HEART Score Calculator
Risk-stratify a patient with acute chest pain in the emergency department with the HEART score. Five elements — History, ECG, Age, Risk factors and Troponin — each score 0, 1 or 2 for a total of 0–10, which maps to the risk of a major adverse cardiac event (MACE) over the next six weeks. Choose the option for each element to get the score, the risk band and the approximate MACE rate.
About the HEART score
The HEART score stratifies short-term cardiac risk in emergency-department chest pain to help decide who can be discharged early and who needs admission and further testing. Sources: Six AJ et al., Netherlands Heart Journal 2008; Backus BE et al., International Journal of Cardiology 2013.
Frequently asked questions
What does HEART stand for?
HEART is an acronym for its five components, each scored 0, 1 or 2: History (how suspicious the story is), ECG, Age, Risk factors, and Troponin. The total runs from 0 to 10. It was designed by Six and colleagues in 2008 specifically for undifferentiated chest pain in the emergency department, rather than for patients already diagnosed with a heart attack.
How is each element scored?
History: slightly suspicious 0, moderately 1, highly suspicious 2. ECG: normal 0, non-specific repolarisation change (or LBBB/pacing/prior changes) 1, significant ST-segment deviation 2. Age: under 45 gives 0, 45–64 gives 1, 65 or older gives 2. Risk factors: none 0, one or two 1, three or more (or known atherosclerotic disease) 2 — risk factors are hypertension, high cholesterol, diabetes, smoking, obesity and a family history of coronary disease. Troponin: at or below the normal limit 0, one to three times normal 1, above three times normal 2.
What do the risk bands mean?
A score of 0–3 is low risk, with roughly a 1–2% chance of a major adverse cardiac event (MACE) within six weeks; 4–6 is moderate risk, around 12–17%; and 7–10 is high risk, around 50%. MACE means death, myocardial infarction or urgent revascularisation. This calculator shows the band and approximate rate for whatever total you build.
How is the HEART score used?
Low-risk patients (0–3), typically with two normal troponins a few hours apart, may be considered for early discharge with outpatient follow-up, as the negative predictive value for 30-day MACE approaches 100%. Moderate (4–6) usually prompts admission or observation with serial troponins and further testing, and high (7–10) prompts more aggressive investigation and cardiology involvement. Local “HEART pathway” protocols pair the score with serial troponins — follow the one used where you practise.
When should the HEART score not be relied on?
It is for adult, non-traumatic chest pain where acute coronary syndrome is being considered, and it does not apply when the ECG already shows a STEMI (that patient needs immediate reperfusion), nor does it rule out non-cardiac emergencies such as pulmonary embolism or aortic dissection. It is a decision aid used with clinical judgement, not a substitute for it. This calculator is an educational reference, not medical advice.
This is a reference tool, not a diagnosis or medical advice. Results depend on the laboratory, assay and clinical context, and reference intervals vary between labs and by age and sex — always read your result against the range printed on your own report and discuss it with a qualified healthcare professional.
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