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HEART Score Calculator — ED Chest Pain Risk

Risk stratification for undifferentiated chest pain in the emergency department, with 6-week MACE risk bands and disposition guidance. Calculations run locally in your browser.

H — History

How suspicious is the history for acute coronary syndrome?

E — ECG

Initial 12-lead ECG findings.

A — Age

Enter age in years.

years

Enter age to auto-score: <45 = 0, 45–64 = +1, ≥65 = +2.

R — Risk factors

Count: hypertension, hypercholesterolaemia, diabetes, current/recent smoker (≤3 months), positive family history of CAD (first-degree <65 yrs), or obesity (BMI >30). Known atherosclerotic disease auto-scores +2.

No risk factors selected — scoring 0.

T — Troponin

Use the local assay's upper reference limit (URL). For high-sensitivity troponin, apply sex-specific 99th-percentile URLs.

HEART Score

Disclaimer: The HEART score supports — but does not replace — clinical judgement. It is validated for adult ED patients with undifferentiated chest pain and is not applicable when STEMI is already evident, when an alternative diagnosis is established, or in patients aged <21 years. Always interpret alongside vitals, haemodynamic status, and serial troponin. A low score does not rule out non-ACS emergencies (aortic dissection, PE, pneumothorax, oesophageal rupture, myopericarditis) — consider these in parallel where the history suggests them.

Frequently asked questions

Is a single troponin enough at score 0–3?

The original HEART score uses a single troponin. The HEART Pathway adds a second troponin at 3 hours (or 0/1-hour serial high-sensitivity troponin) before discharging low-risk patients — this has become the safer standard. Use 0/3-hour serial conventional troponin or 0/1-hour high-sensitivity troponin per your local ACS pathway before applying the "discharge" recommendation.

How does this interact with the 0/1-hour ESC algorithm?

They are complementary, not interchangeable. The ESC 0/1-h algorithm rules in or rules out NSTEMI biochemically; HEART quantifies short-term MACE risk including unstable angina, urgent revascularisation, and death — capturing risk that troponin alone misses. Many Indian tertiary centres use both: ESC 0/1-h for biomarker disposition, HEART for clinical risk and downstream stress/CTCA decisions.

What counts as "known atherosclerotic disease"?

Prior MI, prior PCI/CABG, stroke or TIA, or peripheral arterial disease. Per the original Backus 2013 description, this auto-scores +2 for risk factors regardless of the other six items checked.

References

  1. 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.
  2. 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.
  3. 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.
  4. Byrne RA, Rossello X, Coughlan JJ, et al. 2023 ESC Guidelines for the management of acute coronary syndromes. Eur Heart J 2023;44(38):3720–3826.

MACE estimates are from the Backus 2013 multicentre validation (n=2440). Disposition suggestions follow the HEART Pathway (Mahler 2015) and ESC 2023 ACS guidance. Always defer to your hospital chest-pain pathway where it differs.

Document chest-pain risk scores directly in your patient chart with the Dr. Notes app — works offline, keeps records secure.

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