HEART Score for Major Adverse Cardiac Events
5-component score predicting 6-week MACE (death, MI, revascularisation) in ED chest pain. Score ≥ 4 warrants admission and further workup.
How to use & interpret
The HEART score risk-stratifies adults presenting to the emergency department with chest pain suspected to be cardiac, estimating the 6-week risk of a major adverse cardiac event (MACE). It combines History, ECG, Age, Risk factors and Troponin.
A score of 0–3 is low risk (MACE roughly 1–2%) and, with a non-ischaemic ECG and negative troponin, often supports early discharge; 4–6 is moderate risk warranting admission/observation and further testing; 7–10 is high risk. It is intended for undifferentiated chest pain, not for patients with a clear STEMI or an obvious non-cardiac cause.
Score interpretation
HEART Score 0–3: Low risk. 6-week MACE rate ~1–2%. Safe for discharge with outpatient follow-up.
→ Discharge with safety-netting advice. Arrange outpatient stress testing or CTCA within 72h. Aspirin 300mg if ACS not excluded clinically. Return immediately if: recurrent chest pain, diaphoresis, syncope.
HEART Score 4–6: Moderate risk. 6-week MACE rate ~12–16%. Admission and serial troponins warranted.
→ Admit to chest pain unit / coronary care. Serial troponins at 0, 3h (or 6h depending on assay). ECG monitoring. Aspirin 300mg loading. If troponin rising or ECG changes: escalate to ACS pathway. If stable: exercise stress test or CTCA before discharge decision.
HEART Score 7–10: High risk. 6-week MACE rate ~50–65%. Treat as ACS.
→ Cardiology review. Dual antiplatelet (aspirin 300mg + ticagrelor 180mg or clopidogrel 300mg). LMWH/fondaparinux anticoagulation. Early invasive strategy (angiography within 24h if NSTEMI, within 2h if very high risk features). Refer to cath lab.
Interpretation bands for the HEART Score. Apply clinical judgement and local guidance.
Frequently asked questions
Is one troponin enough with a low HEART score?
Many pathways pair the HEART score with serial high-sensitivity troponin (e.g. 0/1- or 0/3-hour protocols) before discharge. Follow your local chest-pain pathway rather than relying on a single value.
How does HEART compare with TIMI and GRACE?
HEART is designed for undifferentiated ED chest pain and is better at identifying low-risk patients for discharge; TIMI and GRACE are validated in confirmed ACS for prognosis and to guide invasive management.
References
- Six AJ et al. The HEART score for the assessment of patients with chest pain in the emergency department. Neth Heart J. 2010.
- Backus BE et al. A prospective validation of the HEART score for chest pain patients at the emergency department. Int J Cardiol. 2010.
Related
Curated clinical cross-links plus same-class fallbacks.
- EDACS — Emergency Department Assessment of Chest Pain · Chest Pain
- HEAR Score for Acute 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
- Dobutamine (Acute HF / Stress Echo) · Inotrope / Acute Heart Failure
- Milrinone · Inodilator / Acute Heart Failure
- 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)
- 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
Featured in these MRCEM clinical pathways
The HEART Score is covered in detail — with RCEM/NICE evidence base, indications and pitfalls — in the following exam-focused pathways on our sister siteReviseMRCEM.
MRCEM Primary / Intermediate / OSCE candidates: each pathway includes exam-style questions, RCEM/NICE citations, and FAQ summaries.
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.