Clinical Use

Risk stratification for patients presenting with chest pain in the emergency department


The HEART score is a scoring system for patients presenting with chest pain in the emergency department. By assigning patient history, ECG, age, risk factors, and troponin, patients receive a score on a scale of 0‒10.

HistoryHighly suspicious2
Moderately suspicious1
Slightly suspicious0
ECGSignificant ST depression2
Nonspecific repolarisation disturbance1
Age≤65 year2
45-65 year1
<45 year0
Risk factors≥3 risk factors or history of atherosclerotic disease2
1 or 2 risk factors1
No risk factors known0
Troponin>2x normal2
1-2x normal1


* Risk factors include hypercholesterolemia, hypertension, diabetes mellitus, cigarette smoking, positive family history, obesity (BMI >30).

Risk stratification is determined by patient’s total score.

Scores 0-3: Low risk with 0.9-1.7% risk of 6-week MACE**. Recommend discharge with PCP follow-up.

Scores 4-6: Moderate risk with 12-16.6% risk of 6-week MACE**. Recommend admission to Observation for further evaluation OR if negative troponin at 0 and 3 hrs, order outpatient stress test.

Scores ≥7: High risk with 50-65% risk of 6-week MACE**. Recommend admission for inpatient evaluation and cardiology consultation.

** MACE (Major Adverse Cardiac Event) is defined as all-cause mortality, myocardial infarction, or coronary revascularization.


1.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. Abstract


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Developer: Sirikarn Napan, MD, FACC