Scores & indices
HEART score calculator
Five bedside components, one disposition: discharge, observe, or admit — with the validated risk drawn as 100 people.
How to read the result
HEART falls into these published bands.
A 58-year-old smoker with a highly suspicious story, non-specific ECG changes, several risk factors, and a negative troponin.
HEART 6 — moderate risk (~16.6% six-week MACE)
Observation territory: serial troponin and non-invasive evaluation rather than discharge or immediate invasive work-up.
Who this is for
For emergency and acute-care clinicians stratifying stable chest pain. HEART turns the story, ECG, age, risk factors, and troponin into a six-week major-adverse-cardiac-event risk with a validated disposition per band — derived by Six (2008) and validated across 2,440 patients (Backus 2013). STEMI and instability are treated before any score.
How it works
The papers
Derived by Six and colleagues in 2008, prospectively validated across ten Dutch hospitals by Backus in 2013 (2,440 patients), and implementation-tested by Poldervaart in 2017. Paracelsus codifies the published score exactly — the components, points, and event rates are the papers', not ours.
What it calculates
Six-week risk of a major adverse cardiac event for chest pain in the emergency setting, from five bedside components — History, ECG, Age, Risk factors, Troponin — each scored 0–2.
Interpreting the result
0–3: ~1.7% MACE — early discharge is supported when troponin is negative per your pathway. 4–6: ~16.6% — observe with serial troponin. 7–10: ~50.1% — admit for early invasive evaluation. STEMI and instability are treated before any score.
Built on published evidence
- Score each component from the bedside; the troponin band uses your laboratory's reference limit
- Six 2008 (derivation); Backus 2013 (validation); Poldervaart 2017 (implementation)
Codification last reviewed 2026-08-28, and checked against published reference values in automated tests on every release — see the full evidence ledger.
Questions clinicians ask
What counts as a MACE in the HEART studies?
Major adverse cardiac events within six weeks: acute myocardial infarction, revascularisation (PCI or CABG), or death. The band rates — ~1.7% (0–3), ~16.6% (4–6), ~50.1% (7–10) — come from the 2013 multicentre validation.
Can I use HEART if the ECG shows ST elevation?
No. STEMI, new LBBB with a convincing story, or an unstable patient are treated on the ACS pathway immediately — the score is only for the stable, non-STEMI presentation. The in-app chest-pain work-up puts this gate before the score.
Which troponin threshold does the score use?
Your own laboratory's upper reference limit: at or below it scores 0, one to three times it scores 1, above three times scores 2. The paper deliberately anchors to the local assay rather than a fixed number.
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