HEART Score Calculator
Chest pain risk score from history, ECG, age, risk factors, and troponin.
What it does
The HEART score sorts emergency department chest pain into risk bands using five pieces of information that are available within the first hours of a visit. Its name spells them out: History, ECG, Age, Risk factors, and Troponin. Each part scores 0, 1, or 2 points, so the total runs from 0 to 10.
The history item asks how suspicious the pain story sounds. Pain that is central, brought on by exertion, and similar to earlier cardiac events scores highest. The ECG item scores from a normal tracing through nonspecific changes to significant ST segment deviation. Age scores 0 under 45, 1 from 45 to 64, and 2 at 65 and over.
Risk factors cover smoking, diabetes, hypertension, high cholesterol, obesity, and family history: none scores 0, one or two score 1, and three or more score 2. The troponin item follows the first measurement against the local cutoff, scoring 0 when normal, 1 from one to three times the cutoff, and 2 above three times.
Published cohorts link the totals to major cardiac events in the six weeks after presentation. Low scores of 0 to 3 carried event rates near 1.7 percent in the 2018 validation, against 2.5 percent in the original 2008 cohort. Moderate scores of 4 to 6 ran 12 to 17 percent in later studies, and high scores of 7 to 10 ran 50 to 65 percent, against 72.7 percent in the original group.
The score shines as a conversation tool for disposition: who can be reassured, who needs observation, and who needs urgent cardiology attention. Serial troponins, repeat ECGs, and the clinician's judgment still carry the final weight, because a single score never captures the whole patient.
How to use
- Rate the history from slightly to highly suspicious.
- Pick the ECG category that matches the tracing.
- Enter the patient's age in years.
- Count the cardiac risk factors into the three bands.
- Enter the troponin band against the local cutoff.
- Read the total score, its band, and the breakdown of points.
Formula
- history
- 0 slightly, 1 moderately, 2 highly suspicious pain story.
- ECG
- 0 normal, 1 nonspecific changes, 2 significant ST deviation.
- age
- 0 under 45, 1 from 45 to 64, 2 at 65 and older.
- risk factors
- 0 none, 1 for one or two, 2 for three or more.
- troponin
- 0 normal, 1 for 1 to 3 times the cutoff, 2 above 3 times.
Bands: 0 to 3 low, 4 to 6 moderate, 7 to 10 high. The reported event rates are six-week major adverse cardiac event rates from cohort studies, and they vary with the troponin assay and the population studied.
Worked example
Example: moderately suspicious pain, age 58, troponin 1 to 3 times normal
Moderately suspicious history, nonspecific ECG changes, age 58, 1 to 2 risk factors, troponin 1 to 3 times the cutoff.
- History moderately suspicious: 1 point.
- ECG nonspecific: 1 point.
- Age 58 falls in the 45 to 64 band: 1 point.
- One or two risk factors: 1 point.
- Troponin 1 to 3 times normal: 1 point.
- The total is 5, which lands in the moderate risk band (4 to 6).
Reference table
| Score | Risk band | Later validation rates | Original 2008 cohort |
|---|---|---|---|
| 0 to 3 | Low risk | About 1.7 percent | 2.5 percent |
| 4 to 6 | Moderate risk | About 12 to 17 percent | 20.3 percent |
| 7 to 10 | High risk | About 50 to 65 percent | 72.7 percent |
Limits
- Estimates group event rates; it is not a personal prediction.
- Depends on the troponin assay and the local upper limit of normal.
- Was developed and validated mainly on adult emergency department populations.
- Does not replace serial troponins, repeat ECGs, or clinical judgment.
Common mistakes
- Scoring the history as highly suspicious when the description is vague or pleuritic.
- Counting age bands wrong: 45 to 64 scores 1, and 65 and over scores 2.
- Using the score alone to discharge a patient with an abnormal but improving troponin trend.
- Forgetting that ongoing chest pain or hemodynamic instability overrides any low score.
- Mixing up the risk factor bands: exactly one or two factors still scores 1, not 2.
Try it yourself
Quick checks. Answers sit tucked under each question.
Slightly suspicious history, normal ECG, age 40, no risk factors, normal troponin?
Score 0, low risk: every part scores zero.
Highly suspicious history, significant ST deviation, age 70, three or more risk factors, troponin 1 to 3 times normal?
Score 9, high risk: 2 + 2 + 2 + 2 + 1.
Moderately suspicious history, nonspecific ECG, age 45, two risk factors, normal troponin?
Score 4, moderate risk: 1 + 1 + 1 + 1 + 0.
Questions
What does HEART stand for?
History, ECG, Age, Risk factors, and Troponin, the five scored components.
What do the score bands mean?
0 to 3 is low risk, 4 to 6 is moderate, and 7 to 10 is high, based on six week major cardiac event rates.
When is the HEART score used?
In emergency chest pain evaluation, after the first ECG and troponin are available but before the disposition decision.
Can a low score discharge a patient?
It supports the decision. Most pathways add serial troponins and repeat ECGs before sending a low risk patient home.
Does the troponin type matter?
Yes. Rates differ by assay, and the score was validated with both conventional and high sensitivity troponins.
Is the score valid for every chest pain patient?
It fits adults with undifferentiated chest pain. Unstable patients are treated on their clinical picture, not on the score.
Sources
- NCBI: the HEART score, original derivation and cohort rates
- NCBI: HEART score validation with six week event rates