HEART Score

The HEART Score tool is a scoring system designed to stratify risk of major adverse cardiac events in patients coming to the emergency room with chest pain.

The five risk factors the HEART model and their weight (in points) in the final score, can be found in the following table:
HEART risk factors Answer choices (points)
Patient history Highly suspicious (2)
Moderately suspicious (1)
Slightly suspicious (0)
ECG Significant ST depression (2)
Non specific repolarisation disturbance (1)
Normal (0)
Patient age Equal or higher than 65 (2)
Between 45 and 65 (1)
Less than 45 (0)
Risk factors (Hypercholesterolemia, hypertension, diabetes, smoking, obesity) More than 3 risk factors or atherosclerosis history (2)
1 or 2 risk factors are present (1)
No risk factors (0)
Troponin (protein complex involved in cardiac muscle contraction) 3 times higher than normal or more (2)
1 to 3 times higher than normal (1)
Less than normal limit (0)

There are other mortality risk systems for patients suffering from cardiac symptoms, such as the TIMI score or the GRACE score, that are addressed to patients diagnosed with acute coronary syndrome.

Result interpretation

The absence or presence and severity of each of the five risk factors is awarded a number of points (from 0 to 2).

The HEART score varies from 0 to 10, where scores close to 0 mean a low risk of MACE and scores close to 10 indicate a high risk of major cardiac events.

The three risk categories are described below:
Heart score MACE risk Recommendation
0 - 3 Low (1.7%) Discharge can be an option.
4 - 6 Intermediate (20.3%) Clinical observation and further investigations.
7 - 10 High (72.2%) Immediate invasive treatment

About the study

The HEART score resulted after a study conducted by Six et al. in 2008. Data from 122 patients referred to the emergency room for chest pain was analysed.

The five risk factors chosen as most relevant for risk stratification were: History, ECG, Age, Risk factors and Troponin.

The predictive value of the HEART score for reaching an endpoint was evaluated in 120 of the 122 patients.

29 patients reached one or more endpoints with 16 patients diagnosed with acute myocardial infarction.

The score was found to be an accurate predictor of outcome in patients with chest pain.