HEART Score (chest pain in the emergency department)
6-week MACE risk in chest-pain patients from five domains: history, ECG, age, risk factors, troponin.
About this calculator
The HEART score predicts 6-week major adverse cardiac event risk in chest pain patients in the emergency department. Developed by Backus et al. (Int J Cardiol, 2013) in a Dutch cohort of 2440. Five components scored 0-2 each: History, ECG, Age, Risk factors, Troponin. Maximum 10. Interpretation. 0-3 – low risk (MACE 1.7% in 6 weeks), safe discharge without admission, outpatient workup. 4-6 – intermediate (16.6%), admission for serial troponin and stress test or CT angiography. 7-10 – high (50.1%), aggressive strategy – angiography within 24-72 hours. Clinical use. ESC 2023 acute chest pain – HEART is the primary triage tool in the ED. Reduces admissions of low-risk patients by 20-30% without increasing missed ACS. Complemented by HEART Pathway – integrated protocol with two high-sensitivity troponins (0 and 3 hours). Components. History – highly suspicious 2, moderately suspicious 1, slightly suspicious 0. ECG – clear ST depression 2, non-specific repolarization 1, normal 0. Age – >=65 – 2, 45-64 – 1, <45 – 0. Risk – >=3 factors or known CAD 2, 1-2 factors 1, none 0. Troponin – >3× ULN 2, 1-3× ULN 1, <ULN 0. Limitations. Validated for patients >=21 years with unprovoked chest pain. Not used in STEMI – they need immediate reperfusion. Not validated in pregnancy or in patients with known CAD on optimal therapy – any new pain triggers a lower escalation threshold.
Source
Formula version: six-2008-backus-2013-v1