MAGENT

HEART score: how the five parts are added up

The HEART score adds five parts, each worth 0, 1 or 2 points: History, ECG, Age, Risk factors and Troponin. The total runs from 0 to 10. Age scores 0 under 45, 1 from 45 to 64, and 2 at 65 or older.

Not a medical device. Not a diagnosis or dosing recommendation.

Use this calculator via API

What is the HEART score?

The HEART score comes from A. J. Six, B. E. Backus and J. C. Kelder, who described it in the Netherlands Heart Journal in 2008. Their abstract names the five considerations, History, ECG, Age, Risk factors and Troponin, and says each can be scored with zero, one or two points; the score is the sum of the five. The paper looked at patients referred to the emergency room for chest pain.

Magent's calculator is the HEART score from that 2008 paper. It isn't the HEART Pathway, which is a separate calculator.

This page explains the arithmetic. The calculator also returns a band label for the total, 0-3, 4-6 or 7-10, as written in the exact expression below. This page doesn't say what a band means for a particular person.

The HEART formula

HEART = History (0–2)
      + ECG (0–2)
      + Age (0–2): under 45 → 0, 45–64 → 1, 65 or older → 2
      + Risk factors (0–2)
      + Troponin (0–2)
maximum = 10

Exact expression the calculator uses:

HEART = history + ECG + age + risk_factors + troponin; each 0-2; age <45 0, 45-64 1, >=65 2; bands 0-3 / 4-6 / 7-10; max 10

What each part means

Input0 points1 point2 points
historyNonspecificModerately suspiciousHighly suspicious
ecgNormalRepolarization changes without significant ST depression (including bundle branch block, LVH, digoxin, or a known unchanged pattern)Significant ST depression or elevation without those confounders
ageUnder 4545 to 6465 or older
risk_factorsNone1 to 2 risk factors3 or more, or atherosclerotic disease
troponinAt or below the upper limit of normal (ULN)1 to 2 times the ULNMore than 2 times the ULN

How the score works

  1. Score the history. The person using the calculator rates it 0, 1 or 2.
  2. Score the ECG. Also 0, 1 or 2, by the descriptions above.
  3. Score age. The calculator does this from the age in years.
  4. Score risk factors. 0, 1 or 2, by how many there are.
  5. Score troponin. 0, 1 or 2, against the ULN, using the Six 2008 steps.
  6. Add the five parts. The total is 0 to 10.

Inputs come from the user

The record says history, ECG, risk factors and troponin are whole numbers from 0 to 2 assigned by the person using the calculator. Magent's calculator doesn't read an ECG, interpret a history, count risk factors or read a troponin assay. It takes age from 18 to 120 and works out the age points itself. It returns the total, the maximum of 10, the band label, the age it used and a line for each part.

Worked examples

These use Magent's own expected values for the calculator. Each line adds the parts in HEART order: history, ECG, age, risk factors, troponin.

Example 1: age 40, every part 0

  1. Age 40 is under 45 → 0.
  2. Score: 0 + 0 + 0 + 0 + 0 = 0.
  3. Band label: 0-3.

Example 2: age 40, history, ECG and risk factors 1 each

  1. Age 40 → 0; troponin 0.
  2. Score: 1 + 1 + 0 + 1 + 0 = 3.
  3. Band label: 0-3.

Example 3: age 40, history, ECG, risk factors and troponin 1 each

  1. Age 40 → 0.
  2. Score: 1 + 1 + 0 + 1 + 1 = 4.
  3. Band label: 4-6.

Example 4: age 40, history, ECG and risk factors 2 each, troponin 1

  1. Age 40 → 0.
  2. Score: 2 + 2 + 0 + 2 + 1 = 7.
  3. Band label: 7-10.

Example 5: age 65, every part 2

  1. Age 65 is 65 or older → 2.
  2. Score: 2 + 2 + 2 + 2 + 2 = 10, the maximum.
  3. Band label: 7-10.

Values at the age boundaries

Each line changes the age in Example 1, with every other part 0. All are Magent's expected values for the calculator.

