HEART Score Calculator
Calculate the HEART score (History, ECG, Age, Risk factors, Troponin) to assess 6-week MACE risk in chest pain patients. Free online risk stratification tool with component breakdown and charts.
Risk factors: diabetes, smoking, hypertension, hypercholesterolemia, obesity, family history of CAD
About This Calculator
The HEART Score Calculator is a clinical risk stratification tool designed for emergency department physicians, nurses, and medical students to assess the 6-week risk of major adverse cardiovascular events (MACE) in patients presenting with chest pain of undetermined cause. The HEART score was first validated in a prospective study by Six et al. in 2008 and has since been widely adopted in emergency medicine for chest pain triage and discharge decisions.
The HEART acronym represents the five components of the scoring system: History (suspicion for acute coronary syndrome), ECG (12-lead electrocardiogram findings), Age (patient's age group), Risk factors (traditional cardiovascular risk factors), and Troponin (initial cardiac troponin level). Each component is scored on a scale of 0, 1, or 2 based on predefined criteria, giving a total HEART score between 0 and 10.
The total score stratifies patients into three risk categories. Low-risk patients (score 0-3, up to 1.7% 6-week MACE risk) may be suitable for early discharge from the emergency department without admission. Moderate-risk patients (score 4-6, 12-17% MACE risk) require further observation, serial troponin testing, and possibly stress testing or coronary imaging. High-risk patients (score 7-10, 50-65% MACE risk) should be considered for urgent cardiology consultation and early invasive management.
The HEART score has been validated in multiple international cohorts, including studies in the Netherlands, the United States, the United Kingdom, and other European countries. It consistently demonstrates high sensitivity (above 95%) for identifying patients at very low risk of MACE, making it a valuable tool for safe early discharge protocols. The score performs similarly across different healthcare settings and patient populations, supporting its use globally.
Risk factors considered in the HEART score include diabetes mellitus, tobacco smoking, hypertension, hypercholesterolemia, obesity (BMI ≥ 30 kg/m²), and a positive family history of premature coronary artery disease (first-degree relative with CAD before age 55 for men or 65 for women). The scoring system accounts for the cumulative effect of multiple risk factors rather than individual factor severity.
Frequently Asked Questions
What is the HEART score in chest pain assessment?
The HEART score is a validated clinical risk stratification tool for patients presenting with chest pain in the emergency department. It estimates the 6-week risk of major adverse cardiovascular events (MACE) including all-cause mortality, acute myocardial infarction, need for percutaneous coronary intervention (PCI), or coronary artery bypass graft (CABG). The acronym HEART stands for History, ECG, Age, Risk factors, and Troponin — five components each scored 0-2 for a total of 0-10 points.
What are the five components of the HEART score?
The five HEART score components are: History (suspicion for ACS — nonspecific 0, mixed 1, or specific 2), ECG (normal 0, abnormal with no significant ST deviation 1, or significant ST deviation 2), Age (45 or under 0, 46-64 1, 65 or older 2), Risk factors (none 0, 1-2 1, 3 or more 2 — including diabetes, smoking, hypertension, hypercholesterolemia, obesity, and family history of CAD), and Troponin (normal 0, elevated 1-3 times normal 1, elevated more than 3 times normal 2).
How are HEART score risk categories defined?
A HEART score of 0-3 points indicates low risk with a 6-week MACE risk of up to 1.7%. A score of 4-6 indicates moderate risk with a 12-17% MACE risk. A score of 7-10 indicates high risk with a 50-65% MACE risk. Low-risk patients may be suitable for early discharge from the emergency department, while moderate-risk patients require further observation and testing, and high-risk patients should be considered for urgent intervention.
What ECG findings count as significant ST deviation in the HEART score?
Significant ST deviation (2 points) includes ST segment depression or elevation that is new or not known to be old — meaning no previous ECG is available for comparison. Abnormal ECG with repolarization abnormalities (1 point) includes bundle branch block (BBB), left ventricular hypertrophy (LVH), digoxin effect, implanted right-ventricular pacemaker, past myocardial infarction, or unchanged repolarization abnormalities without significant ST deviation. A normal ECG with no abnormalities scores 0 points.
Which patients should not be evaluated with the HEART score?
The HEART score should not be used on patients already diagnosed with acute coronary syndrome (ACS). It is intended specifically for patients presenting with chest pain of unknown cause in the emergency department to help with triage and discharge decisions. Patients with known ACS, ST-elevation myocardial infarction (STEMI), or those who are hemodynamically unstable require urgent cardiology evaluation regardless of their HEART score.
Can I rely on this HEART score calculator for clinical decisions?
This calculator is for educational and reference purposes only. It uses the standard HEART score criteria as published in the medical literature. However, clinical decisions should never be made based solely on a risk score calculation. Always consult a qualified healthcare professional for medical advice, diagnosis, and treatment decisions. The HEART score is a supportive triage tool, not a substitute for clinical judgment or formal cardiology assessment.
How does the HEART score differ from the TIMI score for chest pain?
The HEART score is simpler and more focused on emergency department triage with just five components (History, ECG, Age, Risk factors, Troponin) compared to the TIMI score for unstable angina/NSTEMI which has seven variables. Studies have shown the HEART score has superior discriminative power for predicting 6-week MACE in undifferentiated chest pain patients in the emergency setting. The HEART score is also more intuitive for rapid bedside assessment.
What risk factors are considered in the HEART score?
The HEART score considers six major cardiovascular risk factors: diabetes mellitus (DM), tobacco smoking, hypertension (HTN), hypercholesterolemia (elevated cholesterol), obesity (BMI 30 or higher), and a positive family history of coronary artery disease (CAD) in a first-degree relative. Patients with no risk factors score 0, those with one or two score 1, and those with three or more score 2 points.