HEART Score Calculator
Calculate the HEART score for chest pain risk stratification. The HEART score (History, ECG, Age, Risk factors, Troponin) predicts 6-week risk of major adverse cardiac events (MACE) in emergency department patients.
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Key values and context for this tool: • Score Range: 0-10 • Low Risk: 0-3 • MACE Prediction: C-statistic 0.83
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Why: The HEART score helps emergency physicians identify low-risk chest pain patients who can be safely discharged, reducing unnecessary admissions by up to 20%.
How: Score 5 components (0-2 each): History suspicion, ECG changes, Age, Risk factors, initial Troponin. Sum produces 0-10 risk score.
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Risk Factors
For informational purposes only — not medical advice. Consult a healthcare professional before acting on results.
The HEART Score (History, ECG, Age, Risk factors, Troponin) is a validated emergency department tool for chest pain risk stratification. Developed by Six et al. in 2008, it assigns 0-2 points to each of five domains, totaling 0-10. Low scores (0-3) predict <2% 30-day MACE; high scores (7-10) predict 50-65% MACE. It guides disposition: discharge vs. observation vs. urgent intervention.
Sources: Six et al. 2008, Backus et al. 2013, AHA/ACC, Annals EM.
Key Takeaways
- • HEART Score 0-3: Low risk; consider discharge with 48-72h follow-up
- • HEART Score 4-6: Intermediate; admit for observation, serial troponin, early stress test or CTA
- • HEART Score 7-10: High risk; urgent cardiology, consider catheterization
- • Cocaine use: Avoid beta-blockers and nitroglycerin in acute intoxication
Did You Know?
How Does the HEART Score Work?
History
Non-anginal=0, atypical=1, typical=2. Typical angina is substernal, provoked by exertion, relieved by rest/nitroglycerin.
ECG
Normal=0, non-specific/ST-depression=1, ST-elevation/LBBB=2. Any acute ischemic change elevates the score.
Age & Risk Factors
Age: <45=0, 45-64=1, ≥65=2. Risk factors: diabetes, hypertension, hyperlipidemia, smoking, family history, prior CAD (weighted 2), cocaine.
Expert Tips
HEART Score Risk Categories
| Score | Category | 30-Day MACE | Disposition |
|---|---|---|---|
| 0-3 | Low | 0.9-1.7% | Consider discharge |
| 4-6 | Intermediate | 12-16.6% | Admit, observe |
| 7-10 | High | 50-65% | Urgent intervention |
Frequently Asked Questions
What is the HEART Score?
The HEART Score is a validated risk stratification tool for chest pain in the emergency department. It scores five domains (History, ECG, Age, Risk factors, Troponin) from 0-2 each, totaling 0-10. Low risk (0-3) predicts <2% MACE; intermediate (4-6) predicts 12-17% MACE; high risk (7-10) predicts 50-65% MACE.
What are the HEART Score components?
History: non-anginal=0, atypical=1, typical=2. ECG: normal=0, non-specific/ST-depression=1, ST-elevation/LBBB=2. Age: <45=0, 45-64=1, ≥65=2. Risk factors: 0=0, 1-2=1, ≥3=2 (diabetes, hypertension, hyperlipidemia, smoking, family history, prior CAD, cocaine). Troponin: normal=0, slightly elevated=1, significantly elevated=2.
What are the low, moderate, and high risk thresholds?
Low risk: 0-3 points (0.9-1.7% MACE, consider discharge). Intermediate: 4-6 points (12-16.6% MACE, admit for observation). High risk: 7-10 points (50-65% MACE, urgent cardiology and possible catheterization).
What is MACE?
MACE stands for Major Adverse Cardiac Events: death, myocardial infarction, or coronary revascularization. The HEART Score predicts 30-day and 6-week MACE risk to guide disposition and treatment intensity.
HEART Score vs TIMI Score: when to use which?
HEART is optimized for undifferentiated chest pain in the ED; TIMI is for known ACS. HEART uses 5 bedside components; TIMI uses 7. HEART predicts 6-week MACE; TIMI predicts 14-day death/MI. Use HEART for initial ED triage; use TIMI once ACS is confirmed.
When should the HEART Score be used?
For adults (≥18) presenting to the ED with chest pain suggestive of ACS. It guides disposition: low risk may be discharged with follow-up, intermediate requires observation and further testing, high risk needs urgent cardiology. Not for STEMI (activate cath lab immediately) or hemodynamically unstable patients.
Key Statistics
Official Data Sources
⚠️ Disclaimer: This calculator is for educational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider for clinical decisions. HEART Score should be used as decision support, not in isolation.
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