Heart Score Calculator
Risk-stratify emergency department patients with chest pain using the HEART score. Enter values for instant results with step-by-step formulas.
Formula
HEART = History (0-2) + ECG (0-2) + Age (0-2) + Risk Factors (0-2) + Troponin (0-2)
Each of the five components is scored 0, 1, or 2 based on clinical assessment. Total score ranges from 0 to 10. Low risk (0-3): ~1.7% MACE rate. Moderate risk (4-6): ~12-16.6% MACE rate. High risk (7-10): ~50-65% MACE rate.
Worked Examples
Example 1: Low Risk Chest Pain
Problem: 38-year-old with atypical chest pain, normal ECG, no risk factors, normal troponin.
Solution: History: 0 (Slightly suspicious)\nECG: 0 (Normal)\nAge: 0 (<45)\nRisk Factors: 0 (None)\nTroponin: 0 (Normal)\nTotal HEART = 0\nMACE risk: ~0.9-1.7%
Result: HEART 0 — Low Risk, consider early discharge
Example 2: High Risk Chest Pain
Problem: 70-year-old diabetic smoker with typical angina, ST depression on ECG, elevated troponin.
Solution: History: 2 (Highly suspicious)\nECG: 2 (ST deviation)\nAge: 2 (≥65)\nRisk Factors: 2 (≥3 factors)\nTroponin: 2 (>3x normal)\nTotal HEART = 10\nMACE risk: ~50-65%
Result: HEART 10 — High Risk, early invasive strategy recommended
Frequently Asked Questions
What is the HEART score?
The HEART score is a clinical decision tool for risk stratifying patients presenting to the emergency department with chest pain. It evaluates five components: History, ECG, Age, Risk factors, and Troponin, each scored 0-2. The total score (0-10) predicts the 6-week risk of major adverse cardiac events (MACE) including death, MI, or coronary revascularization. It helps identify low-risk patients suitable for early discharge and high-risk patients needing aggressive management.
How reliable is the HEART score?
The HEART score has been validated in multiple large studies across diverse populations. The HEART Pathway trial demonstrated that using the score safely identified low-risk patients for early discharge, reducing cardiac testing by 12% and length of stay by 12 hours without missing any MACE events at 30 days. Sensitivity for detecting MACE in low-risk patients (score 0-3) exceeds 98%.
What is the recommended management for each HEART score category?
Low risk (0-3): Consider early discharge with outpatient follow-up and stress testing within 72 hours. MACE rate ~1.7%. Moderate risk (4-6): Admit for observation, serial troponins, and non-invasive cardiac testing. MACE rate ~12-16.6%. High risk (7-10): Admit for early invasive management, cardiology consultation, and possible catheterization. MACE rate ~50-65%.
What are the limitations of the HEART score?
Limitations include: 1) Subjective nature of the History component. 2) Requires troponin results, which may delay risk stratification. 3) Not validated in patients with STEMI or obvious ACS. 4) May underperform in young patients with atypical presentations. 5) Should not replace clinical gestalt entirely — always consider the full clinical picture.
How do heart rate training zones work?
Training zones are percentages of maximum heart rate (estimated as 220 minus age). Zone 1 (50-60%) is recovery, Zone 2 (60-70%) builds endurance, Zone 3 (70-80%) improves aerobic capacity, Zone 4 (80-90%) increases threshold, and Zone 5 (90-100%) is maximal effort.
Does Heart Score Calculator work offline?
Once the page is loaded, the calculation logic runs entirely in your browser. If you have already opened the page, most calculators will continue to work even if your internet connection is lost, since no server requests are needed for computation.