HEART Score calculator
Risk-stratifies undifferentiated chest pain in the emergency department by 6-week risk of a major adverse cardiac event (MACE).
What it is used for
The HEART Score is used in adults presenting to the ED with chest pain in whom acute coronary syndrome is being considered but STEMI has already been excluded. It combines five equally-weighted domains, each scored 0, 1 or 2, to give a total out of 10. Its purpose is to separate patients who can be discharged from those who need admission for serial troponins and cardiology assessment. In UK practice it is applied alongside the NICE NG185 chest pain pathway and a high-sensitivity troponin protocol, not instead of them.
The five components (0–2 each, maximum 10)
| Component | Points |
|---|---|
| HistorySlightly / moderately / highly suspicious | 0–2 |
| ECGNormal / non-specific repolarisation change (incl. LBBB, LVH, digoxin effect) / significant ST deviation not attributable to those | 0–2 |
| AgeUnder 45 / 45–64 / 65 or over | 0–2 |
| Risk factorsNone / 1–2 risk factors / 3 or more, or known atherosclerotic disease | 0–2 |
| TroponinAt or below normal ULN / 1–3× ULN / above 3× ULN | 0–2 |
Risk factors counted are hypertension, diabetes, smoking, hypercholesterolaemia, family history and obesity.
How the score is interpreted
When not to use it
- The score assumes STEMI has already been excluded — it is not a triage tool for the undifferentiated 'chest pain' call.
- It requires a troponin result, so it cannot be completed at first contact.
- It is not validated in children, in pregnancy, or in trauma.
Related scores
Browse all 51 calculators in the ResusDoc Clinical Scores app →