What is the heart score?

From the Guidelines

The HEART score is a valuable tool for assessing the risk of major adverse cardiac events in patients presenting with chest pain to the emergency department, consisting of five components: History, ECG, Age, Risk factors, and Troponin, with a total score ranging from 0 to 10, as outlined in the 2019 study by 1. The HEART score is used to evaluate patients with suspected acute coronary ischemia, with each component scored from 0 to 2.

• History: Assess if the chest pain is highly suspicious (2 points), moderately suspicious (1 point), or slightly suspicious (0 points) for acute coronary syndrome.
• ECG: Normal (0 points), non-specific repolarization disturbance (1 point), significant ST-depression (2 points).
• Age: <45 years (0 points), 45-64 years (1 point), ≥65 years (2 points).
• Risk factors: No known risk factors (0 points), 1-2 risk factors (1 point), ≥3 risk factors or history of atherosclerotic disease (2 points).
• Troponin: Normal (0 points), 1-3x normal limit (1 point), >3x normal limit (2 points). A score of 0-3 is considered low risk, with a less than 1% chance of a major cardiac event within 6 weeks, as supported by the study 1, while a score of 4-6 is intermediate risk, and a score of 7-10 is high risk, requiring immediate admission and aggressive management. The HEART score helps standardize risk assessment and guides clinical decision-making, potentially reducing unnecessary admissions for low-risk patients while ensuring appropriate care for those at higher risk, as noted in the 2015 study by 1.
• The score can be used in conjunction with other clinical data, such as the patient’s ECG and historical data, to inform treatment decisions.
• The HEART score has been validated in several studies, including the High STEACS pathway, which uses hs-cTn measures at presentation and 3 h to identify a low-risk group and can provide NPV >99% for 30-day cardiac death or MI, as reported in the study 1.

From the Research

Definition of the HEART Score

• The HEART score is a clinical prediction rule used to assess patients with chest pain in the emergency department 2, 3.
• It consists of 5 elements: history, electrocardiogram, age, risk factors, and troponin 3.

Components of the HEART Score

• History: assessment of the patient's medical history and symptoms 3.
• Electrocardiogram: evaluation of the patient's ECG results 3.
• Age: consideration of the patient's age as a risk factor 3.
• Risk factors: assessment of the patient's risk factors, such as hypertension, diabetes, and family history of cardiovascular disease 3.
• Troponin: measurement of troponin levels to detect cardiac damage 3.

Interpretation of the HEART Score

• A low-risk HEART score (≤ 3) indicates a low risk of major adverse cardiac events (MACE) 3, 4.
• A high-risk HEART score (≥ 7) indicates a high risk of MACE 3, 4.
• A HEART score of 4-6 indicates an intermediate risk of MACE 4.

Validation and Accuracy of the HEART Score

• The HEART score has been validated in several studies, including a multinational validation study 3 and a systematic review and meta-analysis 4.
• The HEART score has been shown to have excellent sensitivity and specificity for predicting MACE, particularly mortality and myocardial infarction 4.
• A prospective study demonstrated the high sensitivity and specificity of the HEART score for risk stratifying patients with chest pain 5.

Clinical Application of the HEART Score

• The HEART score can be used to quickly identify low-risk patients who can be safely discharged from the emergency department without additional testing 3, 6.
• The HEART score can also be used to identify high-risk patients who require intensive monitoring and early intervention 2, 3.
• The HEART score can help reduce hospital admission rates, overuse of resources, and costs by providing a more nuanced risk stratification of patients with chest pain 6.