  • Age 44 → 0.
  • Age 45 → 1.
  • Age 64 → 1.
  • Age 65 → 2.

History of the HEART score

The score comes from Six AJ, Backus BE and Kelder JC, Chest pain in the emergency room: value of the HEART score, Netherlands Heart Journal, 2008 (volume 16, issue 6, pages 191–196).

When it's used

The 2008 paper studied patients who came to the emergency room with chest pain. Later papers by Backus and colleagues tested the score across several centers in 2010 and prospectively in 2013, and Poldervaart and colleagues studied using it in a stepped-wedge, cluster randomized trial published in 2017. The 2021 AHA/ACC chest pain guideline by Gulati and colleagues is also listed under Further reading.

Where it's used

The original paper was set in an emergency room. Four of the five inputs come from the person's history, an ECG and a troponin result; age is entered in years, and the calculator turns it into points.

Who uses it

The person using the calculator rates history, ECG, risk factors and troponin. The calculator scores age and does the adding.

Limits of the calculation

  • It adds up five parts. It doesn't confirm or rule out a heart attack, and it isn't a protocol for sending someone home.
  • History, ECG, risk factors and troponin are ratings you supply. The calculator doesn't interpret any of them.
  • Troponin steps follow Six 2008 (at or below the ULN, 1 to 2 times, more than 2 times), as written in the calculator's record.
  • It's the HEART score, not the HEART Pathway.
  • This page doesn't say what to do with a score or band.

Clinical decisions belong to a qualified clinician who knows the patient.

Glossary

  • ECG: electrocardiogram, a tracing of the heart's electrical activity.
  • ST depression or elevation: a shift in one part of the ECG tracing.
  • Repolarization: the recovery phase of each heartbeat on the ECG.
  • LVH: left ventricular hypertrophy, a thickened main pumping chamber.
  • Troponin: a heart muscle protein measured in the blood.
  • ULN: upper limit of normal for the troponin assay used.

Common mistakes

  • Giving age 64 two points. Age scores 2 from 65.
  • Giving age 44 a point. Age scores 1 from 45.
  • Using a different troponin scale. This calculator follows the Six 2008 steps against the ULN.
  • Entering more than 2 for a part. Each part is 0, 1 or 2; anything else is rejected.
  • Mixing it up with the HEART Pathway. They're separate calculators.

Source

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. DOI: 10.1007/BF03086144. PMID: 18665203

Further reading

  1. Backus BE, Six AJ, Kelder JC, et al. Chest pain in the emergency room: a multicenter validation of the HEART Score. Crit Pathw Cardiol. 2010;9(3):164-169. PMID: 20802272
  2. 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. PMID: 23465250
  3. Poldervaart JM, Reitsma JB, Backus BE, et al. Effect of Using the HEART Score in Patients With Chest Pain in the Emergency Department: A Stepped-Wedge, Cluster Randomized Trial. Ann Intern Med. 2017;166(10):689-697. PMID: 28437795
  4. Gulati M, Levy PD, Mukherjee D, et al. AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR chest pain guideline, 2021. Circulation. 2021;144(22):e368-e454. DOI: 10.1161/CIR.0000000000001029. PMID: 34709879

Frequently asked questions

How do you calculate the HEART score?

Rate history, ECG, risk factors and troponin 0, 1 or 2 each. Add age points: 0 under 45, 1 from 45 to 64, 2 at 65 or older. The total is 0 to 10.

What does a HEART score of 4 mean?

The calculator puts a total of 4 in the 4-6 band, from Six 2008. This page doesn't say what that band means for a particular person; that depends on the person and the clinical context.

What are the HEART score bands?

The calculator labels totals 0-3, 4-6 or 7-10, as in its exact expression.

What is the highest HEART score?

10, when all five parts score 2.

Is the HEART score the same as the HEART Pathway?

No. They're separate calculators. This page covers the HEART score from Six 2008.