Episode 962: HEART Score

Jun 23, 2025

Discover how the HEART score helps emergency providers assess chest pain. The scoring system covers history, EKG results, age, risk factors, and troponin levels. Learn how to interpret scores from 0 to 10, predicting the likelihood of major cardiac events. Points can lead to different patient management strategies, from discharge to intensive care. It's a crucial tool that enhances decision-making in high-pressure situations!

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ADVICE

Use HEART Score for Chest Pain

Use the HEART score to risk-stratify chest pain patients by predicting their 6-week risk of major adverse cardiac events.
This helps decide who can go home, who needs admission, and who requires urgent cardiology workup.

ADVICE

Calculate HEART Score Components

Assign points for each HEART score component: History, EKG findings, Age, Risk factors, and Troponin level.
Use specific criteria such as exertional pain or ST-depression to calculate a total score from 0 to 10.

ADVICE

HEART Score Guides Patient Management

Interpret HEART score ranges to guide management: 0-3 points = low risk, send home; 4-6 points = moderate risk, admit or urgent outpatient testing; 7-10 points = high risk, admit and call cardiology.
This stratification reflects roughly 2%, 20%, and 72% six-week adverse event risk respectively.

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Contributor: Taylor Lynch, MD Educational Pearls:

How do we risk-stratify chest-pain patients?

One option is the HEART score
- This score predicts a patient's 6-week risk of a major adverse cardiac event.
  - Ex. Cath procedure, CABG, PCI, death
H stands for History
- Ask 1) Was the patient diaphoretic? 2) Did they have nausea and/or vomiting? 3) Did the pain radiate down the right or left arm? 4) Was it exertional?
- Yes to one = one point. Two or more = two points.
E stands for EKG
- One point for left ventricular hypertrophy, t-wave inversions, new bundle-branch blocks.
- No points for first degree AV block, benign early repolarization, or QT-prolongation
- Two points for ST-depression
A stands for Age
- >65 gets two points
- 45-64 gets one point
R stands for Risk factors
- Hypertension, hyperlipidemia, diabetes, obesity, family history, smoking, previous MI, previous CABG, stroke, peripheral arterial disease
- 1-2 risk factors get 1 point
- More than two risk factors gets two points
T stands for Troponin
- 1-3x upper limit of normal gets one point
- >3x upper limit of normal gets two points
This gives you a score between zero and ten
- 0-3 points, patients have a ~2% chance of an adverse event
  - These patients likely go home
- 4-6 points, patients have a ~20% chance of an adverse event
  - These patients get admitted or expedited outpatient stress test/echo
- 7-10 points, patients have a ~60% chance of an adverse event
  - Admit and call cardiology.
  - These patients likely get catheterized

References

Backus BE, Six AJ, Kelder JC, Bosschaert MA, Mast EG, Mosterd A, Veldkamp RF, Wardeh AJ, Tio R, Braam R, Monnink SH, van Tooren R, Mast TP, van den Akker F, Cramer MJ, Poldervaart JM, Hoes AW, Doevendans PA. A prospective validation of the HEART score for chest pain patients at the emergency department. Int J Cardiol. 2013 Oct 3;168(3):2153-8. doi: 10.1016/j.ijcard.2013.01.255. Epub 2013 Mar 7. PMID: 23465250.
Laureano-Phillips J, Robinson RD, Aryal S, Blair S, Wilson D, Boyd K, Schrader CD, Zenarosa NR, Wang H. HEART Score Risk Stratification of Low-Risk Chest Pain Patients in the Emergency Department: A Systematic Review and Meta-Analysis. Ann Emerg Med. 2019 Aug;74(2):187-203. doi: 10.1016/j.annemergmed.2018.12.010. Epub 2019 Feb 2. PMID: 30718010.
https://www.mdcalc.com/calc/1752/heart-score-major-cardiac-events

Summarized by Jeffrey Olson, MS4 | Edited by Jorge Chalit, OMS4

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