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HEART score for risk stratification of undifferentiated chest pain in the emergency department, predicting 6-week risk of major adverse cardiac events (MACE).
Clinical decision-support tool for qualified healthcare professionals. Results are not a diagnosis and should not replace professional clinical judgment.
HEART score stratifies 6-week MACE risk (MI, PCI, CABG, death). 0–3 low risk (~1–2% MACE, candidates for early discharge); 4–6 moderate risk (~12–17% MACE, observation with serial troponins); 7–10 high risk (~50–65% MACE, early invasive strategy).
Specialty
Emergency MedicineCategory
EmergencyDifficulty
Basic
Estimated Time
30 seconds
Version
1.0
Last Updated
2026-08-15
Formula
Keywords
Normal Range
0–10 points
Risk-stratifies undifferentiated chest pain in the emergency department for 6-week risk of major adverse cardiac events (MACE).
The HEART score sums five components each scored 0-2: history, ECG, age, risk factors, and troponin, for a total of 0-10. Scores of 0-3 are low, 4-6 moderate, and 7-10 high risk for 6-week major adverse cardiac events.
Clinical suspicion of ACS, scored 0 (slightly/non-suspicious), 1 (moderately suspicious), or 2 (highly suspicious).
ECG, scored 0 (normal), 1 (non-specific repolarization changes), or 2 (significant ST-segment deviation).
Age, scored 0 (under 45), 1 (45-64), or 2 (65 or older).
Cardiac risk factors, scored 0 (none), 1 (1-2 factors), or 2 (3 or more factors or known atherosclerotic disease).
Troponin relative to the assay upper reference limit, scored 0 (normal), 1 (1-3x), or 2 (over 3x).
0–3 low risk (MACE ~1–2%): candidate for early discharge with serial troponins. 4–6 moderate risk (MACE ~12–17%): observation with serial troponins. 7–10 high risk (MACE ~50–65%): early invasive strategy and cardiology consultation.
The HEART score is one of the most widely validated tools for chest pain risk stratification, helping emergency clinicians avoid both missed MACE and unnecessary admissions.
A 62-year-old man with hypertension and diabetes presents with moderately suspicious chest pain, non-specific ECG changes, and a troponin 1.5 times the upper reference limit.
Inputs:
Expected Result: HEART score 5 — moderate risk (6-week MACE ~12–17%). Admit for observation and serial troponin measurement.
0-3: low risk (MACE about 1-2%), candidate for early discharge. 4-6: moderate risk (MACE about 12-17%), observation with serial troponins. 7-10: high risk (MACE about 50-65%), early invasive strategy and cardiology consultation.
HEART is specifically designed for emergency department chest pain evaluation and has been prospectively validated in that setting. TIMI and GRACE are more commonly used for ACS risk stratification once acute coronary syndrome is confirmed.
No. HEART is designed for acute chest pain evaluation in the emergency department. For stable chest pain assessment, use appropriate outpatient evaluation pathways.
Disclaimer: This calculator is intended for educational and clinical decision support purposes only. The HEART score supports, but does not replace, clinical judgment in acute coronary syndrome evaluation.