For healthcare professionals
HEART score calculator (chest pain)
The HEART score is a 0 to 10 point score clinicians use for adults seen in the emergency department with chest pain, after a heart attack with ST elevation has been ruled out. History, ECG, Age, Risk factors and Troponin each score 0, 1 or 2 points, and higher totals went with more heart attacks, coronary procedures and deaths in the original study. This calculator is written for clinicians and is not a diagnosis.
Findings at the emergency department visit
Use the history, first ECG and admission troponin. Nothing you enter leaves this page.
What you will see
The HEART score from 0 to 10, the points for each item, and how often patients with a score in the same group had a heart attack, a coronary procedure or died in the original study.
Educational only, not medical advice. Not a diagnosis and not a decision on discharge or admission.
Source
Six AJ, Backus BE and Kelder JC, Netherlands Heart Journal 2008: the five items, their points and the outcome rate for each score group. The tests check every cut point and the counts behind each rate.
Validated in
120 adults (mean age 61, 60% men) seen with chest pain in the emergency room of one 265-bed community hospital in the Netherlands from January to March 2006, followed for a mean of 423 days. Patients with ST elevation heart attacks went straight to a catheter lab elsewhere and were not included (Six 2008).
Limits
This was a small, single-center, retrospective study: patient history was scored afterwards from hospital charts, and troponin cut points were set for the troponin I test used there (normal at or below 0.04). The outcome rates are for that group of patients and may not match your setting or a high-sensitivity troponin test. The score does not apply to ST elevation heart attacks and does not replace clinical judgement, repeat ECGs or repeat troponin testing.
HEART scoring
Each of the five items scores 0, 1 or 2 points, for a total of 0 to 10 (Six 2008).
| Item | 0 points | 1 point | 2 points |
|---|---|---|---|
| History | Slightly suspicious | Moderately suspicious | Highly suspicious |
| ECG | Normal | Nonspecific repolarisation disturbance | Significant ST deviation |
| Age | Under 45 | 45 to 64 | 65 or older |
| Risk factors | None known | 1 or 2 | 3 or more, or known atherosclerotic disease |
| Troponin | At or below the normal limit | 1 to 2 times the normal limit | More than 2 times the normal limit |
The paper defines the items in its methods. History was graded on how many features of the pain pointed to a coronary cause, from nonspecific to mainly specific. For the ECG, 1 point covers repolarisation changes without significant ST depression and also bundle branch block, left ventricular hypertrophy, digoxin effect or known unchanged repolarisation changes; 2 points go to significant ST depression or elevation without one of those explanations. The risk factors counted were treated diabetes, current or recent smoking (within a month), diagnosed high blood pressure, diagnosed high cholesterol, family history of coronary artery disease and obesity. A history of coronary revascularisation, heart attack, stroke or peripheral arterial disease scores 2 points on its own (Six 2008).
A note on age: the paper's table prints the 2-point age row as "≤65", but its methods text gives 2 points at 65 years or older and 1 point between 45 and 65. This calculator follows the methods text.
Outcomes by score group
The study's combined endpoint was a heart attack, a coronary procedure (PCI or bypass surgery) or death. All endpoints occurred within three months (Six 2008).
| HEART score | Patients | Reached the endpoint |
|---|---|---|
| 0 to 3 | 39 | 1 (2.5%) |
| 4 to 6 | 59 | 12 (20.3%) |
| 7 to 10 | 22 | 16 (72.7%) |
Source: results of Six and colleagues, 2008 (Six 2008). The authors proposed that a low score could support early discharge, a middle score admission for observation, and a high score early invasive treatment. They described this as a first step, and these groupings came from a small sample, so local chest pain pathways and current guidelines should guide those decisions (Six 2008).
Related tools
The HEART score is for acute chest pain. Once unstable angina or NSTEMI is diagnosed, see the TIMI risk score calculator. For long-term heart risk in people without symptoms, see the heart risk calculator (AHA PREVENT) or the ASCVD risk calculator (Pooled Cohort Equations). For other clinician scores on this site, see the Revised Cardiac Risk Index (RCRI) before surgery, the CURB-65 calculator for pneumonia and the Wells score for DVT for a swollen or painful leg. For suspected pulmonary embolism, see the Wells score for PE. For adults with suspected infection, see the qSOFA score calculator.
Sources
- Six AJ, Backus BE, Kelder JC. Chest pain in the emergency room: value of the HEART score. Neth Heart J. 2008;16(6):191-196. doi:10.1007/BF03086144. PMID 18665203. Methods (scoring of predictors), Table 1 and Results. pmc.ncbi.nlm.nih.gov/articles/PMC2442661/
Written and maintained by the uncovermyrisk.com editorial team. We do not have a medical reviewer; every claim links to its primary source above. Last reviewed: 2026-11-01. Spotted an error? See About.