Why a score for chest pain?
Chest pain is one of the most common reasons for an emergency department visit, but only a minority of patients have an acute coronary syndrome. The HEART score, developed in the Netherlands by Backus and Six in 2008, helps identify patients at low risk who can safely go home and those at high risk who need early treatment.
The five elements
Each element scores 0, 1 or 2:
| Element | 0 | 1 | 2 |
|---|---|---|---|
| History | Slightly suspicious | Moderately suspicious | Highly suspicious |
| ECG | Normal | Nonspecific repolarization changes, bundle branch block, LVH, pacemaker | Significant ST depression |
| Age | Under 45 | 45–64 | 65 or older |
| Risk factors | None | 1–2 | 3 or more, or known atherosclerotic disease |
| Troponin | ≤ normal limit | 1–3× limit | > 3× limit |
Risk factors include high cholesterol, hypertension, diabetes, current or recent smoking, family history of early heart disease and obesity.
Worked example
A 58-year-old with moderately suspicious chest pain, a normal ECG, high blood pressure and a normal troponin:
- History 1, ECG 0, age 1, risk factors 1, troponin 0.
- HEART score = 3: low risk.
Score and risk
| Score | Risk group | 6-week major cardiac events (validation) |
|---|---|---|
| 0–3 | Low | about 1.7% |
| 4–6 | Moderate | about 16.6% |
| 7–10 | High | about 50% |
Major adverse cardiac events (MACE) include heart attack, coronary revascularization and death.
The HEART pathway
The HEART pathway combines a HEART score of 0 to 3 with negative troponin results at 0 and 3 hours. In a randomized trial, it reduced unnecessary testing and hospital stays without increasing missed heart attacks. With modern high-sensitivity troponin, faster 0/1-hour algorithms are also used.
Limits
The “history” element is subjective. The score was designed for adults with chest pain suggesting a possible acute coronary syndrome, not for patients with ST elevation on the ECG, who need immediate treatment, or for other causes of chest pain such as pulmonary embolism or aortic dissection.
If you have chest pain, do not wait to calculate a score: call 911.
This calculator is for general information and education. It is not medical advice and does not replace the judgment of a doctor, nurse or pharmacist who knows the full clinical picture.