HEART Score Calculator
HealthCalculate the HEART score for chest pain in the emergency department from history, ECG, age, risk factors, and troponin to estimate 6-week MACE risk.
History
ECG
Age
Risk Factors
Initial Troponin
HEART Score
0/ 10
6-Week MACE Risk
— (0%)
Not a substitute for clinical judgment. The HEART score supports — but never replaces — an emergency physician's evaluation and disposition decision for chest pain. Seek immediate emergency care for any concerning chest pain symptoms.
What is a HEART Score?
The HEART Score Calculator computes the HEART score, a validated clinical decision tool used in emergency departments to risk-stratify patients presenting with chest pain. The score sums points across five components — History, ECG, Age, Risk factors, and Troponin — each scored 0 to 2 points, for a total ranging from 0 to 10, and estimates the 6-week risk of a major adverse cardiac event (MACE).
Select the applicable option for each component below to see your total score and published 6-week MACE risk category. For a related risk tool used once acute coronary syndrome is confirmed, see the GRACE Calculator; for stress-test interpretation, see the Duke Treadmill Score Calculator.
How to use this HEART Score calculator
- Select the applicable History category — slightly, moderately, or highly suspicious.
- Select the applicable ECG finding — normal, nonspecific repolarization disturbance, or significant ST-segment deviation.
- Select the applicable Age band — under 45, 45 to 65, or over 65.
- Select the applicable Risk Factors category — none, 1-2, or ≥3 (or known atherosclerotic disease).
- Select the applicable Initial Troponin category relative to your local lab's normal limit.
- Review your HEART Score and 6-Week MACE Risk Category, and ensure this is discussed as part of a full emergency evaluation by a physician.
Formula & Methodology
The HEART score sums the following points, each component scored 0, 1, or 2: - History: slightly suspicious (0) · moderately suspicious (1) · highly suspicious (2) - ECG: normal (0) · nonspecific repolarization disturbance (1) · significant ST-segment deviation (2) - Age: under 45 (0) · 45-65 (1) · over 65 (2) - Risk factors: none (0) · 1-2 factors (1) · ≥3 factors or known atherosclerotic disease (2) - Troponin: ≤ normal limit (0) · 1-3x normal limit (1) · > 3x normal limit (2) Total score = sum of all five components (range 0-10). 0-3 = low risk (1.7% MACE); 4-6 = moderate risk (16.6% MACE); 7-10 = high risk (50.1% MACE). Worked example: A 58-year-old patient with a moderately suspicious history, a normal ECG, 1-2 risk factors, and troponin at the normal limit scores: History (1) + ECG (0) + Age (1) + Risk factors (1) + Troponin (0) = 3 points total, placing them in the low-risk category (1.7% 6-week MACE risk) per the original Six et al. 2008 validation study — though this must still be interpreted by an emergency physician as part of the complete clinical picture.
Frequently Asked Questions
HEART is an acronym for the five components it scores: History, ECG, Age, Risk factors, and Troponin. Each component is scored 0, 1, or 2 points based on defined criteria, for a total ranging from 0 to 10.
It's used in emergency departments to risk-stratify patients presenting with chest pain, estimating their 6-week risk of a major adverse cardiac event (MACE) such as heart attack, urgent revascularization, or death. It helps guide decisions about further testing, observation, or discharge, always as part of a broader clinical evaluation.
A score of 0-3 is considered low risk with a published 6-week MACE rate of about 1.7%, a score of 4-6 is moderate risk at about 16.6%, and a score of 7-10 is high risk at about 50.1%, based on the original validation study. These published figures come from Six AJ, et al., Netherlands Heart Journal, 2008.
History reflects how suspicious the patient's chest pain presentation is for acute coronary syndrome based on the treating physician's clinical assessment — slightly suspicious (0 points), moderately suspicious (1 point), or highly suspicious (2 points). This component relies on clinical judgment rather than a specific test result.
Traditional cardiac risk factors counted in this component typically include hypertension, hypercholesterolemia, diabetes, obesity, smoking, family history of cardiovascular disease, and known atherosclerotic disease (such as prior MI, PCI, CABG, stroke, or peripheral arterial disease). Known atherosclerotic disease alone is enough to score the maximum 2 points for this component.
Troponin is scored relative to your local lab's upper limit of normal: at or below normal is 0 points, 1 to 3 times the upper limit is 1 point, and more than 3 times the upper limit is 2 points. Your clinical team will have this exact value from your blood test results.
No — even the low-risk group in the original validation study still carried an approximate 1.7% chance of a major adverse cardiac event within 6 weeks, so a low score reduces but does not eliminate risk. It must always be interpreted by a physician alongside the full clinical picture, including repeat troponin testing and physician judgment.
No — this calculator is for informational and educational purposes only and is not a substitute for emergency medical evaluation. If you are experiencing chest pain, shortness of breath, or other concerning symptoms, seek immediate emergency care rather than relying on this tool.
The HEART score was developed by Six AJ, et al. and published in the Netherlands Heart Journal in 2008, then further validated in the HEART Pathway studies by Backus BE, et al. (International Journal of Cardiology, 2013) and subsequent multicenter trials, which support its use for guiding early discharge decisions for low-risk patients.
The [GRACE Calculator](/grace-calculator/) is used once a patient has an established diagnosis of acute coronary syndrome to estimate mortality risk, while the HEART score is used earlier, at initial presentation with undifferentiated chest pain, to help decide on further workup. They address different points in the diagnostic and treatment pathway.
They serve different purposes — the HEART score is applied at initial emergency presentation with acute chest pain, while the [Duke Treadmill Score Calculator](/duke-treadmill-score-calculator/) is used to interpret results from an exercise stress test, typically after the acute presentation has been addressed.
The score is one input a physician uses alongside serial troponin measurements, clinical judgment, and sometimes additional testing to decide whether a patient can be safely discharged, needs observation, or requires further cardiac workup — the score itself does not make this decision automatically.
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