2
History	Slightly suspicious	Moderately suspicious	Highly suspicious
ECG	Normal	Non-specific repolarization disturbance	Significant ST depression
Age	<45 years	45–64 years	≥65 years
Risk factors	None	1–2 risk factors	≥3 risk factors or known CAD
Troponin	≤ normal limit	1–3× normal limit	>3× normal limit

Total Score Interpretation

Total Score	6-week MACE Risk Estimate	Action
0-3	1-2%	Consider early discharge with follow-up
4-6	12-16%	Observation and further cardiac testing
7-10	50-65%	Urgent intervention or admission

Original development and validation: The HEART score was created to stratify ED chest pain patients for 6-week MACE (MI, revascularization, death), with low-risk (0–3) showing ≈1.7% MACE, intermediate (4–6) ≈12–17%, and high (7–10) ≈50–65% across early validation cohorts. Reviews summarize its components, thresholds, and observed event rates in large series.

https://pmc.ncbi.nlm.nih.gov/articles/PMC6005932/
Randomized trial (HEART Pathway): In a pragmatic RCT, the HEART Pathway reduced 30-day objective cardiac testing, increased early discharges, and shortened length of stay without missed 30-day MACE among patients identified for early discharge.

https://www.ahajournals.org/doi/full/10.1161/CIRCOUTCOMES.114.001384

External validations: International cohorts confirm low-risk HEART scores correlate with very low short-term MACE and support modified thresholds in some populations, while maintaining clinical utility.

https://intjem.biomedcentral.com/articles/10.1186/s12245-020-00300-1

Overview

When to use

Why use

Evidences

The HEART Score ranges from 0 to 10 points and is divided into three risk categories. A score between 0 and 3 points indicates a low risk of major adverse cardiac events, with an estimated 1 to 2 percent risk, and patients in this group may be suitable for early discharge.

A score between 4 and 6 points reflects a moderate risk, with approximately a 12 to 16 percent chance of an event, and usually warrants observation with additional cardiac testing. A score between 7 and 10 points represents a high risk, with an estimated 50 to 65 percent likelihood of an event, and these patients typically require urgent intervention.

The HEART Score has been validated in multiple prospective studies and is incorporated into emergency department chest pain protocols to support timely and evidence-based decision-making.

Overview

When to use

Why use

Evidences

Interpretation

HEART Score Table

Component	0	1	2
History	Slightly suspicious	Moderately suspicious	Highly suspicious
ECG	Normal	Non-specific repolarization disturbance	Significant ST depression
Age	<45 years	45–64 years	≥65 years
Risk factors	None	1–2 risk factors	≥3 risk factors or known CAD
Troponin	≤ normal limit	1–3× normal limit	>3× normal limit

Total Score Interpretation

Total Score	6-week MACE Risk Estimate	Action
0-3	1-2%	Consider early discharge with follow-up
4-6	12-16%	Observation and further cardiac testing
7-10	50-65%	Urgent intervention or admission

Original development and validation: The HEART score was created to stratify ED chest pain patients for 6-week MACE (MI, revascularization, death), with low-risk (0–3) showing ≈1.7% MACE, intermediate (4–6) ≈12–17%, and high (7–10) ≈50–65% across early validation cohorts. Reviews summarize its components, thresholds, and observed event rates in large series.

https://pmc.ncbi.nlm.nih.gov/articles/PMC6005932/
Randomized trial (HEART Pathway): In a pragmatic RCT, the HEART Pathway reduced 30-day objective cardiac testing, increased early discharges, and shortened length of stay without missed 30-day MACE among patients identified for early discharge.

https://www.ahajournals.org/doi/full/10.1161/CIRCOUTCOMES.114.001384

External validations: International cohorts confirm low-risk HEART scores correlate with very low short-term MACE and support modified thresholds in some populations, while maintaining clinical utility.

https://intjem.biomedcentral.com/articles/10.1186/s12245-020-00300-1

Frequently Asked Questions

Features and Services FAQs

Discover the full range of features and services we offer and how to use them.

What does HEART stand for?+

Can the HEART Score be used for patients with ECG evidence of STEMI?+

How quickly can the score be calculated?+

Does the HEART Score replace clinical judgment?+

What is the main benefit of using the HEART Score?+

What outcomes does HEART predict?+