The HEART Score

By assigning zero, one, or two points — towards an atypical patient history, ECG anomalies, the patient's age, any risk factors present, and elevated Troponin — patients score on a scale of 0‒10.

Discriminative Power

This graph shows that the HEART score is a perfect predictor of MACE within six weeks after presentation at the emergency room. The X axis represents the increasing HEART score of a patient, while the Y axis indicates the increasing risk of a cardiac event. The S shaped curve represents a discrimination between low risk and high risk patients. Low HEART scores accompany a low likelihood of MACE; high HEART scores predict high incidence of MACE.

Score	% pts	MACE/n	MACE	Death	Policy
0-3	32%	38/1993	1.9%	0.05%	Discharge
4-6	51%	413/3136	13%	1.3%	Observation Risk management
7-10	17%	518/1045	50%	2.8%	Observation Treatment, CAG

Proposed Policy

Patients can be divided into three distinct groups:

A score of 0-3 indicates a risk of 1.6% for reaching a MACE, and therefore supports a policy of early discharge.

A HEART score of 4-6 points, with a risk of MACE of 13%, immediate discharge is not an option. These patients should be admitted for clinical observation and subjected to non-invasive investigations such as repeated troponin or advanced ischemia detection.

A HEART score ≥ 7 points, with a risk of 50% for a MACE, calls for early aggressive treatments possibly including invasive strategies without preceding non-invasive testing.

Download this chart as PDF.