HEAR Score for Acute Chest Pain
HEART score without its troponin item. A HEAR score < 2 identifies chest pain at very low risk of 30-day AMI or death, in whom troponin testing might be avoided (Moumneh 2021).
Score interpretation
30-day AMI or death 0.1 % with HEAR < 2 (Moumneh 2021, 4106 patients); sensitivity 97.6 % for 30-day MACE in a UK validation (Todd 2022).
→ Discharge without troponin only within a local pathway that has adopted HEAR; otherwise follow the local chest pain pathway.
Very-low-risk criteria not met.
→ Troponin testing and risk stratification per the local chest pain pathway (e.g. HEART score with troponin).
Interpretation bands for the HEAR. Apply clinical judgement and local guidance.
References
- Moumneh T, et al. Identifying patients with low risk of acute coronary syndrome without troponin testing: validation of the HEAR score. Am J Med. 2021;134(4):499-506.
- Todd F, Duff J, Carlton E. Identifying low-risk chest pain in the emergency department without troponin testing: a validation study of the HE-MACS and HEAR risk scores. Emerg Med J. 2022;39(7):515-518.
- 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.
Related
Curated clinical cross-links plus same-class fallbacks.
- HEART Score for Major Adverse Cardiac Events · Chest Pain
- EDACS — Emergency Department Assessment of Chest Pain · Chest Pain
- ACTION ICU Score for Intensive Care in NSTEMI · Chest Pain
- Marburg Heart Score · Chest Pain
- INTERCHEST Clinical Prediction Rule · Chest Pain
- Subtle Anterior STEMI Calculator (4-Variable) · Chest Pain
- Methoxyflurane · Inhaled Analgesic — Acute Pain
- Morphine (Orthopaedic Acute Pain) · Opioid Analgesic — Strong
- Dexketoprofen (Acute Musculoskeletal Pain) · NSAID — Non-selective COX Inhibitor (S-enantiomer of Ketoprofen)
- Glyceryl Trinitrate (Sublingual / IV) · Nitrate / Acute Angina
- Dobutamine (Acute HF / Stress Echo) · Inotrope / Acute Heart Failure
- Milrinone · Inodilator / Acute Heart Failure
- 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.