HEART Score
- 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 |
| History | |
|---|---|
| Highly Suspicious | +2 |
| Moderately Suspicious | +1 |
| Slightly Suspicious | 0 |
| ECG | |
| ST deviation not due to LBBB, LVH, or digoxin | +2 |
| No ST deviation but LBBB, LVH, or repolarization changes | +1 |
| Normal | 0 |
| Age | |
| ≥ 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 |
| Troponin | |
| ≥ 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
References
- ↑ 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
- ↑ 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
- ↑ 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].
- ↑ Stopyra JP, Riley RF, Hiestand BC, et al. The HEART Pathway Randomized Controlled Trial One Year Outcomes. Acad Emerg Med. 2018
- ↑ 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.