HEART Score

Formula

History 0-2 + ECG 0-2 + age (<45: 0, 45-64: 1, 65 or above: 2) + risk factors (0: 0, 1-2: 1, 3 or more or known atherosclerosis: 2) + troponin (1x or below: 0, 1-3x: 1, 3x or above: 2).

Limitations

• History and ECG grading are clinician judgements; this tool only sums them.
• Troponin bands differ between versions: the 2008 derivation paper scored 1-2x the normal limit as 1 point and more than 2x as 2 points, whereas later publications score 1-3x as 1 point and 3x the normal limit or more as 2 points; this tool uses the later 3x convention, and assay-specific cut-offs apply.
• Risk groups 0-3 / 4-6 / 7-10 are the original groupings; use them with clinical judgement and the local pathway.

References

1. Chest pain in the emergency room: value of the HEART score. Six AJ, Backus BE, Kelder JC. Neth Heart J. 2008;16(6):191-196. PMID 18665203
2. Chest pain in the emergency room: a multicenter validation of the HEART Score. Backus BE, Six AJ, Kelder JC, et al. Crit Pathw Cardiol. 2010;9(3):164-169. PMID 20802272
3. A prospective validation of the HEART score for chest pain patients at the emergency department. Backus BE, Six AJ, Kelder JC, et al. Int J Cardiol. 2013;168(3):2153-2158. PMID 23465250