Risk-stratify chest pain patients in the ED. The HEART Score estimates 6-week MACE risk using History, ECG, Age, Risk Factors, and Troponin — validated in 10+ prospective studies.
Score each component 0–2 · Total 0–10 · For chest pain presentations
The HEART score gives emergency doctors a number. That number tells them whether to send a chest pain patient home or admit them.
5 variables. Each scored 0, 1, or 2. Total out of 10. Takes about 90 seconds to calculate.
TIMI and GRACE assume you already know the patient has ACS. HEART works before the diagnosis. That's the whole point.
0–3 = go home. 4–6 = watch and wait. 7–10 = call cardiology now. The score maps directly to a clinical action.
In the Six et al. 2010 validation, a score of 0–3 missed almost nothing. 1.7% MACE rate. That's a number you can discharge on.
Each component scores 0, 1, or 2. Add them up.
TIMI was built for confirmed ACS patients. GRACE predicts 6-month mortality after you already know what happened. Both assume a diagnosis you don't have yet when someone walks into the ED with chest pain.
Mahler et al. tested all 3 head-to-head in a 2015 US study of 1,070 patients. HEART beat TIMI on sensitivity and GRACE on specificity. For undifferentiated chest pain, it's the right tool.
Different questions entirely. HEART asks: does this person need to be admitted right now? The AHA PREVENT calculator asks: what's this stable outpatient's 10-year cardiac risk?
Use HEART in the ED. Use PREVENT in the clinic. Both are free here.
History, ECG, Age, Risk factors, Troponin.
0–3 is low risk. There's no "normal" since any chest pain warrants a look, but a score of 0–3 carries about 1.7% MACE risk at 6 weeks. That's dischargeable territory.
4–6 usually means observation with serial troponins. 7–10 means call cardiology, because 65% of those patients have a major cardiac event within 6 weeks.
No. The HEART score is a clinical triage tool for acute chest pain. The heart calcium score (CAC score) is a CT measurement of calcified coronary plaque, used for long-term risk in asymptomatic stable patients. Completely different clinical questions.
Zero is ideal. 1–99 is mild, 100–299 is moderate, 300+ is high risk. A score above 300 in someone without symptoms often changes the treatment conversation significantly.
You can't reverse calcified plaque. But you can slow its growth: statins, getting LDL under 70 mg/dL if you're high risk, blood pressure under 130/80, quitting smoking. Your cardiologist should drive this.