The HEART Score is a clinical risk-stratification tool used in emergency/acute care to help estimate the short-term risk of major adverse cardiac events (MACE) in adults presenting with chest pain concerning for possible acute coronary syndrome (ACS). It was developed for “undifferentiated” chest pain in the ED setting and is commonly used to support disposition decisions (e.g., discharge with follow-up vs observation vs admission), alongside clinician judgment and local protocols. AAFP+1
What “HEART” stands for
HEART is an acronym for 5 elements, each scored 0, 1, or 2 points (total 0–10):
- History (how suspicious the story is for ischemia)
- ECG (ischemic changes)
- Age
- Risk factors (and/or known atherosclerotic disease)
- Troponin (relative to the assay’s upper reference limit) AAFP+1
What counts as MACE (typical definition)
Many HEART score studies define MACE within ~6 weeks as all-cause mortality, myocardial infarction, or coronary revascularization. ceemjournal.org
Interpreting the score (common categories)
A widely used interpretation is:
- 0–3 = Low risk (about 0.6–1.7% MACE at ~4–6 weeks)
- 4–6 = Intermediate risk (about 16.6% MACE)
- 7–10 = High risk (about 50.1% MACE) AAFP+1
Recent summaries also report low-risk HEART (0–3) as having <3% (~2.5%) 6-week MACE in combined evidence, and emphasize using the HEART Pathway (score plus serial troponins) where appropriate. ABEM+1
