HEART Score Calculator

Score	Risk tier	6-week MACE	Typical disposition
0–3	Low	0.9–1.7%	Consider early discharge with outpatient follow-up
4–6	Moderate	12–16.6%	Admit for observation and serial troponin/ECG
7–10	High	50–65%	Admit; early invasive strategy / cardiology consult

Item	0 points	1 point	2 points
History	Slightly suspicious	Moderately suspicious	Highly suspicious
ECG	Normal	Nonspecific repolarization disturbance	Significant ST deviation
Age	< 45 years	45–64 years	≥ 65 years
Risk factors	None known	1–2 risk factors	≥3 risk factors, or known atherosclerotic disease
Troponin	≤ normal limit	1–3× normal limit	> 3× normal limit

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Walk-through

How to Use This Calculator

5 steps

1

Score the patient's History

Select how suspicious the presenting history is for acute coronary syndrome: slightly suspicious (0 points), moderately suspicious (1 point), or highly suspicious (2 points).

2

Score the ECG

Select the ECG finding: normal (0 points), a nonspecific repolarization disturbance such as left bundle branch block, LVH, or digoxin effect (1 point), or significant ST-segment deviation not explained by another cause (2 points).

3

Select the patient's Age band

Choose the age bracket: under 45 (0 points), 45 to 64 (1 point), or 65 and older (2 points).

4

Count cardiovascular Risk Factors

Count hypertension, hypercholesterolemia, diabetes, obesity (BMI > 30), current or recent (within 3 months) smoking, a positive family history, and known atherosclerotic disease. Select none (0 points), 1–2 factors (1 point), or 3 or more factors — or any known atherosclerotic disease, which scores 2 points regardless of factor count.

5

Enter the Troponin result

Select whether the initial troponin is at or below the normal limit (0 points), 1–3 times the normal limit (1 point), or more than 3 times the normal limit (2 points).

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Reference

Formula & Methodology

1 formula

HEART Score

HEART Score = History + ECG + Age + Risk Factors + Troponin (each 0–2 points, total 0–10)

The HEART score sums five clinical variables, each scored 0, 1, or 2 points, for a total of 0 to 10. The total maps to three risk tiers for 6-week major adverse cardiac events (MACE — death, myocardial infarction, or coronary revascularization): Low (0–3, ~0.9–1.7% MACE), Moderate (4–6, ~12–16.6% MACE), and High (7–10, ~50–65% MACE). The score and tier boundaries come from the original HEART score derivation (Six et al. 2008) and its multicenter HEART Pathway validation (Backus et al. 2013).

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High YMYL

Trust, Methodology & Sources

Reviewed by Calculover Clinical Content Team · Updated 2026-07-22 · 3 sources

Editorial accountability

Author: Calculover Clinical Content Team - Clinical calculator content authoring

Owner: Calculover Editorial Team - Health & Fitness category editorial owner

Reviewer: Calculover Clinical Content Team - Clinical reviewer

Last reviewed: 2026-07-22

Last verified: 2026-07-22

Data effective: 2026-07-22

Methodology

The HEART score sums five clinical variables (History, ECG, Age, Risk factors, Troponin), each scored 0, 1, or 2 points, for a total of 0–10. Risk-tier boundaries (Low 0–3, Moderate 4–6, High 7–10) and their associated 6-week MACE percentages (0.9–1.7%, 12–16.6%, and 50–65% respectively) are taken from the original HEART score derivation study (Six AJ, Backus BE, Kelder JC. Neth Heart J. 2008;16(6):191-6) and confirmed by the multicenter HEART Pathway validation (Backus BE et al. Int J Cardiol. 2013).

Assumption: The patient is at least 21 years old and is presenting to an emergency department with chest pain being evaluated for possible acute coronary syndrome.

Assumption: The troponin value entered reflects a single measurement (typically the initial or 0-hour draw) relative to the local assay's upper limit of normal, unless the clinician is tracking serial values separately per the HEART Pathway protocol.

Assumption: The 'Risk factors' item counts hypertension, hypercholesterolemia, diabetes, obesity (BMI > 30), current/recent smoking, family history of cardiovascular disease, and known atherosclerotic disease; known atherosclerotic disease alone scores the maximum 2 points for this item.

