HE-MACS (History and ECG-Based Manchester ACS Risk Score)
Rapid history- and ECG-based ACS risk stratification tool. Can be applied before troponin results, enabling early rule-out in the ED. Developed and validated in Manchester, UK.
Score interpretation
HE-MACS <= 3. Low probability of ACS. Negative predictive value >98% in validation cohorts.
→ Can consider early discharge pending single troponin. Arrange GP follow-up and stress testing if clinically appropriate.
HE-MACS 4-6. Intermediate probability. Serial troponin required.
→ Standard ED pathway. Serial troponin at 0h and 3h. Cardiology review if troponin positive or ECG changes.
HE-MACS >= 7. High probability of ACS. Urgent assessment required.
→ Urgent cardiology referral. Serial troponin. Antiplatelet therapy. Consider early invasive strategy (angiography).
Interpretation bands for the HE-MACS. Apply clinical judgement and local guidance.
References
- Body R, et al. A care pathway for patients with possible acute coronary syndromes and a low risk HE-MACS. Emerg Med J. 2019;36(3):141-146.
Related
Curated clinical cross-links plus same-class fallbacks.
- Emollient bath and shower products, paraffin-containing · Paraffin-based bath/shower emollient
- Emollient creams and ointments, hydrogenated castor oil-containing · Hydrogenated castor oil-based emollient
- Dimeticone · Topical pediculicide (silicone-based)
- Methoxyflurane · Inhaled Analgesic — Acute Pain
- Fentanyl Transdermal Patch (Elderly Chronic Pain) · Opioid Analgesic — Transdermal Patch
- Morphine Slow-Release (Elderly Chronic Pain) · Opioid Analgesic — Modified-Release Oral
- Acute Heart Failure · ESC 2021 Heart Failure Guidelines; NICE NG106
- NSTEMI / Unstable Angina · ESC 2020 NSTEMI Guidelines; NICE NG185
- New-Onset Atrial Fibrillation · ESC 2020 AF Guidelines; NICE NG196
- Hypertensive Emergency · ESC/ESH 2018 Hypertension Guidelines; NICE NG136
- Bradycardia Management · Resuscitation Council UK ABCDE; ESC 2021 Pacing Guidelines
- Ventricular Tachycardia / Fibrillation · Resuscitation Council UK ACLS; ESC 2022 Ventricular Arrhythmia Guidelines
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.