HEART Score

History

ECG

Age (years)

Troponin (× upper limit of normal)

Enter 1 for a troponin exactly at the upper limit of normal.

Risk factors

Currently treated diabetes mellitusCurrent smoker, or stopped within the last monthDiagnosed hypertensionDiagnosed hypercholesterolaemiaFamily history of coronary artery diseaseObesityHistory of atherosclerotic diseaseCoronary revascularisation, myocardial infarction, stroke or peripheral arterial disease. Scores the maximum 2 on its own.

Enter age and troponin to see the score.

Notes

Troponin here follows the original 2008 paper, which scores 1–2× the upper limit of normal as 1 point and above 2× as 2. Several widely used calculators print 1–3× and >3× instead. Between two and three times normal the two versions differ by a point, which around the 3/4 boundary can move a patient between the low and moderate bands — worth knowing if your number here disagrees with another tool.

ST changes explained by bundle branch block, left ventricular hypertrophy or digoxin score 1, not 2. The 2 points are for significant ST deviation in the absence of those.

It is for undifferentiated chest pain, not for patients already diagnosed with acute coronary syndrome. That is what separates it from TIMI and GRACE, which estimate risk in established ACS.

MACE means all-cause mortality, myocardial infarction or coronary revascularisation within six weeks. The score is most widely validated with conventional-sensitivity troponin.

History and ECG are both judgement calls, and the score is only as good as those two. It supports a disposition decision; it does not make it.

Source

Six AJ, Backus BE, Kelder JC. Chest pain in the emergency room: value of the HEART score. Neth Heart J. 2008;16(6):191–196.