HEART Score for Chest Pain
History, ECG, Age, Risk factors, Troponin
Stratify risk of major adverse cardiac events (MACE) in patients with chest pain. HEART score guides early discharge vs admission and observation in the emergency department.
What is the HEART Score?
The HEART score is a validated 5-variable risk stratification tool for patients presenting to the emergency department with chest pain of possible cardiac origin. Each of the five components — History, ECG, Age, Risk factors, and Troponin — is scored 0, 1, or 2, giving a maximum of 10 points. Low-risk patients (HEART score 0–3) have a very low 6-week MACE rate (<2%) and can be safely discharged from the emergency department without admission, significantly reducing unnecessary hospitalisation. High-risk patients (score 7–10) require urgent cardiological referral and admission.
When to use it
Apply to all patients presenting to the emergency department with acute chest pain where ACS must be excluded. Particularly useful for the large proportion of chest pain presentations that are ultimately non-cardiac.
Scoring Criteria
HEART Score — Variables & Points
History (highly suspicious / moderately suspicious / slightly suspicious)
Highly suspicious: typical ACS features (chest pressure, radiation, diaphoresis). Slightly suspicious: non-specific or atypical features.
ECG (LBBB or ST depression ≥1mm / non-specific repolarisation / normal)
Age (≥65 / 45–64 / <45)
Risk factors (≥3 or known atherosclerotic disease / 1–2 risk factors / none)
Risk factors: hypertension, diabetes, hypercholesterolaemia, obesity, smoking, family history of CAD
Troponin (>3× normal / 1–3× normal / normal)
Score Interpretation
Low risk
MACE risk <2% at 6 weeks; safe early discharge; outpatient follow-up
Moderate risk
MACE risk ~12–17%; admit for observation and further testing
High risk
MACE risk ~50–65%; urgent cardiology referral; early invasive strategy
Guideline Recommendation
ESC 2023 ACS Guidelines endorse validated risk scores (including HEART) as adjuncts to the 0h/1h high-sensitivity troponin pathway for chest pain risk stratification. Low HEART score + negative hs-cTnI at 0h supports safe discharge.
Clinical Pearls
The HEART score is best used alongside the ESC 0h/1h high-sensitivity troponin algorithm — together they identify a large "rule-out" population for safe ED discharge.
Serial troponin (0h and 1h or 2h) is central to HEART scoring — the troponin component carries significant weight.
A score of 0 with negative troponins and a normal ECG supports very early discharge even in patients with a worrying initial history.
Do not use in STEMI or haemodynamically unstable patients — these require immediate intervention regardless of HEART score.
Limitations
The "History" component introduces subjective clinical assessment.
Requires high-sensitivity troponin assays for optimal accuracy.
Not validated as a standalone tool in patients with STEMI or suspected type 2 MI (demand ischaemia).
Interactive Calculator
Interactive calculator requires a free account
Create a free Prognia account to use the HEART Score calculator — including auto-scored results, interpretation, and CPD logging.
Free plan · No credit card · Instant access
Frequently Asked Questions
What HEART score is safe for discharge?
A HEART score of 0–3 is classified as low risk, with a 6-week major adverse cardiac event (MACE) rate below 2%. These patients can be safely discharged from the emergency department with outpatient cardiology follow-up, provided their initial and serial troponins are negative.
What does HEART stand for in the HEART score?
HEART is an acronym for the five variables: History (chest pain characteristics), ECG findings, Age, Risk factors for coronary artery disease, and Troponin level. Each component is scored 0–2, giving a maximum total of 10.