Chest Pain / ACS Risk Stratification
HEART Score — History, ECG, Age, Risk Factors, Troponin
The HEART Score is a validated, clinician-friendly tool for risk stratification of patients presenting with chest pain. Each of the five components (History, ECG, Age, Risk Factors, Troponin) is scored 0–2, yielding a total of 0–10. Low-risk patients (HEART ≤ 3) have a MACE rate of 0.9–1.7% at 30 days and are safe for early discharge. High-risk patients (HEART ≥ 7) have a MACE rate exceeding 50% and warrant early invasive evaluation. HEART has been prospectively validated in multiple multicenter trials and endorsed by ACC/AHA and ACEP.
Pathway Steps
Chest Pain of Possible Cardiac Origin
Confirm appropriate patient selection before scoring
HEART Score Components
Score each component 0–2 using the criteria below: • History: 0=slightly suspicious (well-described non-cardiac features), 1=moderately suspicious (mixed features), 2=highly suspicious (pressure, exertion, radiation, diaphoresis, nausea) • ECG: 0=normal sinus rhythm, 1=non-specific repolarization disturbance (LVH, early repol, digoxin changes), 2=significant ST depression, new T-wave inversion, or new LBBB • Age: 0=under 45 years, 1=45–64 years, 2=65 years or older • Risk Factors: 0=no known risk factors, 1=1–2 risk factors or BMI>30, 2=≥3 risk factors, known diabetes, or known atherosclerotic disease (prior MI, PCI, CABG, stroke, PAD) • Troponin: 0=≤ normal limit, 1=1–3× normal limit, 2=>3× normal limit
Clinical Disclaimer
This pathway provides clinical decision support only. HEART Score does not replace clinical judgment, serial troponins, or shared decision-making. Do not use in patients with STEMI, prior PCI/CABG within 90 days, or hemodynamic instability — these patients require urgent/emergent evaluation regardless of HEART score.