HEART Score ❤️🔥
HEART score for ED chest pain risk stratification (History, ECG, Age, Risk factors, Troponin). Low, moderate, and high short-term MACE risk bands for NCHDs.
HEART Score
Risk stratification for suspected ACS in the ED (HEART score; Backus et al.). Educational aid only — follow local pathways.
History
How suspicious is the chest pain for ACS?
ECG
Initial ED tracing.
Age
Risk factors
HTN, dyslipidaemia, DM, obesity, smoking, FH of CAD <65y; ≥3 factors OR known atherosclerotic disease scores 2.
Troponin
Relative to local assay upper reference limit (URL).
Total HEART score
—
HEART score derivation and validation are reported by Dr Barbra Backus and colleagues (see primary literature, e.g. Crit Pathw Cardiol / related ED chest pain series). Interpretation thresholds vary slightly between studies; always combine with clinical judgement, serial troponins, and hospital protocol.
Why use it
- HEART estimates short-term major adverse cardiac event (MACE) risk in undifferentiated chest pain when ACS is in the differential.
- Score each domain 0–2 (total 0–10). Follow local chest pain / ACS pathways for disposition; this tool does not replace serial troponins or senior review.
Interpretation
0–3
- Risk
- Low
- Typical next steps
- Accelerated assessment or ED discharge with follow-up per local protocol, if serial troponins and clinical picture allow.
4–6
- Risk
- Moderate
- Typical next steps
- Further observation, serial troponins, and cardiology input per local pathway.
7–10
- Risk
- High
- Typical next steps
- Admit / urgent cardiology pathway; treat as high ACS risk until proven otherwise.
| Score | Risk | Typical next steps |
|---|---|---|
| 0–3 | Low | Accelerated assessment or ED discharge with follow-up per local protocol, if serial troponins and clinical picture allow. |
| 4–6 | Moderate | Further observation, serial troponins, and cardiology input per local pathway. |
| 7–10 | High | Admit / urgent cardiology pathway; treat as high ACS risk until proven otherwise. |
Related NICE guidance
Full guidance on nice.org.uk. BetterCall is not endorsed by NICE.
Educational reference only. Medical disclaimer