HEART Score Calculator for Chest Pain

How the result reads

Points	Risk	Meaning
0–3	Low risk	About 2% had a major cardiac event within 6 weeks in the largest early validation.
4–6	Moderate risk	About 17% had a major cardiac event within 6 weeks in the largest early validation.
7–10	High risk	About 50% had a major cardiac event within 6 weeks in the largest early validation.

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Using the result

HEART scores History, ECG, Age, Risk factors and Troponin from 0 to 2 each, for a total of 0 to 10, in adults with chest pain in the emergency department. In the largest early validation (2,440 patients in 10 Dutch hospitals), major adverse cardiac events within 6 weeks occurred in about 2% of patients scoring 0 to 3, 17% scoring 4 to 6 and 50% scoring 7 to 10.

How it is used:

Low score (0 to 3). Combined with negative serial troponins, a low score identifies patients who can usually be discharged for outpatient follow-up rather than admitted. This is the basis of the HEART Pathway (Mahler, 2015).
Intermediate score (4 to 6). Observation, serial troponin and further testing are usual.
High score (7 to 10). Treat as likely acute coronary syndrome, with early cardiology involvement.

In a stepped-wedge trial in nine Dutch hospitals, care guided by the HEART score was safe but did not reduce admissions or resource use compared with usual care (Poldervaart, 2017).

Limitations and when not to use it

Not for patients with ST-segment elevation or other clear acute ischaemia on the ECG, or with haemodynamic instability.
The history item is a judgement and varies between clinicians.
It was developed with conventional troponin assays. Many hospitals now use high-sensitivity troponin pathways (for example the 0/1-hour algorithm), with or without HEART; follow the local pathway for troponin cut-offs.
A low score is not zero risk: about 1 to 2% of low-score patients still have an event within 6 weeks.
It does not address other dangerous causes of chest pain, such as aortic dissection or pulmonary embolism.

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HEART score: common questions

What is a good HEART score?

0 to 3 is low risk. With normal serial troponins, most such patients can be safely discharged with follow-up.

What counts as a risk factor?

Hypercholesterolaemia, hypertension, diabetes, current or recent smoking, a family history of early coronary disease and obesity. Known atherosclerotic disease (prior MI, revascularisation, stroke or peripheral artery disease) scores 2 points on its own.

How is the troponin item scored?

0 at or below the normal limit, 1 for one to three times the normal limit, 2 for more than three times.

Is HEART still useful with high-sensitivity troponin?

Yes, as part of a pathway, but the troponin cut-offs come from the assay's own algorithm. Several pathways combine a low HEART score with high-sensitivity troponin.

References

Six AJ, Backus BE, Kelder JC. Chest pain in the emergency room: value of the HEART score. Neth Heart J. 2008;16(6):191-196.
Backus BE, Six AJ, Kelder JC, et al. A prospective validation of the HEART score for chest pain patients at the emergency department. Int J Cardiol. 2013;168(3):2153-2158.
Mahler SA, Riley RF, Hiestand BC, et al. The HEART Pathway randomized trial: identifying emergency department patients with acute chest pain for early discharge. Circ Cardiovasc Qual Outcomes. 2015;8(2):195-203.
Poldervaart JM, Reitsma JB, Backus BE, et al. Effect of using the HEART score in patients with chest pain in the emergency department: a stepped-wedge, cluster randomized trial. Ann Intern Med. 2017;166(10):689-697.

Last updated October 29, 2026 by 2 Minute Medicine. For healthcare professionals. A decision aid that supports, and never replaces, clinical judgment.

HEART Score Calculator for Chest Pain