# What is the HEART score?

Adds up the HEART score for chest pain (Six 2008) from history, ECG, age, risk factors, and troponin to a total of 0 to 10, and shows the band and the rate of cardiac events the original study found.

- Page: https://www.acalculator.org/health/heart-score-calculator
- JSON spec: https://www.acalculator.org/health/heart-score-calculator.json
- Version: 1f96ea30915a

## Default answer

Example with the default inputs (History Slightly suspicious (0), ECG Normal (0), Age 50, Risk factors None known (0), Troponin At or below the normal limit (0)): The HEART score is 1 (Low); in the 2008 study, 2.5% of such patients had a major cardiac event.

## Inputs

| Key | Label | Description |
| --- | --- | --- |
| h | History | How suspicious the story of the chest pain is for a heart cause. |
| ecg | ECG | The electrocardiogram. |
| age | Age | Age in whole years, 18 to 120: under 45 scores 0, 45 to 64 scores 1, 65 or more scores 2. |
| r | Risk factors | Diabetes, smoking, high blood pressure, high cholesterol, family history of heart disease, obesity. |
| t | Troponin | The first troponin compared with the normal limit of the lab. |

## Outputs

| Key | Label | Description |
| --- | --- | --- |
| score | HEART score | The total of the five parts, 0 to 10. |
| band | Band | Low (0 to 3), moderate (4 to 6), or high (7 to 10). |
| rate | Event rate in the 2008 study | Share of patients in this band who had a heart attack, a procedure to open the heart arteries, or died, in Six 2008. |
| agePoints | Age points | 0 (under 45), 1 (45 to 64), or 2 (65 or more). |

## Method

HEART = History + ECG + Age + Risk factors + Troponin, each 0 to 2 (total 0 to 10). Low 0 to 3, moderate 4 to 6, high 7 to 10.

## Assumptions

- For adults seen in the emergency department with chest pain, as in Six 2008 (120 patients in one hospital).
- Troponin points follow Six 2008 (1 to 2 times, over 2 times the normal limit). Some later tables use 3 times the limit as the upper cutoff.
- The rate is what the 2008 study observed in each band, not a personal prediction.

## Worked examples

1. h = 0, ecg = 0, age = 50, r = 0, t = 0 gives score = 1, band = Low, rate = 2.5%, agePoints = 1. Source: Six 2008 Table 1: age 45 to 65 scores 1.
2. h = 2, ecg = 1, age = 66, r = 1, t = 0 gives score = 6, band = Moderate, rate = 20.3%, agePoints = 2. Source: Six 2008: 2 + 1 + 2 + 1 + 0 = 6, band 4 to 6 had 20.3% events.
3. h = 2, ecg = 2, age = 70, r = 2, t = 1 gives score = 9, band = High, rate = 72.7%, agePoints = 2. Source: Six 2008: 2 + 2 + 2 + 2 + 1 = 9, band 7 to 10 had 72.7% events.
4. h = 1, ecg = 0, age = 44, r = 1, t = 1 gives score = 3, band = Low, agePoints = 0. Source: Six 2008: age under 45 scores 0.
5. h = 1, ecg = 1, age = 65, r = 0, t = 0 gives score = 4, band = Moderate, agePoints = 2. Source: Six 2008 Table 1: 65 or more scores 2.

## FAQ

### What is the HEART score?

A score for people seen in an emergency department with chest pain, published by Six, Backus, and Kelder in 2008. HEART stands for History, ECG, Age, Risk factors, and Troponin. Each scores 0, 1, or 2, for a total of 0 to 10.

### What do the bands mean?

In the 2008 study of 120 patients, major cardiac events (heart attack, a procedure to open the heart arteries, or death) happened in 2.5% of those scoring 0 to 3, 20.3% of those scoring 4 to 6, and 72.7% of those scoring 7 to 10.

### Which risk factors count?

Diabetes, smoking, high blood pressure, high cholesterol, a family history of heart disease, and obesity (Six 2008). A history of atherosclerotic disease scores 2 on its own.

### How is troponin scored?

In the 2008 paper: at or below the normal limit 0, 1 to 2 times the limit 1, over 2 times 2. Some later tables use 3 times the limit as the upper cutoff. This page follows the 2008 paper, because its event rates belong to its own troponin bands.

### How is age scored?

Under 45 scores 0, 45 to 64 scores 1, and 65 or more scores 2. Six 2008 Table 1 prints 45 to 65 for 1 point, but the Methods of the same paper give 2 points at 65 years or older; this page follows the Methods.

### Do later studies give the same rates?

No. Larger studies found lower rates in each band (for example Backus 2013 in 2,440 patients), so the 2008 numbers describe that first study, not a personal risk.

## 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. https://doi.org/10.1007/BF03086144 (open at https://pmc.ncbi.nlm.nih.gov/articles/PMC2442661/, retrieved 2026-10-05)
- Backus BE, Six AJ, Kelder JC, et al. A prospective validation of the HEART score for chest pain patients at the emergency department. Int J Cardiol. 2013;168(3):2153-2158. https://doi.org/10.1016/j.ijcard.2013.01.255 (retrieved 2026-10-05)