HEART Score for Chest Pain Calculator — 6-Week MACE Risk

The HEART score risk-stratifies patients presenting to the emergency department with chest pain suspected of an acute coronary syndrome. It was derived by Six and colleagues in 2008 and prospectively validated by Backus and colleagues in 2013. The name is a mnemonic for its five components, each scored 0, 1 or 2:

• H — History: slightly (0) / moderately (1) / highly (2) suspicious for ACS.
• E — ECG: normal (0) / non-specific repolarisation disturbance (1) / significant ST deviation (2).
• A — Age: < 45 (0) / 45–64 (1) / ≥ 65 (2).
• R — Risk factors: none (0) / 1–2 (1) / ≥ 3 or known atherosclerotic disease (2).
• T — Troponin: ≤ normal limit (0) / 1–3× limit (1) / > 3× limit (2).

The total is HEART = History + ECG + Age + Risk factors + Troponin, ranging from 0 to 10. There is no arithmetic beyond adding the five points. The counted risk factors are hypertension, hypercholesterolaemia, diabetes mellitus, current or recent smoking, a family history of premature coronary artery disease, and obesity (BMI > 30). Any history of atherosclerotic disease — prior MI, PCI or CABG, stroke or TIA, or peripheral arterial disease — scores the maximum 2 for the R component on its own.

Each total maps to a risk band with a validated 6-week rate of major adverse cardiac events (MACE), defined in Backus 2013 as acute myocardial infarction, percutaneous coronary intervention, coronary artery bypass grafting, or death within six weeks:

• Low (0–3) — ≈ 1.7% MACE. Consider discharge: the HEART Pathway pairs this with a negative serial troponin.
• Moderate (4–6) — ≈ 16.6% MACE. Admit for observation with serial troponin.
• High (7–10) — ≈ 50.1% MACE. Early invasive strategy and urgent cardiology referral.

Because the total is a simple sum, this tool cross-checks every result through a second independent code path and only shows the score once the two agree. The one lab-dependent input is troponin: the normal reference limit is assay-specific, so the tool asks you to band the value against your own laboratory rather than entering a raw number.

• Six AJ, Backus BE, Kelder JC. Chest pain in the emergency room: value of the HEART score. Neth Heart J 2008;16(6):191–196 (original derivation)
• Backus BE, Six AJ, Kelder JC, et al. A prospective validation of the HEART score for chest pain patients at the emergency department. Int J Cardiol 2013;168(3):2153–2158 (per-band 6-week MACE rates)
• Mahler SA, Riley RF, Hiestand BC, et al. The HEART Pathway randomized trial. Circ Cardiovasc Qual Outcomes 2015;8(2):195–203 (low-risk discharge pathway)

The component definitions, risk bands and 6-week MACE rates on this page were last cross-checked against these sources on 2026-07-13. This tool is for education and reference only; it is a decision aid, does not provide medical advice, and does not replace assessment by a qualified clinician.