Heart Score Calculator
The HEART score is the emergency department score for chest pain: it grades History, ECG, Age, Risk factors and initial Troponin from 0 to 2 each, adds them into a total of 0 to 10, and uses that total to estimate the risk of a major adverse cardiac event (MACE) within 6 weeks. Enter the five components below and click Calculate to get the total, the risk band and a component-by-component breakdown. This calculator is decision support and education, not a substitute for clinical judgement: if you have chest pain now, seek emergency care instead of using any calculator.
Clinical disclaimer: this calculator is decision support for clinicians and education only. It is not a substitute for clinical judgement, a full emergency department workup, or serial troponin testing, and it must not be used to discharge or admit any patient on its own. If you have chest pain now, seek emergency care instead of using this calculator.
Quick Answer
The pre-filled example, a 52-year-old with a highly suspicious history, a non-specific ECG change, two risk factors (hypertension and smoking) and an initial troponin 1 to 3 times the normal limit, scores 6 of 10: moderate risk. In the validation studies, patients scoring 4 to 6 had a 6-week MACE risk of 12 to 16.6%, so the usual course is admission for observation and further workup rather than discharge.
Key takeaways
- Five components, 0 to 2 points each: History, ECG, Age, Risk factors and initial Troponin. The total runs from 0 to 10.
- Three bands decide the direction of care: 0 to 3 low (6-week MACE 0.9 to 1.7%), 4 to 6 moderate (12 to 16.6%), 7 to 10 high (50 to 65%).
- The score was built for undifferentiated emergency department chest pain, before a diagnosis is settled. Confirmed heart attacks are already high risk and are not what this tool is for.
- Two inputs only exist inside a hospital workup: the ECG reading and the troponin blood test. At home you cannot complete the score, and chest pain needs emergency care, not a calculator.
How to use the HEART score calculator
Grade each of the five components as the emergency department team recorded them, then click Calculate. Results stay hidden until you do.
- History. The assessing clinician grades how suspicious the pain story sounds: slightly, moderately or highly suspicious. Radiation, exertional pattern, associated symptoms and how the story hangs together all feed this grade.
- ECG. Use the admission tracing: normal, a non-specific repolarisation disturbance, or significant ST-segment deviation.
- Age. Type the age in years. The tool applies the published bands itself: under 45 scores 0, 45 to 64 scores 1, 65 or older scores 2.
- Risk factors. Tick hypertension, hypercholesterolaemia, diabetes, obesity, current smoking and family history as they apply. The tool counts them: none scores 0, one or two score 1, three or more score 2. Known atherosclerotic disease scores 2 by itself.
- Initial troponin. Score the first result against the laboratory normal limit only: at or below it scores 0, up to 3 times it scores 1, above 3 times it scores 2.
- Read the band, not just the number. The result shows the total, the per-component breakdown, the band and the 6-week MACE range that band carried in the validation studies.
The five HEART components
HEART is an acronym, and every letter is one scored component. The definitions below are the published ones, introduced by Six, Backus and Kelder in the Netherlands Heart Journal in 2008 and prospectively validated by Backus and colleagues in 2013.
| Component | 0 points | 1 point | 2 points |
|---|---|---|---|
| History | Slightly suspicious | Moderately suspicious | Highly suspicious |
| ECG | Normal | Non-specific repolarisation disturbance | Significant ST-segment deviation |
| Age | Under 45 | 45 to 64 | 65 or older |
| Risk factors | No risk factors | 1 to 2 risk factors | 3 or more risk factors, or known atherosclerotic disease |
| Troponin (initial) | At or below the normal limit | 1 to 3 times the normal limit | More than 3 times the normal limit |
Counted risk factors: hypertension · hypercholesterolaemia · diabetes · obesity (BMI over 30) · current smoking · positive family history of cardiovascular disease
MACE means a major adverse cardiac event: heart attack, coronary intervention or bypass surgery, or death, within 6 weeks of the visit.
The risk factor count is the component people most often get wrong. A patient with hypertension, diabetes and smoking has three counted factors and scores 2, even though each condition on its own sounds routine. Known atherosclerotic disease, such as a previous heart attack, a coronary stent, bypass surgery or a stroke, skips the count entirely and scores 2, because established arterial disease carries the same weight as a stack of risk factors.
