Predicts 6-week risk of major adverse cardiac event
Total Score
Low Risk (0.9-1.7%). Discharge may be considered.
Disclaimer: The clinical scoring and algorithms on this platform are intended strictly for professional informational purposes. They do not constitute a definitive medical diagnosis, treatment, or clinical decision. The final judgment and responsibility lie with the treating physician.
Yasal Uyarı: Bu platformdaki klinik skorlamalar ve algoritmalar yalnızca sağlık profesyonellerini bilgilendirme amaçlıdır. Herhangi bir kesin tıbbi teşhis, tedavi veya klinik karar yerine geçemez. Nihai karar ve sorumluluk hastayı yatak başında değerlendiren hekime aittir.
The HEART score (History, ECG, Age, Risk factors, Troponin) is a specific scoring system designed to stratify the risk of emergency patients presenting with acute chest pain. Compared to TIMI and GRACE scores, it is specifically tailored for the ED population, allowing safe discharge of low-risk patients.
The 'History' parameter is subjective but the most critical. Be cautious when assigning a low history score to elderly or diabetic patients with atypical presentations (silent ischemia). Never discharge a high-risk history patient based on a single negative troponin.
Six AJ, Backus BE, Kelder JC. Chest pain in the emergency room: value of the HEART score. Neth Heart J. 2008;16(6):191-196.
Backus BE, Six AJ, Kelder JC, et al. A prospective validation of the HEART score for chest pain patients at the emergency department. Int J Cardiol. 2013;168(3):2153-2158.
Disclaimer: The clinical scoring and algorithms on this platform are intended strictly for professional informational purposes. They do not constitute a definitive medical diagnosis, treatment, or clinical decision. The final judgment and responsibility lie with the treating physician.
Apply the HEART Score to adult ED patients presenting with chest pain who require risk stratification for Major Adverse Cardiac Events (MACE: AMI, PCI, CABG, death) within 6 weeks. The score is most useful when troponin results are available. A score of 0–3 in a low-risk patient supports early discharge and avoidance of serial troponins; scores of 7–10 should trigger urgent cardiology consultation. Do not use the HEART Score in patients with ST-elevation on ECG — those patients require immediate STEMI pathway activation regardless of score.
The 'History' domain is the most clinician-dependent component. 'Highly suspicious' (2 pts) includes classic crushing substernal pressure radiating to the jaw or arm, diaphoresis, and relief with nitrates. 'Moderately suspicious' (1 pt) includes atypical features (exertional, positional, or reproducible pain without classic radiation). 'Slightly suspicious' (0 pts) is non-cardiac in character (sharp, pleuritic, reproducible on palpation). Careful history-taking dramatically changes the HEART Score — a single domain error can shift a patient across risk categories.
Risk factors for the HEART Score include HTN, hypercholesterolaemia, DM, obesity (BMI > 30), smoking, positive family history, and known atherosclerotic disease. Note that 'known atherosclerotic disease' (prior MI, PCI, CABG, stroke, or peripheral arterial disease) always scores 2 points — do not score these patients in the '≥ 3 risk factors' column if the reason for high concern is known prior disease. Also, the HEART Score was validated with conventional troponin assays; its thresholds may need local recalibration when high-sensitivity troponin platforms are used.