HEART score for chest pain

What goes into the HEART score

• History: Slightly suspicious (0); Moderately suspicious (1); Highly suspicious (2)
• ECG: Normal (0); Non-specific repolarization (1); Significant ST deviation (2)
• Age: < 45 (0); 45-64 (1); ≥ 65 (2)
• Risk factors: None known (0); 1-2 risk factors (1); ≥ 3, or known atherosclerosis (2)
• Initial troponin: ≤ normal limit (0); 1-3× normal limit (1); > 3× normal limit (2)

How to interpret the result

• 0–3: low risk (about 1–2% MACE); early discharge is reasonable if serial troponins are negative
• 4–6: moderate risk (about 12–17%); observe and arrange further testing
• 7–10: high risk (about 50–65%); early invasive strategy and cardiology involvement

Clinical pearls

• Not for STEMI or obvious ACS: treat those directly.
• Pair it with serial high-sensitivity troponin (the HEART pathway) rather than a single value.
• Risk factors: hypercholesterolemia, hypertension, diabetes, smoking, family history, obesity; known atherosclerosis scores 2.

Evidence

1. Six AJ, Backus BE, Kelder JC. Chest pain in the emergency room: value of the HEART score. Neth Heart J. 2008;16:191-196.
2. Backus BE, et al. A prospective validation of the HEART score for chest pain patients at the emergency department. Int J Cardiol. 2013;168:2153-2158.

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