HEART score for chest pain in the emergency department
The HEART score classifies patients with chest pain in the emergency department by their risk of major adverse cardiac events (MACE). Each of the five criteria scores 0 to 2 points.
⚠︎ Learning tool for medical education – not for use in patients or for treatment decisions.
Classification (original publication)
| Score | Classification (original publication) |
|---|---|
| 0–3 | Low risk – MACE 2.5% in the original study (Six 2008) |
| 4–6 | Intermediate risk – MACE 20.3% in the original study (Six 2008) |
| 7–10 | High risk – MACE 72.7% in the original study (Six 2008) |
Risk factors in the HEART score
Risk factors are arterial hypertension, hypercholesterolaemia, diabetes mellitus, obesity (BMI > 30), smoking (current or stopped within 3 months; within 1 month in the original study) and a positive family history. Troponin is scored according to the later version (1–3× or > 3× the normal limit; Backus 2013); in the original study (Six 2008) the thresholds were 1–2× and > 2× the normal limit. Known atherosclerotic disease (e.g. previous myocardial infarction, revascularisation, stroke, peripheral arterial disease) scores two points.
Limitations
The percentages come from the small original study; in later, larger studies the event rates were lower: 0.99 / 11.6 / 65.2% (Backus 2010) and 1.7 / 16.6 / 50.1% (Backus 2013). The score does not replace serial ECGs or repeated troponin measurements.
FAQ
What does HEART stand for?▾
History, ECG, age, risk factors and troponin.
References
- Six AJ, Backus BE, Kelder JC. Chest pain in the emergency room: value of the HEART score. Neth Heart J 2008;16:191–6. · PubMed
- Backus BE et al. Chest pain in the emergency room: a multicenter validation of the HEART Score. Crit Pathw Cardiol 2010;9:164–9. · PubMed
- Backus BE et al. A prospective validation of the HEART score for chest pain patients at the emergency department. Int J Cardiol 2013;168:2153–8. · PubMed
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Open in browser Download on the App StoreIntended purpose: learning tool for medical education only. Not intended for use in patients or for diagnostic or treatment decisions; not a medical device. Calculations follow the cited original publications; no guarantee of completeness or correctness. Last updated: 10/2026 · Dr. Pascal Bafteh