History
ECG
Age
Risk Factors
Diabetes, smoker, hypertension, hyperlipidemia, family history of CAD, known atherosclerotic disease.
Troponin
HEART Score for Major Adverse Cardiac Events
The HEART Score is a clinical decision rule used to risk-stratify patients presenting to the Emergency Department with chest pain. It helps predict the 6-week risk of major adverse cardiac events (MACE), including all-cause mortality, myocardial infarction, or coronary revascularization.
Scoring Criteria
The score is an acronym based on five key elements:
- History: Based on the clinician's assessment of the patient's story (Slightly, Moderately, or Highly suspicious).
- ECG: Findings on the electrocardiogram (Normal, Non-specific changes, or Significant ST deviation).
- Age: Patient's age in years (<45, 45-64, or ≥65).
- Risk Factors: Number of atherosclerotic risk factors (0, 1-2, or ≥3). Risk factors include diabetes, smoking, hypertension, hyperlipidemia, family history of CAD, and known atherosclerotic disease.
- Troponin: Initial troponin level compared to the local laboratory's normal limit (Normal, 1-3x normal, or >3x normal).
Risk Stratification
| Score | Risk of MACE | Recommended Action |
|---|---|---|
| 0-3 | Low (0.9-1.7%) | Discharge |
| 4-6 | Intermediate (12-16.6%) | Admission for observation |
| ≥7 | High (50-65%) | Early invasive strategy |
Clinical Application
The HEART Score is a simple and effective tool for making safe and efficient decisions about patient care.
- Low-risk patients can often be safely discharged from the ED, reducing unnecessary hospital admissions.
- Intermediate and high-risk patients can be identified for further monitoring, investigation, and treatment.
It has been validated in numerous studies and is recommended by several international guidelines for the management of patients with acute chest pain.
References
- Backus, B. E., Six, A. J., Kelder, J. C., Bosschaert, M. A., Mast, E. G., Mosterd, A., ... & Doevendans, P. A. (2013). A prospective validation of the HEART score for chest pain patients at the emergency department. International journal of cardiology, 168(3), 2153-2158.
- Six, A. J., Backus, B. E., & Kelder, J. C. (2008). Chest pain in the emergency room: value of the HEART score. Netherlands Heart Journal, 16(6), 191-196.
- Mahler, S. A., Riley, R. F., Hiestand, B. C., Russell, G. B., Hoekstra, J. W., Lefebvre, C. W., ... & Herrington, D. M. (2015). The HEART pathway randomized trial: identifying emergency department patients with acute chest pain for early discharge. Circulation: Cardiovascular Quality and Outcomes, 8(2), 195-203.
- Amsterdam, E. A., Kirk, J. D., Bluemke, D. A., Diercks, D., Farkouh, M. E., Garvey, J. L., ... & Zieman, S. J. (2010). Testing of low-risk patients presenting to the emergency department with chest pain: a scientific statement from the American Heart Association. Circulation, 122(17), 1756-1776.
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