HEART Score

The HEART Score: Triage of Chest Pain in the ER

The HEART Score (History, ECG, Age, Risk factors, Troponin) is a globally recognized clinical assessment tool designed specifically for the emergency department. It helps estimate the probability of a patient with chest pain developing a Major Adverse Cardiac Event (MACE: myocardial infarction, percutaneous coronary intervention, coronary artery bypass grafting, or death) within the next 6 weeks.

Clinical Utility and Decision Making

Unlike the TIMI or GRACE scores, which apply to patients already diagnosed with acute coronary syndrome, the HEART score applies to undifferentiated patients arriving at the emergency room with chest pain. Its main strength is safely identifying low-risk patients who can be sent home:

• Score 0-3 (Low risk): The risk of MACE is approximately 0.9 to 1.7%. These patients can generally be discharged home with outpatient follow-up, avoiding unnecessary and costly hospitalizations.
• Score 4-6 (Intermediate risk): The risk of MACE is 12 to 16.6%. Observation in the emergency department, further testing, or hospitalization is recommended.
• Score 7-10 (High risk): The risk of MACE reaches 50 to 65%. These patients require immediate hospitalization, often with an early invasive strategy (coronary angiography).

Risk Stratification

Total Score	Risk	MACE Probability (6 weeks)
0 - 3 pts	Low (Discharge home)	0.9 - 1.7 %
4 - 6 pts	Intermediate (Observation)	12.0 - 16.6 %
7 - 10 pts	High (Hospitalization / Invasive)	50.0 - 65.0 %

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References:

1. Six AJ, Backus BE, Kelder JC. A fast assessment of likelihood in patients with chest pain in the emergency department. Neth Heart J. 2008;16(5):191-196. [PMC - NIH]
2. Backus BE, et al. Validation of the HEART score in the emergency department. Crit Pathw Cardiol. 2010. [LWW Journals]