Limitations & guidance

Not validated for patients with ST-elevation myocardial infarction (STEMI) or hemodynamic instability — those presentations require immediate activation of the acute coronary syndrome protocol regardless of the calculated HEART score.

Not intended to replace serial troponin measurement or continued ECG monitoring where clinically indicated; the HEART Pathway protocol pairs the score with troponin drawn at 0 and 3 hours.

The 'History' item is a subjective clinical judgment and carries some interobserver variability between clinicians.

This calculator is a decision-support aid, not a diagnostic tool, and does not replace the judgment of a treating clinician or an institution's own chest-pain protocol.

Professional guidance: This calculator is for clinical decision support and educational purposes only. It is not a substitute for professional medical judgment, diagnosis, or treatment, and it does not replace an institution's own chest-pain evaluation protocol. Always use clinical judgment and consult appropriate specialists when managing a patient with chest pain.

Primary sources

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

Backus BE et al. A prospective validation of the HEART score for chest pain patients at the emergency department. Int J Cardiol. 2013;168(3):2153-8.

MDCalc — HEART Score for Major Cardiac Events

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Glossary

Key Terms Explained

7 terms

HEART score A 5-item, 0–10 point clinical decision tool (History, ECG, Age, Risk factors, Troponin) that estimates the short-term risk of a major adverse cardiac event in emergency department patients with chest pain.

MACE Major Adverse Cardiac Event — a composite outcome (in the HEART literature, typically death, myocardial infarction, or coronary revascularization) used to measure the real-world risk each HEART score tier predicts over a 6-week window.

Troponin A cardiac biomarker protein released into the blood when heart muscle is damaged. An elevated troponin above the assay's normal limit supports a diagnosis of myocardial injury or infarction.

ACS Acute Coronary Syndrome — the umbrella term for conditions caused by sudden reduced blood flow to the heart, including unstable angina, NSTEMI, and STEMI. The HEART score helps triage patients being evaluated for possible ACS.

Risk stratification The process of sorting patients into groups (e.g., low, moderate, high risk) based on their likelihood of a bad outcome, so that testing, monitoring, and disposition decisions can be matched to that likelihood.

HEART Pathway A clinical protocol that combines the HEART score with serial troponin measurements (typically at 0 and 3 hours) to decide whether a chest-pain patient can be safely discharged or needs further cardiac workup and admission.

Chest pain Discomfort in the chest that can arise from cardiac causes (such as ischemia) or non-cardiac causes (musculoskeletal, gastrointestinal, pulmonary, or anxiety-related); the HEART score is applied to patients whose chest pain raises concern for a cardiac cause.

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Scenarios

Real-World Examples

3 worked examples

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Low-risk discharge candidate

A 38-year-old with atypical, brief chest discomfort, a normal ECG, one risk factor (smoking), and a normal troponin.

History Slightly suspicious (0 pts) ECG Normal (0 pts) Age < 45 years (0 pts) Risk factors 1–2 risk factors (1 pt) Troponin ≤ normal limit (0 pts)

Total score 1 — Low risk (0.9–1.7% 6-week MACE). A patient in this range is often a candidate for early discharge with outpatient follow-up, per local HEART Pathway protocols and clinical judgment.

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Moderate-risk observation admit

A 58-year-old with moderately concerning chest pain, a nonspecific ECG change, three risk factors, and a mildly elevated troponin.

History Moderately suspicious (1 pt) ECG Nonspecific repolarization disturbance (1 pt) Age 45–64 years (1 pt) Risk factors ≥3 risk factors (2 pts) Troponin 1–3× normal limit (1 pt)

Total score 6 — Moderate risk (12–16.6% 6-week MACE). This tier typically prompts admission for observation with serial troponin and ECG monitoring rather than immediate discharge.

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High-risk admission

A 71-year-old with a highly suspicious history, significant ST-segment deviation, known coronary artery disease, and a markedly elevated troponin.