Worked example: a moderate-risk presentation
The calculator is pre-filled with a 52-year-old patient: a highly suspicious history, a non-specific repolarisation disturbance on the ECG, hypertension and current smoking as the only risk factors, and an initial troponin 1 to 3 times the normal limit. Here is exactly how the total is built.
| Component | Finding | Points |
|---|---|---|
| History | Highly suspicious | 2 |
| ECG | Non-specific repolarisation disturbance | 1 |
| Age | 52 years (45 to 64 band) | 1 |
| Risk factors | 2 counted: hypertension, smoking | 1 |
| Troponin (initial) | 1 to 3 times the normal limit | 1 |
| Total: 6 of 10, moderate risk | 6 |
Two boundary checks you can reproduce in the tool. Set every component to its lowest grade, with an age of 44, and the total is 0: low risk. Then change only the age: 44 scores 0, 45 scores 1, 64 still scores 1, and 65 scores 2, because the published age bands break at 45 and 65. Set every component to its highest grade and the total is 10: high risk, the band where roughly half to two thirds of patients had a major event within 6 weeks in the validation cohorts.
Reading your result: the three risk bands
The total only means something through its band. Each band below pairs the 6-week MACE rate seen in the validation studies with the course of action the score was designed to support.
| Total | Band | 6-week MACE risk | Usual course |
|---|---|---|---|
| 0 to 3 | LOW | 0.9 to 1.7% | Discharge may be appropriate, with follow-up arranged |
| 4 to 6 | MODERATE | 12 to 16.6% | Admit for observation and further workup |
| 7 to 10 | HIGH | 50 to 65% | Admit, early invasive strategy with cardiology |
The low band is the reason the score exists. Most emergency chest pain is not a heart attack, and a validated way to identify the small group who can go home safely, with a miss rate around 1 to 2%, is what separates the HEART score from unstructured judgement. The stepped-wedge trial across nine Dutch emergency departments (Poldervaart and colleagues, 2017) found HEART-guided care non-inferior to usual care for 6-week MACE, and the HEART Pathway, which pairs a low score with negative serial troponins, safely increased early discharge in its randomized trial (Mahler and colleagues, 2015). The 2021 AHA/ACC chest pain guideline covers how scores like this sit inside a full emergency evaluation.
HEART also differs from the older TIMI and GRACE scores in one practical way: TIMI and GRACE were built for patients whose acute coronary syndrome is already diagnosed, while HEART was built for the undifferentiated patient at the door, which is why it needs no diagnosis-dependent inputs. A different bedside score on this site, the CHA2DS2-VASc calculator, answers yet another question: long-term stroke risk in atrial fibrillation.
What competing calculators miss
Chest pain scoring is a keyword where a sloppy tool does real harm, because the band changes what happens to the patient next. The gaps below are the ones that matter:
- MDCalc: the clinical reference point for the HEART score, with the component definitions stated cleanly. Gap for a lay reader: it is written for clinicians, assumes you already know what a non-specific repolarisation disturbance looks like, and gives no worked example a patient or student can follow.
- Tools that score the wrong troponin: the published score uses the initial troponin only. Pages that quietly fold in the second or third result, or that ask for an exact troponin number and convert it themselves, are running a modified score while keeping the original name and its validation numbers.
- Tools that blur the risk factor rule: the count has a closed definition, six named factors plus known atherosclerotic disease as an automatic 2. Calculators that accept free-text risk factors, or that count known disease as just one more factor, understate exactly the patients the rule was written to catch.
- Long-term risk tools wearing the HEART name: 10-year prevention scores such as Framingham, the ASCVD Pooled Cohort Equations and SCORE2 estimate risk in people without an acute presentation. They are useful tools, but they are not the HEART score, and a page that offers them under this name cannot answer the emergency question the searcher actually has.
- The gap this page fills: the genuine clinical HEART score with the published component definitions, the risk factor count and the known-disease rule handled explicitly, age banded automatically from the age you enter, a per-component breakdown in every result, and the validation bands stated with their sources.
