The HEART Score is a clinical prediction rule for risk-stratifying chest pain patients in the emergency department. HEART stands for History, ECG, Age, Risk factors, and Troponin. Each component is scored 0–2 for a maximum score of 10.

Score 0–3: Low risk (MACE rate 0.9–1.7%) — consider early discharge. Score 4–6: Moderate risk (MACE rate 12–16.6%) — observe and consider further testing. Score 7–10: High risk (MACE rate 50–65%) — early invasive strategy recommended.

Risk factors for HEART scoring include: hypertension, hypercholesterolemia, diabetes mellitus, obesity (BMI >30), smoking (current or quit ≤3 months), family history of CAD (first-degree relative <65), and known atherosclerotic disease.

Multiple validation studies show that patients with HEART scores 0–3 have a very low rate of MACE (0.9–1.7%) at 6 weeks. Many institutions use this as a basis for early discharge protocols. However, clinical judgment should always supplement scoring tools.