From the Guidelines
The HEART score is a clinical decision tool used to risk-stratify patients presenting with chest pain to predict their likelihood of having a major adverse cardiac event (MACE) within the next 6 weeks, and it is predictive of all-cause mortality, MI, or coronary revascularization. The score evaluates five components: History (0-2 points), ECG findings (0-2 points), Age (0-2 points), Risk factors (0-2 points), and Troponin levels (0-2 points), with a total possible score ranging from 0-10. Patients with low scores (0-3) have approximately 1-2% risk of MACE within 6 weeks and may be candidates for early discharge, while those with intermediate (4-6) or high scores (7-10) have progressively higher risks (15-20% and 50-65%, respectively) and typically require admission and more aggressive evaluation 1.
Key Components of the HEART Score
- History: evaluates the patient's medical history and symptoms
- ECG: assesses the patient's electrocardiogram findings
- Age: considers the patient's age as a risk factor
- Risk factors: evaluates the patient's risk factors for cardiovascular disease
- Troponin: assesses the patient's troponin levels to detect myocardial injury
Clinical Application of the HEART Score
The HEART score is used in the emergency department to rapidly stratify patients with chest pain and determine their risk of MACE. It helps emergency physicians decide which patients can be safely discharged and which require admission and further cardiac workup. The score's simplicity, ease of calculation, and ability to incorporate both clinical judgment and objective data make it a valuable tool for guiding management decisions in patients with chest pain 1.
Limitations and Considerations
While the HEART score is a useful tool, it should be used in conjunction with clinical judgment and other diagnostic tests to ensure accurate risk stratification. The score's performance may vary depending on the population and setting, and it should be validated in different contexts to ensure its accuracy and reliability 1.
From the Research
Purpose of the HEART Score
- The HEART score is a clinical prediction rule used to provide a simple, early, and reliable predictor of cardiac risk in patients presenting with chest pain 2.
- It is designed to identify patients in whom an acute coronary syndrome (ACS) can be safely ruled out based on findings from history, physical examination, and early cardiac marker measurement 2.
Predictive Value of the HEART Score
- The HEART score is predictive of major adverse cardiac events (MACE), including acute myocardial infarction, revascularization, or death within 6 weeks after presentation 2, 3, 4, 5, 6.
- A HEART score above the low-risk threshold (≥4) has a high sensitivity (95.9%) and moderate specificity (44.6%) for MACE 3.
- A high-risk HEART score (≥7) has a lower sensitivity (39.5%) but high specificity (95.0%) for MACE 3.
- The HEART score has excellent performance for prediction of MACE, particularly mortality and myocardial infarction, in chest pain patients 3, 4, 6.
Comparison with Other Scoring Systems
- The HEART score has been compared to the Thrombolysis in Myocardial Infarction (TIMI) score, with the HEART score showing better predictive accuracy for MACE 3, 4.
- The HEART score has also been compared to the Global Registry of Acute Coronary Events (GRACE) score, with the HEART score showing superior predictive value for MACE within 30 days 6.
Clinical Application
- The HEART score can be used to guide clinical decision-making, including reassurance and discharge of patients with low scores and intensive monitoring and early intervention in patients with high HEART scores 2.
- The score can be used in both emergency department and prehospital settings to risk-stratify patients with chest pain 2, 5.