History Highly suspicious (2 pts) ECG Significant ST deviation (2 pts) Age ≥ 65 years (2 pts) Risk factors Known atherosclerotic disease (2 pts) Troponin > 3× normal limit (2 pts)

Total score 10 — High risk (50–65% 6-week MACE). This tier warrants admission and an early invasive strategy or cardiology consultation, not outpatient management.

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Deep Dive

Understanding the HEART Score

3 chapters · 4 min read

The HEART score is one of the most widely used and best-validated clinical decision tools for chest pain in the emergency department. It turns five pieces of information a clinician already gathers — History, ECG, Age, Risk factors, and Troponin — into a single 0–10 number that estimates a patient's short-term cardiac risk.

How the HEART score works

Each of the five components is scored 0, 1, or 2 points based on how strongly it points toward acute coronary syndrome, and the five scores are summed for a total of 0–10. The total places the patient into one of three risk tiers for major adverse cardiac events (MACE) within 6 weeks: Low (0–3), Moderate (4–6), or High (7–10). These tiers and their associated MACE rates were established in the original derivation study by Six et al. (2008) and confirmed in the larger multicenter HEART Pathway validation by Backus et al. (2013).

The five components

History captures how classic the presenting symptoms are for cardiac ischemia — retrosternal pressure radiating to the arm or jaw scores higher than atypical, sharp, or positional pain. ECG scores any ST-segment deviation not otherwise explained highest, nonspecific repolarization changes (e.g., LBBB, LVH, digoxin effect) in the middle, and a normal tracing lowest. Age reflects rising baseline cardiovascular risk with each decade. Risk factors tallies hypertension, hypercholesterolemia, diabetes, obesity, smoking, family history, and known atherosclerotic disease — a patient with established atherosclerotic disease automatically scores the maximum 2 points for this item. Troponin uses the local assay's upper limit of normal as the reference point for scoring an initial (or first available) value.

Scope and limitations

The HEART score was derived and validated specifically for adult (≥21 years) emergency department patients being evaluated for possible acute coronary syndrome — it is not intended for patients who already have a STEMI or who are hemodynamically unstable, both of which require immediate protocol activation regardless of score. The History item is inherently subjective, which introduces some interobserver variability. The HEART Pathway protocol pairs the score with serial troponin testing (commonly at 0 and 3 hours) rather than relying on a single value, and clinical judgment should always be able to override a calculated low-risk score when something about the presentation is concerning.

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Questions

Frequently Asked Questions

6 questions

What is the HEART score?+

The HEART score is a 5-item clinical decision tool (History, ECG, Age, Risk factors, Troponin) that emergency clinicians use to estimate a chest-pain patient's risk of a major adverse cardiac event within 6 weeks. Each item is scored 0–2 points for a total of 0–10, which maps to Low, Moderate, or High risk.

Who is the HEART score for?+

It is intended for adult patients (21 years and older) presenting to the emergency department with chest pain that could plausibly represent acute coronary syndrome. It is a triage aid for clinicians, not a self-assessment tool for patients.

What does a low-risk HEART score mean?+

A score of 0–3 corresponds to roughly 0.9–1.7% risk of a major adverse cardiac event within 6 weeks. Many HEART Pathway protocols consider this range compatible with early discharge and outpatient follow-up, provided the treating clinician has no other clinical concerns.

When should troponin be measured — once or serially?+

The original HEART Pathway protocol combines the HEART score with troponin drawn at presentation (0 hours) and again at 3 hours. A single troponin value can be used to compute the score, but serial measurements are the standard way the score is applied in practice to rule out evolving myocardial injury.

When should the HEART score not be used?+

The HEART score is not validated for patients who already have ST-elevation myocardial infarction (STEMI) or who are hemodynamically unstable — those patients need immediate activation of the acute coronary syndrome protocol regardless of any score. It is also not intended for patients whose chest pain has an obvious non-cardiac explanation on initial evaluation.

How well-validated is the HEART score?+

The HEART score was derived by Six et al. (2008) and has since been validated in multiple prospective cohorts, most notably the HEART Pathway studies led by Backus et al. (2013), which confirmed its ability to identify a low-risk group suitable for early discharge across thousands of emergency department patients.

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