Doctors and cardiologists use the HEART score tool to assess a person’s risk of cardiovascular events, such as a heart attack.

In the United States, a person dies every 34 seconds from cardiovascular disease. It is the leading cause of death for people of most racial and ethnic groups, regardless of gender.

Therefore, doctors need good tools to help them evaluate a person’s risk of these serious health conditions. One such tool is the HEART score tool, which physicians developed in 2008.

This article looks at the HEART score and how doctors use it.

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A HEART score is a risk assessment tool that clinicians use to evaluate the risk of a major cardiac event in people with chest pain.

HEART is an acronym for:

  • History: Doctors will look at whether the person has previously had heart problems.
  • EKG: An EKG uses sensors attached to the skin of the chest to check the heart’s rhythm and electrical activity.
  • Age: The risk of having a major cardiac event may increase with age.
  • Risk factors: These can include smoking, high cholesterol, obesity, and a family history of heart disease, among others.
  • Troponin: This protein exists in the heart muscle. Usually, it does not circulate in the blood, but if the heart becomes damaged, troponin leaks into the bloodstream. The greater the damage, the more troponin is present in the blood.

Doctors often use the HEART score as a decision-making tool in the emergency department. They can use it to classify someone with chest pain as having a low, moderate, or high risk of developing acute coronary syndrome (ACS).

ACS is an umbrella term for conditions that doctors associate with a suddenly reduced blood flow to the heart.

The HEART score helps identify people with an increased risk of having a major adverse cardiac event (MACE) within 6 weeks. There are many ways to define MACE, one of which involves the following factors:

This tool also helps doctors identify low risk individuals whom they can discharge from the hospital earlier.

The HEART score originated in the Netherlands in 2008. A group of physicians developed it after realizing they could use patient history, EKG abnormalities, age, risk factors for coronary artery disease, and increased cardiac troponin levels to predict MACE.

Although various diagnostic prediction tools exist, the HEART score is the only one that multiple independent research groups have validated through clinical impact studies.

An individual receives a score of 0, 1, or 2 for each of the five HEART score factors, producing a total of up to 10.

The table below shows the five components of the HEART score.

FactorScore of 0Score of 1Score of 2
Historyno specific historysome aspects of ACS historyspecific ACS history
EKGnormal EKGabnormal EKG but without certain elements typical of ACSabnormal EKG with substantial deviations
Ageunder 45 years45–64 years65 years or older
Risk factorsnoneone or two risk factorsthree risk factors or a documented heart disease
Troponinnormal leveltroponin levels one to three times highertroponin level more than three times higher

Interpreting the results

Doctors interpret someone’s overall score as follows:

  • Between 0 and 3: These individuals may have a risk of up to 1.7% of experiencing an adverse cardiac event. Doctors may choose to discharge them because of the lower risk.
  • Between 4 and 6: People with this score may have a 12–17% risk of an adverse cardiac event. A doctor will likely admit someone with this score to the hospital.
  • Between 7 and 10: These individuals may have a significant adverse cardiac event risk of 50–65%. A doctor may recommend early invasive methods to reduce the risk and improve the individual’s outlook.

Although the HEART score is a useful tool, it is not perfect. Some experts believe that emergency departments should reconsider using it because of its weaknesses, including:

  • It lacks formal validation.
  • It considers all risk factors equal, but this might not be the case.
  • It omits some important risk factors, such as sex assigned at birth.
  • It may be unreliable.
  • It is unsophisticated.
  • It is not as sensitive as some other tools.

The HEART Pathway builds on the HEART score tool and is more reliable and powerful. It uses clinical data to define someone’s risk of ACS and helps doctors identify who would benefit from hospitalization and whom they can safely send home.

Research has shown that the HEART Pathway has the following benefits:

  • reducing hospital stays
  • increasing early hospital discharges
  • an accuracy of more than 99% in ruling out MACE

People can find the HEART score calculator for MACE here.

The HEART score is a diagnostic tool that helps doctors identify people at risk of major cardiac events.

It identifies a person’s risk factors and combines information from their medical history, EKG results, and troponin levels to achieve an overall score. This number, between 0 and 10, helps doctors decide whether to discharge someone, admit them to the hospital, or begin emergency treatment to improve their outcome.

The HEART Pathway is a more sophisticated version of the original tool. It addresses some of the shortcomings of the HEART score and may be more reliable.