HEART Score (Chest Pain Stratification)
Risk-stratify chest pain in the Emergency Department to predict 6-week Major Adverse Cardiac Events (MACE). The standard tool for safe discharge decisions vs admission.
Select an option for all 5 criteria to see the HEART score.
Discharge low-risk chest pain safely — with documentation
EasyClinic stores the full HEART pathway record including ECG snapshot, hsTroponin values, score, and disposition reasoning — audit-ready for medico-legal protection.
Also Known As
What is the HEART score?
The HEART score (History, ECG, Age, Risk factors, Troponin) is the most widely validated tool for risk-stratifying chest pain in the Emergency Department. It predicts 6-week Major Adverse Cardiac Events (MACE) — death, MI, or urgent revascularisation — and identifies patients who can be safely discharged.
Range: 0–10. Each of the 5 components is scored 0, 1 or 2.
MACE Risk by Score (validation cohorts)
- 0–3 (Low): 1.7% MACE → discharge with outpatient follow-up
- 4–6 (Moderate): 16.6% MACE → admit for observation + further workup
- 7–10 (High): 50.1% MACE → early invasive strategy (angiography ≤ 24–72h)
HEART Pathway vs HEART Score
The HEART Pathway adds a 0- and 3-hour troponin to the HEART score. Patients with HEART ≤ 3 AND both troponins negative are discharged. The HEART Pathway has been shown in RCTs to reduce admission rates by ~20% with no missed MACE.
Risk Factor Definition (the "R")
- Hypertension
- Hypercholesterolaemia
- Diabetes mellitus
- Current/recent smoker
- Family history of CAD (first-degree relative, M < 55, F < 65)
- Obesity (BMI > 30; consider lower threshold for South Asian patients)
- Known atherosclerotic disease (prior MI, PCI, CABG, stroke, PAD) → automatic 2 points
Frequently Asked Questions
▸Can I discharge a HEART score 3 patient without troponin?
No. The score requires at least one troponin. If using conventional troponin, the HEART Pathway recommends a second troponin at 3h before discharge. With high-sensitivity troponin and a negative single sample, the 0/1h or 0/3h hsTn algorithms can be combined with HEART.
▸How does HEART compare to TIMI and GRACE scores?
HEART outperforms TIMI and GRACE for ED chest pain risk stratification (higher sensitivity for low-risk identification). TIMI is better for confirmed UA/NSTEMI to guide invasive vs conservative; GRACE for in-hospital mortality after confirmed ACS.
▸Is HEART score validated in South Asian / Indian patients?
Yes — multiple cohort studies from India and the UK South Asian population confirm validity. Note: Indians develop CAD ~10 years earlier, so the "Age < 45" cutoff misses some at-risk young Indian patients — use clinical judgment alongside the score.
▸What counts as "significant ST depression" on the ECG component?
New, horizontal or downsloping ST depression ≥ 0.5 mm in 2 contiguous leads. ST elevation = STEMI, do not use HEART. LBBB, paced rhythms, and LVH with strain confound the ECG component — score as "non-specific repolarisation" (1 point).
▸Should I use HEART for cocaine-related chest pain?
It has not been validated in this population. Cocaine/sympathomimetic chest pain has a different mechanism (coronary spasm, demand ischaemia) and patients are typically younger with low traditional risk factors but still at MI risk. Use clinical judgment + troponin + observation.
References
- Six AJ, Backus BE, Kelder JC. Chest pain in the emergency room: value of the HEART score. Neth Heart J 2008;16(6):191-6
- Mahler SA et al. The HEART Pathway randomised controlled trial. Circ Cardiovasc Qual Outcomes 2015;8(2):195-203
- AHA/ACC Guideline for the Evaluation and Diagnosis of Chest Pain 2021
- ESC Guidelines for the management of acute coronary syndromes 2023
- Cardiological Society of India (CSI) Consensus on Acute Coronary Syndrome Management
Chest pain workflow, end to end
EasyClinic captures HEART score, ECG findings, serial troponins, and prior risk factors on a single screen — and auto-flags low-risk patients eligible for discharge per HEART pathway.
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