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HEART Score

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HEART Score

  • See Also
  1. Chest Pain
  2. Acute Chest Pain
  3. Angina Diagnosis
  4. Cardiac Risk Assessment
  5. Cardiac Risk Management
  6. Coronary Risk Stratification of Chest Pain
  7. TIMI Risk Score
  8. Bosner Chest Pain Decision Rule
  9. Cardiac Risk in Diabetes Score
  10. Chest Wall Pain Prediction Rule
  11. Framingham Score
  12. Cardiac Risk in Diabetes Score
  13. GRACE Score
  14. Vancouver Chest Pain Rule
  • Indications
  1. Chest Pain risk stratification in the emergency department
  • Criteria
  1. History
    1. Score 2: History highly suspicious for coronary syndrome
    2. Score 1: History moderately suspicious for coronary syndrome
    3. Score 0: History slightly suspicious for coronary syndrome
  2. Electrocardiogram (EKG)
    1. Score 2: EKG with Significant ST Depression or ST Elevation
    2. Score 1: EKG with Non-specific repolarization disturbance
      1. Any T Wave Inversion
      2. Any Bundle Branch Block
      3. Left Ventricular Hypertrophy
    3. Score 0: EKG Normal (including Early Repolarization)
  3. Age
    1. Score 2: Age 65 years or older
    2. Score 1: Age 45 to 65 years old
    3. Score 0: Age <45 years old
  4. Risk Factors
    1. Score 2: Three or more risk factors for or history of atherosclerotic disease
    2. Score 1: One to 2 risk factors for atherosclerotic disease
    3. Score 0: No risk factors for atherosclerotic disease
  5. Troponin
    1. Score 2: More than twice the normal Troponin upper limit
    2. Score 1: One to 2 times the normal Troponin upper limit
    3. Score 0: Within normal limits for Troponin levels
  • Interpretation
  • Based on sum of 5 criteria above (of total possible points 10)
  1. Total Score 0-3
    1. Adverse outcome risk: 2.5% (very low to low risk)
    2. Supports early discharge with appropriate follow-up
  2. Total Score 4-6
    1. Adverse outcome risk: 20.3% (moderate risk)
    2. Supports admission with standard rule-out management (serial Troponins) and stress testing
  3. Total Score 7-10
    1. Adverse outcome risk: 72.7% (high to very high risk)
    2. Risk in first 30 days >50%
    3. Supports early aggressive management and typically with cardiac catheterization
  • Interpretation
  • History Component Modifiers
  1. Background
    1. History component of the HEART Score is subjective
    2. Criteria have been developed to assign ACS suspicion based on more objective scoring
  2. Criteria (assign one point for each positive finding)
    1. Chest Pain and Vomiting
    2. Chest Pain and diaphoresis
    3. Chest Pain radiating to either side of the torso
    4. Chest Pain worse with exertion
  3. Interpretation
    1. Score 0: Assign 0 history points on HEART Score (slightly suspicious for ACS)
    2. Score 1: Assign 1 history point on HEART Score (moderately suspicious for ACS)
    3. Score >=2: Assign 2 history points on HEART Score (highly suspicious for ACS)
  4. References
    1. Mattu (2023) EM:Rap 23(6): 18-9
  1. Allows for meaningful risk stratification of Low Risk Chest Pain
    1. Identifies 36% of Low Risk Chest Pain patients as lower risk for adverse event (HEART Score 0-3)
    2. Contrast with TIMI Score which only risk stratified 5% of the same low risk patients
    3. Identifies high risk patients (HEART Score >6) who have a >50% risk of adverse event in the next 30 days
  2. References
    1. Swadron and Mallon in Herbert (2015) EM:Rap 15(12): 11-2
    2. Bachus (2013) Int J Cardiol 168(3): 2153-8 +PMID: 23465250 [PubMed]
  • Efficacy
  • HEAR Score (Experimental)
  1. HEAR score (without Troponin) is being evaluated for efficacy as of 2023
    1. HEAR Score 0 to 1 is associated with low risk stratification and early ED discharge
  2. References
    1. Moumneh (2021) Am J Med 134(4):499-506.e2 +PMID: 33127371 [PubMed]
  • References
  1. Six (2008) Neth Heart J 16(6):191-6 [PubMed]