Cardiac Scores

HEART Score for Chest Pain (HEART) Calculator

Sorts emergency patients with chest pain into low, intermediate and high risk of a major cardiac event within 6 weeks.

Reviewed by Alex G, BSN, RN, CEN, CCRN, CMC, NREMT-P · From the Reference tab of the app

Turn on JavaScript to use this calculator, or open it in the web app.

Formula

History, ECG, Age, Risk factors and Troponin each score 0, 1 or 2
Age: 45 or younger 0, over 45 and under 65 +1, 65 or older +2
Risk factors: none 0, 1–2 +1, 3 or more or known atherosclerotic disease +2
Troponin: at or below the normal limit 0, over 1 and under 3 times +1, 3 or more times +2
Total 0–10: low 0–3, intermediate 4–6, high 7–10

How it is used

• In 2,388 unselected emergency chest-pain patients at 10 Dutch hospitals, 6-week major adverse cardiac events (MI, PCI, CABG, significant stenosis managed medically, death) occurred in 15 of 870 (1.7%) at 0–3, 183 of 1,101 (16.6%) at 4–6 and 209 of 417 (50.1%) at 7–10 (Backus 2013).
• A low score excluded 6-week events with over 98% certainty, so the authors suggest a reserved policy at 0–3 and a more aggressive one at 7–10; it outperformed TIMI and GRACE (C statistic 0.83 vs 0.75 and 0.70) (Backus 2013).
• Scored on the first data only, with a conventional (not high-sensitivity) troponin; history is subjective, so two clinicians may differ by a point (Six 2008; Backus 2013).

Key points

• The score is for undifferentiated chest pain: ST elevation on the ECG is a STEMI pathway, not a HEART score.

Same formula as the app. Open it in the web app.

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For education and exam preparation only. Follow your institution’s protocols. For education and exam preparation only. Verify results independently and follow your institution’s protocols. Not a substitute for clinical judgment.