• The score has been derived and validated in an ED population and predicts 6 week adverse cardiac events[1][2][3][4][5]
  • Low risk patients have a score 0-3 and have a less than 2% risk of MACE at 6 weeks.
Criteria Point Value
Highly Suspicious +2
Moderately Suspicious +1
Slightly Suspicious 0
ST deviation not due to LBBB, LVH, or digoxin +2
No ST deviation but LBBB, LVH, or repolarization changes +1
Normal 0
≥ 65 +2
45-65 +1
≤ 45 0
Risk Factors (Hypercholesterolemia, Vascular Disease, Hypertension, Diabetes Mellitus, Smoking,Obesity)
≥ 3 risk factors or history of atherosclerotic disease +2
1-2 risk factors +1
No risk factors known 0
≥ 3× normal limit +2
1-3× normal limit +1
≤ normal limit 0
  • 0-3: 0.9-1.7% risk of adverse cardiac event. Patient's can be discharged with follow-up.
  • 4-6: 12-16.6% risk of adverse cardiac event. Patients should be admitted to the hospital for trending of troponin and provocative testing.
  • ≥7: 50-65% risk of adverse cardiac event, suggesting early invasive measures with these patients and close coordination with inpatient cardiology


  1. Six AJ, Backus BE, Kelder JC. Chest pain in the emergency room: value of the HEART score. Neth Heart J. 2008 Jun;16(6):191-6.PMID 18665203
  2. Backus BE, Six AJ, Kelder JC, Bosschaert MA. et al. A prospective validation of the HEART score for chest pain patients at the emergency department. Int J Cardiol. 2013 Oct 3;168(3):2153-8 PMID 2346525
  3. Ljung L et al. A rule-out strategy based on high-sensitivity troponin and HEART score reduces hospital admissions. Ann Emerg Med 2019 Jan 17; [e-pub].
  4. Stopyra JP, Riley RF, Hiestand BC, et al. The HEART Pathway Randomized Controlled Trial One Year Outcomes. Acad Emerg Med. 2018
  5. Mahler SA, Riley RF, Hiestand BC, et al. The HEART Pathway randomized trial: identifying emergency department patients with acute chest pain for early discharge. Circ Cardiovasc Qual Outcomes. 2015;8(2):195-203.