The HEART score is a standardized, rapid assessment tool used in the emergency department to efficiently evaluate adult patients presenting with chest pain who do not have an immediate diagnosis of a heart attack. The score quickly stratifies a patient’s risk of experiencing a Major Adverse Cardiac Event (MACE), such as a heart attack or death, within the short term, typically defined as the next 30 to 42 days. This systematic approach helps providers determine which patients can be safely discharged and which require timely, specialized cardiac care.
The Five Components of the HEART Score
The score is derived from five distinct clinical variables, each representing a different aspect of a patient’s cardiac status. These factors are systematically evaluated and assigned a numerical value to form the final risk assessment. The History component analyzes the quality, location, and severity of the chest pain. A highly characteristic description of chest pain, often described as pressure or heaviness radiating to the jaw or arm and strongly suggestive of ischemia, carries a higher point value than non-specific or atypical pain.
The ECG (Electrocardiogram) findings are the second factor. A completely normal tracing receives zero points, while non-specific changes, such as minor repolarization abnormalities, increase the score. The highest score is assigned for findings showing significant ST-segment deviation, which is a strong indicator of acute cardiac injury.
Age is an objective variable where increasing age is associated with an elevated baseline risk of coronary artery disease. Patients under 45 years old receive the lowest score, while those aged 65 and older are assigned the maximum points for this category.
Risk Factors include conditions like diabetes mellitus, hypertension, current or recent smoking, obesity, and a family history of premature coronary artery disease. A patient with no known risk factors scores lowest. Those with a history of established atherosclerotic disease, such as a previous heart attack or coronary bypass surgery, receive the highest point value.
The Troponin level is the fifth variable, measuring a specific protein released into the bloodstream when heart muscle is damaged. A normal level indicates no measurable cardiac injury, while an elevated reading, particularly one that is three times the upper limit of normal, significantly increases the patient’s score.
Translating Variables into a Numerical Risk
Each of the five components—History, ECG, Age, Risk Factors, and Troponin—is independently assigned a numerical value of 0, 1, or 2 points based on the severity or presence of the factor. The scores from all five categories are then summed to yield a total HEART score, which can range from 0 to 10 points.
This total score translates the clinical findings into a quantifiable risk profile, which is divided into three specific risk categories. Patients who achieve a total score of 0 to 3 are classified as Low Risk. This category is associated with a MACE rate of approximately 0.9% to 2.5% within the subsequent six weeks.
A total score between 4 and 6 places the patient in the Intermediate Risk category, where the projected MACE rate ranges from 12% to over 20%. The highest scores, from 7 to 10, denote a High Risk profile. Patients in this group face a high risk of an adverse event, with MACE rates reported to be between 50% and 72.7%.
Clinical Action Based on Risk Category
The final HEART score serves as a decision support tool, guiding the physician’s management plan. For patients classified as Low Risk (score 0 to 3), the clinical pathway typically involves safe discharge from the hospital. This approach avoids the costs and risks associated with unnecessary hospitalization and extensive cardiac testing.
Patients falling into the Intermediate Risk category (scores 4 to 6) warrant admission for observation. This requires serial evaluation, including repeated blood tests for troponin and follow-up ECGs over several hours. Further non-invasive testing, such as a cardiac stress test or a CT angiogram, is often arranged to investigate the cause of the chest pain and better define the coronary anatomy.
A High Risk score of 7 to 10 dictates the most aggressive management strategy. These patients are immediately admitted to a specialized cardiac unit, and urgent consultation with a cardiologist is initiated. Early invasive strategies, such as cardiac catheterization, are often planned to visualize and potentially treat any blockages in the coronary arteries.