Limits you should know about
The HEART score supports a decision; it does not make one. It was derived and validated in adults who presented to an emergency department with chest pain, and it performs worst outside that setting: it was not built for confirmed ST-elevation heart attacks (those patients go straight to the catheter laboratory), for chest pain with an obvious non-cardiac cause that itself needs admission, or for screening people with no symptoms. The History grade is a clinician judgement, so two assessors can grade the same story one step apart, which is why real pathways pair the score with serial troponins and repeat ECGs rather than treating a single total as final. A low score also never overrides a worrying presentation: ongoing pain, instability or a rising troponin wins over the arithmetic every time. Finally, the band percentages come from the derivation and validation cohorts, mostly Dutch and US emergency populations; an individual department with a different case mix can see somewhat different event rates, which is why the ranges are printed as ranges here rather than as single precise figures.
Frequently asked questions
The HEART score is a clinical decision tool for emergency department patients with chest pain. It scores five components, History, ECG, Age, Risk factors and initial Troponin, each from 0 to 2, for a total of 0 to 10 that estimates the risk of a major adverse cardiac event (MACE) within 6 weeks.
History grades how suspicious the chest pain story sounds, ECG grades the tracing from normal to significant ST deviation, Age scores under 45 as 0, 45 to 64 as 1 and 65 or older as 2, Risk factors counts conditions such as hypertension, diabetes and smoking, and Troponin scores the first blood result against the normal limit.
A total of 0 to 3 is low risk. In the validation studies, 0.9 to 1.7 percent of low-risk patients had a major adverse cardiac event within 6 weeks, and discharge with follow-up may be appropriate when the treating clinician agrees and no other concern is present.
A total of 4 to 6 is moderate risk, with a 6-week MACE rate of about 12 to 16.6 percent in the validation studies. Patients in this band are usually admitted for observation, serial troponin testing and further workup rather than discharged.
A total of 7 to 10 is high risk, with a 6-week MACE rate of about 50 to 65 percent in the validation studies. These patients generally need admission and an early invasive strategy, such as coronary angiography, guided by a cardiology team.
The counted risk factors are hypertension, hypercholesterolaemia, diabetes, obesity with a body mass index over 30, current smoking and a positive family history of cardiovascular disease. No risk factors scores 0, one or two score 1, and three or more score 2. Known atherosclerotic disease, such as a prior heart attack, stent, bypass surgery or stroke, also scores 2 on its own.
Only the initial troponin result is scored. A result at or below the normal limit scores 0, a result 1 to 3 times the normal limit scores 1, and a result more than 3 times the normal limit scores 2. Later or serial troponin results are used in ongoing care but do not change the original HEART score.
It is for adults who come to an emergency department with chest pain that could be cardiac, where the diagnosis is not yet settled. It was not designed for confirmed heart attack patients, who are already known to be high risk, and it does not replace scores such as TIMI or GRACE once acute coronary syndrome is diagnosed.
Not fully. Two components, the ECG and the troponin blood test, only exist inside a hospital workup, and the History grade is a clinical judgement. This calculator is for education and for clinicians checking a score. If you have chest pain now, seek emergency care instead of scoring yourself.
No. The score supports a decision, it does not make one. Clinicians combine it with the examination, repeat ECGs and troponins, and the overall picture, and pathways such as the HEART Pathway add a second troponin. A low score never overrides a worrying presentation.
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References
- Six AJ, Backus BE, Kelder JC. Chest pain in the emergency room: value of the HEART score. Netherlands Heart Journal. 2008;16(6):191-196. Accessed October 24, 2026.
- Backus BE, Six AJ, Kelder JC, et al. A prospective validation of the HEART score for chest pain patients at the emergency department. International Journal of Cardiology. 2013;168(3):2153-2158. Accessed October 24, 2026.
- Mahler SA, Riley RF, Hiestand BC, et al. The HEART Pathway randomized trial: identifying emergency department patients with acute chest pain for early discharge. Circulation: Cardiovascular Quality and Outcomes. 2015;8(2):195-203. Accessed October 24, 2026.
- 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. Annals of Internal Medicine. 2017;166(10):689-697. Accessed October 24, 2026.
- Gulati M, Levy PD, Mukherjee D, et al. 2021 AHA/ACC guideline for the evaluation and diagnosis of chest pain. Circulation. 2021;144(22):e368-e454. Accessed October 24, 2026.