HEART Score
Predicts MACE occurrence in the next 6 weeks based on five risk factors.
In the text below the calculator there is more information about the HEART model and about major adverse cardiac events.
The HEART score predicts 6 week risk of major adverse cardiac events (MACE) based on patient age and medical history, ECG findings, troponin levels and the presence of specific heart disease risk factors (Hypercholesterolemia, hypertension, diabetes, smoking, obesity).
The score is addressed to patients presenting to ER with chest pain.
MACE is a group of conditions with sudden occurrence and high mortality and morbidity, that includes cardiac death, target lesion revascularization and nonfatal myocardial infarction.
Each of the five risk factors is given a number of points from 0 to 2, depending on whether is present or not and how severe.
The HEART score varies from 0 to 10, where 0 means low risk and 10 means a high risk of MACE. There are three risk categories:
| Heart score | MACE risk | Recommendation |
| 0 - 3 | Low (1.7%) | Discharge can be an option. |
| 4 - 6 | Intermediate (20.3%) | Clinical observation and further investigations. |
| 7 - 10 | High (72.2%) | Immediate invasive treatment |
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The scoring system explained
The HEART clinical tool is a scoring system designed to stratify risk of major adverse cardiac events in patients coming to the emergency room with chest pain.
The five risk factors the HEART model and their weight (in points) in the final score, can be found in the following table:
| HEART risk factors | Answer choices (points) |
| Patient history | Highly suspicious (2) Moderately suspicious (1) Slightly suspicious (0) |
| ECG | Significant ST depression (2) Non specific repolarisation disturbance (1) Normal (0) |
| Patient age | Equal or higher than 65 (2) Between 45 and 65 (1) Less than 45 (0) |
| Risk factors (Hypercholesterolemia, hypertension, diabetes, smoking, obesity) | More than 3 risk factors or atherosclerosis history (2) 1 or 2 risk factors are present (1) No risk factors (0) |
| Troponin (protein complex involved in cardiac muscle contraction) | 3 times higher than normal or more (2) 1 to 3 times higher than normal (1) Less than normal limit (0) |
There are other mortality risk systems for patients suffering from cardiac symptoms, such as the TIMI score or the GRACE score, that are addressed to patients diagnosed with acute coronary syndrome.
Result interpretation
The absence or presence and severity of each of the five risk factors is awarded a number of points (from 0 to 2).
The HEART score varies from 0 to 10, where scores close to 0 mean a low risk of MACE and scores close to 10 indicate a high risk of major cardiac events.
The three risk categories are described below:
| Heart score | MACE risk | Recommendation |
| 0 - 3 | Low (1.7%) | Discharge can be an option. |
| 4 - 6 | Intermediate (20.3%) | Clinical observation and further investigations. |
| 7 - 10 | High (72.2%) | Immediate invasive treatment |
About the study
The HEART score resulted after a study conducted by Six et al. in 2008. Data from 122 patients referred to the emergency room for chest pain was analysed.
The five risk factors chosen as most relevant for risk stratification were: History, ECG, Age, Risk factors and Troponin.
The predictive value of the HEART score for reaching an endpoint was evaluated in 120 of the 122 patients.
29 patients reached one or more endpoints with 16 patients diagnosed with acute myocardial infarction.
The score was found to be an accurate predictor of outcome in patients with chest pain.
Major adverse cardiac events
MACE is a group of cardiovascular conditions with sudden occurrence and resulting in high mortality and morbidity. It includes cardiac death, nonfatal myocardial infarction and target lesion revascularization.
Sudden cardiac death (SCD) is an unexpected death caused by sudden cardiac arrest (loss of heart function). It occurs when the electrical system of the heart becomes suddenly irregular with ventricle flutter or fibrillation.
Blood circulation is therefore impaired, which means there is a dramatic decrease of brain perfusion which leads to loss of consciousness and exitus in case emergency intervention doesn’t take place. SCD is responsible for almost 50% of heart disease mortality.
Myocardial infarction occurs when a blockage in the coronary arteries prevents blood flow to the heart thus stops the cardiac muscle from performing its function.
Cardiovascular risk factors are either linked to physical status or to habits. They can be increased by unhealthy habits and decreased by simple lifestyle changes or by medication.
The following table introduces some of the most common CVD risk factors:
| Elderly age | Physical status (sedentarism) | High blood sugar (diabetes) |
| Gender | Diet (obesity or unhealthy diet) | High total cholesterol High LDL and low HDL |
| Family and personal history | Smoking | Hypertension |
Original source
Six AJ, Backus BE, Kelder JC. Chest pain in the emergency room: value of the HEART score. Neth Heart J. 2008; 16(6): 191–196.
Validation
Backus BE, Six AJ, Kelder JC, Bosschaert MA, Mast EG, Mosterd A, Veldkamp RF, Wardeh AJ, Tio R, Braam R, Monnink SH, van Tooren R, Mast TP, van den Akker F, Cramer MJ, Poldervaart JM, Hoes AW, Doevendans PA. A prospective validation of the HEART score for chest pain patients at the emergency department. Int J Cardiol. 2013; 168(3):2153-8.
Other references
1. Poldervaart JM et al. Effect of Using the HEART Score in Patients With Chest Pain in the Emergency Department: A Stepped-Wedge, Cluster Randomized Trial. Ann Intern Med. 2017; 166(10):689-697.
2. Choi WS, Lee JH, Park SH, Kim KH, Kang JK, Kim NY, Cho HJ, Yoon JY, Lee SH, Bae MH, Ryu HM, Yang DH, Park HS, Cho Y, Chae SC, Jun JE, Park WH. Prognostic value of standard electrocardiographic parameters for predicting major adverse cardiac events after acute myocardial infarction. Ann Noninvasive Electrocardiol. 2011; 16(1):56-63.
Specialty: Cardiology
System: Cardiovascular
Objective: Risk Predictor
Type: Score
No. Of Items: 5
Year Of Study: 2008
Abbreviation: HEART
Article By: Denise Nedea
Published On: June 4, 2017 · 07:53 AM
Last Checked: June 4, 2017
Next Review: June 4, 2023