HEART Score
Risk stratification for acute coronary syndrome in chest pain patients
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Why use it
Identifies low-risk chest pain patients who can be safely discharged from the ED. Reduces unnecessary admissions and testing. Simple, validated, and widely adopted in ED protocols.
About
The HEART Score is designed for risk stratification of patients presenting with chest pain in the emergency department. It predicts the 6-week risk of major adverse cardiac events (MACE) including acute MI, PCI, CABG, and death. It uses five elements: History, ECG, Age, Risk factors, and Troponin.
When to use
- Chest pain evaluation in the emergency department
- Risk stratification for acute coronary syndrome
- Disposition decisions for chest pain patients
Formula
Pearls & pitfalls
- Low HEART score (0-3) has been validated for safe ED discharge with <2% MACE at 6 weeks.
- Troponin should be at presentation (and ideally serial) — high-sensitivity troponin improves accuracy.
- The History component is subjective — consider using a structured approach.
- HEART Pathway combines HEART score with serial troponins for further risk reduction.
- Does not replace clinical judgment — always consider the overall clinical picture.
Next steps
Score 0-3: Low risk (~1.6% MACE), consider early discharge. Score 4-6: Moderate risk (~12% MACE), admit for observation and further workup. Score 7-10: High risk (~65% MACE), early invasive strategy.
Evidence
Validated in multiple studies including HEART-GPS, HEART Pathway, and large multicenter retrospective analyses. A meta-analysis (Poldervaart et al., 2017) confirmed that HEART 0-3 identifies low-risk patients with MACE rate ~1-2%.