About the HEART Score Calculator
The HEART score helps emergency clinicians judge how likely a patient with chest pain is to have a major adverse cardiac event (MACE) — heart attack, coronary revascularisation or death — within six weeks. Five elements are each scored 0, 1 or 2: History, ECG, Age, Risk factors and Troponin, for a total of 0 to 10. It was developed by Six, Backus and Kelder in the Netherlands in 2008 and prospectively validated in 2,440 unselected emergency chest-pain patients in ten Dutch hospitals.
This calculator turns the patient’s age and risk factors into points automatically and reports the risk group with the MACE rates from that prospective validation: about 1.7% for scores 0–3, 16.6% for 4–6 and 50.1% for 7–10. It is designed for emergency physicians, nurses, paramedics and students.
The HEART score applies to adults presenting with suspected acute coronary syndrome, not to patients with obvious ST-elevation myocardial infarction, who need immediate treatment. The history and ECG elements require clinical judgement, and the troponin element should use your laboratory’s 99th-percentile upper reference limit.
With the default inputs, the heart score is 3 / 10. Change any value above to recalculate instantly.
How to use the heart score calculator
- 1Exclude ST-elevation myocardial infarction first — the HEART score is not for STEMI.
- 2Grade how suspicious the history is for acute coronary syndrome.
- 3Score the ECG and enter the patient’s age.
- 4Tick each cardiovascular risk factor and any known atherosclerotic disease.
- 5Select the first troponin relative to your lab’s upper reference limit.
- 6Read the total, risk group and six-week MACE rate.
Formula and method
History scores 0 (slightly suspicious), 1 (moderately) or 2 (highly suspicious for ACS). ECG scores 0 if normal, 1 for non-specific repolarisation changes, bundle branch block, LVH, probable digoxin effect or unchanged known repolarisation abnormalities, and 2 for significant ST deviation. Age scores 0 under 45, 1 from 45 to 64 and 2 at 65 or older. Risk factors — diagnosed hypertension, diagnosed hypercholesterolaemia, currently treated diabetes, current or recent (under one month) smoking, family history of coronary disease and obesity — score 0 for none, 1 for one or two, and 2 for three or more or any known atherosclerotic disease. Troponin scores 0 at or below the normal limit, 1 for 1–3 times and 2 for more than 3 times the limit — the bands used in the validation studies; the 2008 derivation paper used 1–2 times and more than 2 times.
In the 2013 prospective multicentre validation by Backus et al., six-week MACE occurred in 1.7% of patients scoring 0–3, 16.6% scoring 4–6 and 50.1% scoring 7–10.
- H
- History: suspicion of ACS (0–2)
- E
- ECG findings (0–2)
- A
- Age: <45 = 0, 45–64 = 1, ≥65 = 2
- R
- Risk factors: 0, 1–2, or ≥3 / known atherosclerosis
- T
- Initial troponin relative to the normal limit (0–2)
Worked examples
52-year-old with moderately suspicious pain
A moderately suspicious history (1), normal ECG (0), age 52 (1), two risk factors — hypertension and high cholesterol (1) — and a normal troponin (0) total 3, the low-risk group with 1.7% six-week MACE in the validation study.
68-year-old with prior stent and ST depression
Highly suspicious history (2), significant ST depression (2), age 68 (2), known coronary disease (2) and troponin 1–3 times normal (1) add to 9 — high risk, with 50.1% six-week MACE in the validation cohort.
40-year-old smoker with atypical pain
Slightly suspicious history (0), non-specific ECG changes (1) and age 40 (0); three risk factors — smoking, family history and obesity — score 2, and troponin is normal (0). The total is 3, low risk.
Frequently asked questions
What is a low-risk HEART score?+
A score of 0–3 is low risk. In the prospective Dutch validation, 1.7% of these patients had a heart attack, revascularisation or death within six weeks.
What does HEART stand for?+
History, ECG, Age, Risk factors and Troponin — the five elements, each scored 0, 1 or 2 for a maximum of 10.
Which risk factors count in the HEART score?+
Diagnosed hypertension, hypercholesterolaemia, diabetes, current or recent smoking, a family history of coronary artery disease and obesity. Known atherosclerotic disease scores 2 points on its own.
Can the HEART score be used with high-sensitivity troponin?+
Yes. The troponin element is scored relative to the assay’s normal limit (99th percentile), and pathways such as the HEART Pathway combine the score with serial troponin measurements.
How does HEART compare with the TIMI score?+
In the 2013 validation the HEART score discriminated better than TIMI and GRACE for six-week MACE (c-statistic 0.83 vs 0.75 and 0.70).
For healthcare professionals and education only. This calculator implements a published formula or score but is not a diagnosis and does not replace clinical judgment. Verify inputs and results against the original source before using them in patient care.