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Calculator · Chest pain — risk of a major cardiac event at 6 weeks
HEART score
Built for undifferentiated chest pain at the front door, which is where GRACE does not belong — GRACE assumes ACS is already the diagnosis. HEART asks whether it is.
What it asks
| Criterion | Points |
|---|---|
| History How suspicious is the story, taken as a whole | Slightly suspicious — 0 Moderately suspicious — 1 Highly suspicious — 2 |
| ECG | Normal — 0 Non-specific repolarisation change — 1 Significant ST deviation — 2 |
| Age | Under 45 — 0 45 – 64 — 1 65 or over — 2 |
| Risk factors Diabetes, smoking, hypertension, hypercholesterolaemia, family history, obesity — or known atherosclerotic disease | None — 0 1 or 2 — 1 3 or more, or known atherosclerotic disease — 2 |
| Troponin | Within normal limits — 0 1 – 3 × the upper limit — 1 More than 3 × the upper limit — 2 |
How to read the score
| Score | Means | What to do |
|---|---|---|
| 0–3 | Low risk | Around 1.7% risk of a major adverse cardiac event at 6 weeks. Discharge is reasonable in most protocols — but the score assumes a normal ECG and a negative troponin taken at the right time, and a single early troponin is not a rule-out. |
| 4–6 | Moderate risk | Around 12–17%. Admit for observation and serial troponin. This is the band the score exists to identify. |
| 7–10 | High risk | Around 50–65%. Early invasive strategy — refer to cardiology now rather than after the next troponin. |
Before you use it
It does NOT rule out the other things that kill: aortic dissection, pulmonary embolism, oesophageal rupture and tension pneumothorax all score low on HEART because none of them is a cardiac event. A low HEART score in a patient with tearing pain, a BP differential or surgical emphysema means the score was the wrong question. And it was derived with conventional troponin — with a high-sensitivity assay and a proper 0/3h or 0/1h protocol, your trust pathway is the authority, not this.
Source: Six et al 2008; Backus et al 2013 validation
Checked, and shown
Every threshold on this page was checked against its primary source by a practising doctor. Here is what that involved, and what it found.