Summary
Usage The HEART Score identifies patients with higher risk of having a major adverse cardiac event or MACE (all-cause mortality, myocardial infarction or coronary revascularization) in the following 6 weeks. It is intended to assist emergency department providers risk-stratify undifferentiated chest pain patients into low, moderate and high-risk groups. The HEART Score can guide management and improve resource utilization by differentiating groups who can be managed outpatient verses inpatient monitoring with or without invasive interventions. HEART is an acronym for History, Age, Risk factors and Troponin. The provider will need to take a detailed chest pain history and have some skill in reading EKGs to adequately address two components of the score. Older ACS scores (TIMI Score for UA/NSTEMI or GRACE ACS Risk Score) measure risk of death for patients with diagnosed acute coronary syndrome (ACS). However, the HEART Score is not intended for those already diagnosed with ACS and outperforms the TIMI Score in safely identifying more low-risk patients. Do not use the HEART Score if the patient presents with new ST-segment elevation requiring immediate intervention or clinically unstable patients.. Summary HEART is an acronym for History, Age, Risk factors and Troponin components of the Heart Score. Each component is scored with 0, 1 or 2. 0 Points1 Point2 PointsHistory*Slightly suspiciousModerately suspiciousHighly suspiciousEKGNormalNon-specific repolarization disturbance*Significant ST deviation*Age (years)< 4545-64≥ 65Risk Factors*No known risk factors1-2 risk factors≥ 3 risk factors or history of atherosclerotic diseaseInitial Troponin*≤ normal limit1-3x normal limit> 3x normal limit *History Chest Pain FeaturesHigh Risk FeaturesLow Risk FeaturesRetrosternal pain, pressureRadiation to jaw/left shoulder/armsDuration 5-15 minInitiated by exercise, cold, emotionPerspirationNausea/vomitingReaction on nitrates within minutesWell-localizedSharpNon-exertionalNo diaphoresisNo nausea or vomitingReproducible with palpation *Non-specific Repolarization DisturbanceNo ST deviationLBBBTypical changes suggesting LVH, Repolarization disorders (i.e. digoxin)Unchanged known repolarization disorders *Significant ST DeviationST deviation not due to LBBB, LVH or digoxin *Risk FactorsHTNHypercholesterolemiaDMObesity (BMI > 30 kg/m²)Smoking (current or cessation ≤ 3 months)Positive family history (parent or sibling with CVD before age 65)Atherosclerotic diseasePrior MIPCI/CABGCVA/TIAPeripheral arterial disease *Initial TroponinUse local, regular sensitivity troponin assays and corresponding cutoffs. Management Low Score (0-3 pts): MACE Risk 0.9 - 1.7%In the HEART Score study, these patients were discharged (0.99% in the retrospective study, 1.7% in the prospective study).If troponin is positive, many experts recommend further workup and admission even with a low HEART Score.If EKG is highly suspicious, many experts recommend further workup and admission even with a low HEART Score. Moderate Score (4-6 pts): MACE Risk 12 - 16.6%In the HEART Score study, these patients were admitted to the hospital (11.6% in the retrospective study, 16.6% in the prospective study).If troponin is positive, many experts recommend further workup and admission even with a low HEART Score.If EKG is highly suspicious, many experts recommend further workup and admission even with a low HEART Score. High Score (7-10 pts): MACE Risk 50 - 65%In the HEART Score study, these patients were candidates for early invasive measures (65.2% in the retrospective study, 50.1% in the prospective study). A MACE (Major Adverse Cardiac Event) was defined as all-cause mortality, myocardial infarction, or coronary revascularization. .