What does the HEART score stand for?

HEART is an acronym for its five components: History (clinical suspicion), ECG (changes), Age, Risk factors (cardiovascular), and Troponin. Each scores 0, 1, or 2, for a maximum total of 10.

How is the HEART score interpreted?

A total of 0–3 is low risk with roughly 1–2% risk of a major adverse cardiac event at 6 weeks and supports discharge. A score of 4–6 is moderate risk (around 12–17%) warranting observation and serial troponin. A score of 7–10 is high risk (50% or more) needing early invasive management.

How are the risk factors counted?

Risk factors include hypertension, hypercholesterolaemia, diabetes, smoking, a positive family history, and obesity, plus a history of atherosclerotic disease. No risk factors scores 0, one or two scores 1, and three or more (or any known atherosclerotic disease) scores 2.

How is troponin scored?

Troponin at or below the normal limit scores 0, between one and three times the limit scores 1, and more than three times the upper reference limit scores 2. Use your local assay cut-off.

Is my data stored anywhere?

No. The calculation runs entirely in your browser and nothing you enter is transmitted or saved on any server.

HEART Score for Chest Pain

The HEART score is the most widely used tool for stratifying undifferentiated chest pain in the emergency department. It identifies patients at low enough risk of a major adverse cardiac event (MACE) to discharge safely, while flagging those who need admission and an early invasive strategy.

How it works

Five components are each scored 0, 1, or 2, and the values are summed for a total from 0 to 10:

History — clinical suspicion: 0 = slightly suspicious, 1 = moderately suspicious, 2 = highly suspicious.
ECG — 0 = normal, 1 = non-specific repolarisation changes, 2 = significant ST deviation.
Age — 0 = under 45, 1 = 45–64, 2 = 65 or over.
Risk factors — 0 = none, 1 = one or two, 2 = three or more or known atherosclerotic disease.
Troponin — 0 = at or below normal, 1 = one to three times normal, 2 = more than three times normal.

The total maps to a 6-week MACE risk band:

0–3 — low risk (~1.7%): consider discharge.
4–6 — moderate risk (~16.6%): admit for observation and serial troponin.
7–10 — high risk (~50.1%): early invasive management.

Example and notes

A 60-year-old (1) with a moderately suspicious history (1), non-specific ECG changes (1), two risk factors (1), and a normal troponin (0) scores 4 — moderate risk, observe.

The HEART score assumes a thoughtful clinical history; the History component is the most subjective and most influential. Pair the score with serial troponin where the assay is highly sensitive, and always treat ongoing ischaemic pain on its own merits regardless of the total.