HEART Score Calculator — Chest Pain Risk Stratification

Formula

How this is calculated

The HEART score was developed by Backus et al. and first published in 2010 (Int J Cardiol), with earlier validation work by Six et al. 2008 (Ann Emerg Med). It assigns 0–2 points to each of five domains: History (how typical the chest-pain narrative is for acute coronary syndrome); ECG findings (normal = 0, non-specific changes = 1, significant ST changes/LBBB = 2); Age (<45 = 0, 45–64 = 1, ≥65 = 2); Risk factors (none = 0, 1–2 traditional CV risk factors = 1, ≥3 or known atherosclerotic disease = 2); and Troponin relative to the institutional upper limit of normal (ULN).

The resulting 0–10 score separates patients into three risk groups. A score of 0–3 (low risk) was associated with a 6-week MACE rate of roughly 1–2% in validation cohorts — sufficient for safe early discharge with outpatient follow-up in many guidelines. Scores of 4–6 (moderate) carry roughly 12–16% MACE and warrant serial troponin testing and monitoring. Scores of 7–10 (high) carry roughly 50–65% MACE and typically prompt early invasive evaluation.

The score has been prospectively validated in multiple countries and is incorporated into chest-pain pathways by the European Society of Cardiology and various national guidelines as an optional tool. It should always be interpreted alongside clinical judgment, serial troponins, and the overall clinical picture — it is not a standalone diagnostic test.