HEART Score Calculator (Chest Pain)
Risk-stratify emergency chest pain with the HEART score — History, ECG, Age, Risk factors, Troponin — with 6-week major adverse cardiac event rates and disposition guidance.
How it works
History 0–2 + ECG 0–2 + Age 0–2 + Risk factors 0–2 + Troponin 0–2; 0–3 low, 4–6 moderate, 7–10 high
The HEART score was designed for undifferentiated chest pain in the emergency department, where the question is who can safely go home. It blends the clinician’s impression of the history with the ECG, age, cardiovascular risk factors and the first troponin, each scored 0 to 2. A score of 0–3 carries under 2% risk of a major adverse cardiac event within six weeks; the HEART Pathway adds a second troponin at three hours and, if both are negative, supports discharge without stress testing. Scores of 4–6 warrant observation and further work-up, and 7 or more predict a MACE rate above 50%, prompting early invasive evaluation.
Worked example
A 55-year-old with a moderately suspicious history, normal ECG, two risk factors and a normal troponin: 1 + 0 + 1 + 1 + 0 = 3 — low risk, about 1–2% MACE.
Frequently asked questions
How does HEART compare with TIMI and GRACE?
TIMI and GRACE were built for confirmed acute coronary syndrome and prognosis; HEART was built for the undifferentiated ED chest-pain population and discriminates low risk better in that setting.
Can a high-sensitivity troponin be used?
Yes — score it relative to the assay’s 99th-percentile upper reference limit. Many pathways now pair HEART with 0/1-hour or 0/3-hour hs-troponin protocols.
Related calculators
Clinical decision tool for education and for use by trained clinicians alongside judgement — not a diagnosis and not a substitute for medical assessment. Scores validated in specific populations may not apply to every patient.