HEART Score

HEART Score: Validated chest pain triage tool for Predicting Major Adverse Cardiac Events (MACE).

History

ECG

Age

Risk Factors

Troponin

Guidelines & Evidence

Verified

Last Review: 2026-07-17

When to Use

Stratifying risk for patients presenting to the emergency department with undifferentiated chest pain of suspected cardiac origin

Predicting the 6-week risk of a Major Adverse Cardiac Event (MACE: acute myocardial infarction, PCI, CABG, or death)

Determining the safety of early ED discharge versus the need for prolonged observation, serial troponins, or admission

Guiding resource allocation in chest pain units

Patient Population

Adult ED patients presenting with non-traumatic chest pain suspicious for acute coronary syndrome (ACS). It explicitly excludes patients presenting with new ST-segment elevation myocardial infarction (STEMI), extreme hemodynamic instability, or those with a clearly obvious non-cardiac cause of pain (e.g., tension pneumothorax, severe trauma).

How it Works

Scoring Variables

History: Highly suspicious (2 points), Moderately suspicious (1 point), Slightly or non-suspicious (0 points)

ECG: Significant ST depression (2 points), Non-specific repolarization disturbances / LBBB / PM (1 point), Normal (0 points)

Age: ≥65 years (2 points), 45–64 years (1 point), <45 years (0 points)

Risk Factors: ≥3 risk factors or history of atherosclerotic disease (2 points), 1-2 risk factors (1 point), No risk factors (0 points)

Initial Troponin: ≥3x normal limit (2 points), 1-3x normal limit (1 point), ≤normal limit (0 points)

Interpretation Thresholds

Score 0–3	Low Risk: 0.9–1.7% risk of MACE at 6 weeks. Often safe for early ED discharge without stress testing.
Score 4–6	Moderate Risk: 12–16.6% risk of MACE. Admit for observation, serial troponins, and provocative testing.
Score 7–10	High Risk: 50–65% risk of MACE. Consider early invasive strategy and admission to cardiology.

Last Comprehensive Review: 2026-07-17

Recent Journal Updates

JAMAJul 21, 2026

Correction to Primary Composite Outcome in a Trial of Transfusion Strategy

Clinical Context

We think this might be relevant to the clinical guidance for HEART Score — Chest Pain Risk Stratification.

Cancer MedicineJul 16, 2026

Notch3/4 Knockdown Inhibits Colon Adenocarcinoma Progression by Suppressing Tumor Cell Activity and Orchestrating VEGFA‐Dependent Tumor Immune Microenvironment

Clinical Context

We think this might be relevant to the clinical guidance for HEART Score — Chest Pain Risk Stratification.

FDA MedWatchJul 2, 2026

Heart Pump Recall: Abiomed Removes Impella CP Sets with SmartAssist

Clinical Context

We think this might be relevant to the clinical guidance for HEART Score — Chest Pain Risk Stratification.

HEART Score

When to Use

When to Use

Patient Population

How it Works

Scoring Variables

Interpretation Thresholds

Clinical Pearls

Clinical Pearl

Known Limitations

Next Steps

Actionable Clinical Management

The Evidence

Derivation Study

Chest pain in the emergency room: value of the HEART score.

Origins & History

Development Context

Recent Journal Updates

HEART Score

When to Use

When to Use

Patient Population

How it Works

Scoring Variables

Interpretation Thresholds

Clinical Pearls

Clinical Pearl

Known Limitations

Next Steps

Actionable Clinical Management

The Evidence

Derivation Study

Chest pain in the emergency room: value of the HEART score.

Origins & History

Development Context

Recent Journal Updates