Cardiovascular
HEART Score Risk-stratify chest pain patients in the ED for major adverse cardiac events (MACE).
When to use: Use HEART Score in the emergency department to risk-stratify undifferentiated chest pain patients and guide disposition. A score of 0–3 supports safe early discharge with a sensitivity for MACE of ~99% when combined with a negative initial troponin. It outperforms TIMI and GRACE scores in the ED chest pain context.
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Formula HEART = History(0-2) + ECG(0-2) + Age(0-2) + Risk Factors(0-2) + Troponin(0-2)
Max score = 10
0-3 = Low (1.7% MACE), 4-6 = Moderate, 7-10 = High (>50% MACE)
Key Points for NEET PG
HEART acronym: History, ECG, Age, Risk factors, Troponin, each scored 0/1/2. Score ≤3: ~1.7% MACE (safe for discharge); score 4-6: ~12% MACE (admit); score ≥7: >50% MACE (urgent cath). HEART score is validated specifically for ED chest pain; GRACE score is validated for risk in confirmed ACS patients. Troponin component uses lab-specific upper limit of normal (ULN); high-sensitivity troponin (hs-cTnI/T) allows faster rule-out. Compare with TIMI (for NSTEMI/UA) and GRACE (for ACS in-hospital/6-month mortality) which are validated in different populations. References
Six AJ et al. The HEART score for the assessment of patients with chest pain in the emergency department · Neth Heart J (2010)
Mahler SA et al. The HEART Pathway randomized trial · Circ Cardiovasc Qual Outcomes (2015)
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