Calculate the HEART score from History, ECG, Age, Risk factors, and Troponin to estimate a chest pain patient’s 6-week MACE risk and guide disposition.
HEART Score Formula
HEART = H + E + A + R + T
Each of the five parts is scored 0, 1, or 2, so the total HEART score runs from 0 to 10. A higher total means a higher chance of a major adverse cardiac event (MACE) within six weeks.
- H = History: 0 if the story is slightly suspicious, 1 if moderately suspicious, 2 if highly suspicious for cardiac chest pain.
- E = ECG: 0 if normal, 1 for non-specific repolarization changes, 2 for significant ST deviation not caused by a bundle branch block, LVH, or digoxin.
- A = Age: 0 for under 45, 1 for 45 to 64, 2 for 65 and older.
- R = Risk factors: 0 for none, 1 for one or two, 2 for three or more or any known atherosclerotic disease. The counted risk factors are hypertension, high cholesterol, diabetes, obesity (BMI over 30), current or recent smoking, and a family history of early coronary artery disease.
- T = Troponin: 0 at or below the normal limit, 1 for one to three times the limit, 2 above three times the limit.
The calculator adds the five parts for you. Enter the age in years and it assigns the age points automatically, and the risk factor helper counts the checked factors and applies the automatic 2 points when atherosclerotic disease is present. The HEART Pathway option applies a second rule on top of the score:
Discharge candidate = HEART 0 to 3 with a negative troponin at 0 and 3 hours
In HEART Pathway mode a patient is flagged as a possible early discharge only when the score is 0 to 3 and both the initial and the 3-hour troponin are not elevated.
HEART Score Risk Categories and MACE Rates
The total sorts the patient into one of three risk bands. The MACE rates below are the pooled six-week figures reported in the derivation and validation studies.
| HEART score | Risk category | 6-week MACE | Typical next step |
|---|---|---|---|
| 0-3 | Low | 0.9-1.7% | Often safe for early discharge with follow-up |
| 4-6 | Moderate | 12-17% | Admit or observe with serial troponin |
| 7-10 | High | 50-65% | Early invasive strategy and cardiology input |
The HEART score is not the only chest pain risk tool. The table below shows how it differs from the TIMI and GRACE scores, which are built for patients who already have a diagnosis of acute coronary syndrome rather than undifferentiated chest pain.
| Score | Main inputs | Best population | What it predicts |
|---|---|---|---|
| HEART | History, ECG, age, risk factors, troponin | Undifferentiated ED chest pain | 6-week MACE, mainly to find low-risk patients |
| TIMI | Age 65+, 3+ CAD risk factors, known CAD, aspirin use, severe angina, ST change, positive marker | Suspected or confirmed UA/NSTEMI | Death, MI, or urgent revascularization at 14 days |
| GRACE | Age, heart rate, systolic BP, creatinine, Killip class, arrest, ST change, markers | Confirmed ACS | In-hospital and 6-month mortality |
Use the HEART score at the front door for the patient whose chest pain is not yet explained. Reach for TIMI or GRACE once acute coronary syndrome is confirmed and you need to grade its severity.
HEART Score Example
These two cases match the calculator so you can check your inputs against the output.
Example 1. A 58-year-old has a moderately suspicious history (1), non-specific repolarization changes on the ECG (1), age 58 (1), hypertension and current smoking for two risk factors (1), and an initial troponin at the normal limit (0). The total is 1 + 1 + 1 + 1 + 0 = 4, which is moderate risk with a roughly 12 to 17 percent six-week MACE rate. This patient is observed with a repeat troponin rather than sent home.
Example 2. A 40-year-old has a slightly suspicious history (0), a normal ECG (0), age 40 (0), no risk factors (0), and a normal troponin (0). The total is 0, which is low risk. With a negative second troponin this patient fits the early discharge group in HEART Pathway mode.
HEART Score FAQ
What counts as a low HEART score? A total of 0 to 3 is low risk, with about a 1 to 2 percent chance of a major adverse cardiac event over the next six weeks. Many chest pain protocols treat this group as candidates for early discharge with outpatient follow-up, though local policy and a repeat troponin still apply.
What does the HEART score actually predict? It estimates the six-week risk of a major adverse cardiac event, defined as myocardial infarction, coronary revascularization by PCI or CABG, or death. It is a risk stratification tool, not a diagnosis of acute coronary syndrome, so you should identify a STEMI on the ECG before you apply any score.
How is the HEART Pathway different from the HEART score? The HEART Pathway keeps the same 0 to 10 score but adds a second troponin drawn about three hours after the first. A patient is placed in the early discharge group only when the HEART score is 0 to 3 and both troponins are not elevated, which lowers the miss rate compared with a single troponin.