This HEART score calculator risk-stratifies emergency-department chest pain across five bedside elements — History, ECG, Age, Risk factors and Troponin — each scored 0, 1 or 2, for a total of 0–10 that sorts patients into low, moderate and high risk of major adverse cardiac events (MACE). It is one of the most validated chest-pain instruments in emergency medicine, and its purpose is explicitly practical: identify who can safely go home, who needs observation and testing, and who needs cardiology now.

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Five Letters, One Disposition Decision

HEART was designed by Dutch cardiologist Barbra Backus and colleagues (2008–2013) to fix a specific failure mode: chest-pain patients were being admitted in vast numbers “for safety” while a meaningful minority of discharged ones still had events — gestalt alone sorted poorly in both directions. Each element was chosen to be available within the first hour: the story's suspiciousness, the ECG, the patient's age, the atherosclerotic risk burden (hypertension, diabetes, hyperlipidemia, smoking, family history, obesity — or established atherosclerotic disease, which auto-scores 2), and the initial troponin binned against the assay's normal limit. Score each honestly — the History element's inter-rater softness is the score's known weak joint, and inflating or deflating it to reach a preferred disposition defeats the instrument's validation entirely.

The bands drive the HEART Pathway used in many EDs: 0–3 with negative serial troponins → early discharge (the pathway's whole economic and human point); 4–6 → observation and objective testing; 7–10 → admission with early invasive management. Reported MACE rates differ modestly between the derivation (Six/Backus) and later validation cohorts and between troponin generations — high-sensitivity assays reclassify the Troponin element's thresholds, and pathways built on them apply modified cutoffs. This calculator reports the widely validated ranges and says so; local protocol, built on your assay, is the operative document.

Worked Example

  • Defaults — the classic borderline: moderately suspicious history (1) + non-specific ECG changes (1) + age 45–64 (1) + 1–2 risk factors (1) + normal troponin (0) = 4 — the first point of the moderate band, and empirically the score where disposition arguments happen. The pathway's answer is observation and objective testing, not a coin flip.
  • The discharge candidate: slightly suspicious story, normal ECG, age 38, no risk factors, normal troponin = 0 — with a second timed troponin negative, this is the patient HEART exists to send home safely.
  • The obvious admission: highly suspicious story (2) + ST deviation (2) + age 70 (2) + known CAD (2) + troponin 2× limit (1) = 9 — scores this high correlate with MACE in roughly half of cases in validation cohorts; cardiology's involvement is not a consultation question.

HEART Discipline

  • Score the History as it presents, not as the workup later reframes it — the element is prospective by design.
  • Troponin bins depend on the assay's own 99th-percentile limit; high-sensitivity pathways use different rule-out logic (often 0/1-hour deltas) layered on the same score.
  • HEART does not exclude aortic dissection, PE or other chest-pain catastrophes — a low score with a tearing pain story or a wide mediastinum is a different pathway entirely (our PERC and Wells PE tools cover one neighboring branch).
  • Dynamics matter: HEART is computed at presentation; rising troponins and evolving ECGs reclassify patients mid-course, and the pathway includes the serial measurements for this reason.
  • Document the score and the pathway step taken: medico-legally and clinically, “HEART 2, pathway discharge, follow-up in 72h” is a complete sentence; “low risk, home” is not.

Related Tools

Frequently Asked Questions

How is the HEART score calculated?

Score five elements 0–2 each: History (slightly/moderately/highly suspicious), ECG (normal/non-specific changes/significant ST deviation), Age (<45 / 45–64 / ≥65), Risk factors (none / 1–2 / ≥3 or known atherosclerotic disease), and Troponin (≤ limit / 1–3× / >3× the normal limit). Total 0–10. Bands: 0–3 low risk, 4–6 moderate, 7–10 high — with validation-cohort MACE rates of roughly 1–2%, 12–17% and ~50% respectively at about six weeks.

What does a low HEART score allow?

Within the validated HEART Pathway, a score of 0–3 combined with negative serial (timed) troponins identifies patients at low enough risk (~1–2% short-term MACE, lower still in the pathway's own trials) for early discharge with arranged outpatient follow-up — the pathway safely reduces admissions compared with gestalt-plus-single-troponin practice. The score alone, without the pathway's troponin timing and follow-up conditions, is not the discharge decision.

HEART vs TIMI — which should be used?

They answer different questions for different populations. HEART was built for undifferentiated ED chest pain — its superpower is identifying low-risk patients safe for discharge. TIMI (UA/NSTEMI) was built for patients already diagnosed with acute coronary syndrome, stratifying their 14-day risk to guide intensity of therapy. Using TIMI to discharge undifferentiated chest pain misapplies it (it was never validated for that and misses low-risk discrimination); using HEART in confirmed ACS discards TIMI's treatment-linked granularity. Our TIMI calculator is the companion page.

How do high-sensitivity troponins change HEART?

High-sensitivity assays detect troponin in most healthy people, so the score's simple ≤ limit / 1–3× / >3× bins blur; modern pathways therefore pair HEART with assay-specific 0/1-hour or 0/2-hour delta algorithms for rule-out instead of relying on the classic bins alone. The score's other four elements are unchanged, and the combined pathways retain HEART's low-risk discrimination. Always follow your institution's assay-specific protocol over any generic calculator thresholds, including these.

What counts as a “risk factor” in HEART?

The atherosclerotic burden list: hypertension, diabetes mellitus, hypercholesterolemia, current/recent smoking, family history of premature cardiovascular disease, and obesity (BMI > 30). Count them: 0 factors = 0 points, 1–2 = 1 point, 3 or more = 2 points — and a history of atherosclerotic disease itself (prior MI, PCI/CABG, stroke/TIA, peripheral arterial disease) scores the full 2 regardless of the factor count.

Can HEART be used for chest pain from other causes?

HEART predicts cardiac events; it doesn't evaluate the pain's other dangerous causes. Pulmonary embolism, aortic dissection, pneumothorax and esophageal rupture all present as chest pain and none moves the HEART score — low HEART with features of those conditions (tearing quality, hypoxia, pulse deficits, risk factors for VTE) demands their own pathways. Clinicians use HEART to answer “how likely is ACS and what cardiac pathway fits?” after — or alongside — screening the presentation for the non-cardiac killers.

What MACE rate does each band carry?

Across the major validation cohorts (Backus 2013 and successors, ~6-week follow-up): scores 0–3 carried about 1–2% MACE (the original Dutch cohort reported 1.7%), scores 4–6 about 12–17%, and scores 7–10 about 50% (some cohorts up to ~65%). Exact percentages vary with cohort, era and troponin generation — the calculator reports ranges rather than false precision, and local pathway documents quote their own audited figures.

Is this HEART score calculator free?

Yes — free and instant. It's an educational aid that reproduces the published scoring; disposition decisions belong to the treating clinician and local protocol.