What is the HEART Score?
The HEART score risk-stratifies patients presenting to the emergency department with chest pain, helping identify those at low risk who may be suitable for early discharge versus those needing admission and further workup. It was developed by Six and colleagues in the Netherlands and published in the Netherlands Heart Journal in 2008, designed specifically to be more intuitive for emergency clinicians evaluating undifferentiated chest pain than scores originally built for confirmed ACS populations (like TIMI or GRACE).
How to calculate the HEART Score
Five components, each scored 0–2 (total 0–10):
- History — clinical suspicion based on the character of the pain
- ECG — normal, nonspecific changes, or significant ST deviation
- Age — <45, 45–65, or ≥65
- Risk factors — traditional cardiac risk factors or known atherosclerotic disease
- Troponin — relative to the local normal limit
Interpretation
| Score | Risk | ~6-week MACE |
|---|---|---|
| 0–3 | Low | ~1.7% |
| 4–6 | Moderate | ~16.6% |
| 7–10 | High | ~50.1% |
The "HEART Pathway" protocol combines a low HEART score with two negative serial troponins to support safe early discharge — check your local protocol for how it's implemented.
References
Six AJ, Backus BE, Kelder JC. Chest pain in the emergency room: value of the HEART score. Neth Heart J. 2008.
See also: ECG Interpretation Basics & STEMI Criteria.