Assess the risk of major adverse cardiac events (MACE) in patients presenting with chest pain in the emergency department. This validated tool helps guide disposition and management decisions.
For chest pain patients in the emergency department
HEART Score: 0
Risk Category:
6-week MACE Risk:
Recommendation:
The HEART Score is a clinical decision rule designed to risk-stratify patients presenting to the emergency department with chest pain. It helps clinicians identify patients at low risk for major adverse cardiac events (MACE) who may be suitable for early discharge.
The acronym HEART represents five key components: History, ECG findings, Age, Risk factors, and Troponin levels. Each component is scored from 0-2 points, creating a total score range of 0-10 points.
This tool was developed and validated to help emergency physicians make more informed decisions about chest pain patients, potentially reducing unnecessary admissions while maintaining patient safety.
| HEART Score | Risk Category | 6-week MACE Risk | Recommendation |
|---|---|---|---|
| 0-3 | Low Risk | 0.9-1.7% | Safe for early discharge |
| 4-6 | Moderate Risk | 12-16.6% | Further evaluation needed |
| 7-10 | High Risk | 50-65% | Immediate evaluation/admission |
A 52-year-old male presents to the ED with chest pain that started 2 hours ago. The pain is substernal, pressure-like, and radiates to his left arm. He has a history of hypertension and smoking. His ECG shows non-specific T-wave changes, and his initial troponin is 1.5x the upper limit of normal.
History: Moderately suspicious = +1 point
ECG: Non-specific changes = +1 point
Age: 52 years (45-64) = +1 point
Risk Factors: 2 risk factors (HTN, smoking) = +1 point
Troponin: 1.5x normal = +1 point
Total HEART Score: 5 points
Risk Category: Moderate Risk (6-week MACE risk: 12-16.6%)
Recommendation: Further evaluation and monitoring recommended. Consider stress testing or coronary imaging.
Cardiology, Electrophysiology
Dr. Eleanor Vance is a board-certified cardiologist with over 15 years of experience specializing in cardiac electrophysiology and the management of atrial fibrillation. After graduating summa cum laude from Johns Hopkins School of Medicine, she completed her residency at Massachusetts General Hospital and a fellowship in cardiology at the Cleveland Clinic.
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