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    HEART Score for Major Cardiac Events

    Predicts 6-week risk of major adverse cardiac event.
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    INSTRUCTIONS

    Use in patients ≥21 years old presenting with symptoms suggestive of ACS. Do not use if new ST-segment elevation ≥1 mm or other new EKG changes, hypotension, life expectancy less than 1 year, or noncardiac medical/surgical/psychiatric illness determined by the provider to require admission. See also the HEART Pathway for a validated clinical pathway using the HEART Score.

    When to Use
    Pearls/Pitfalls
    Why Use

    Any ED patient with chest pain that the physician deems appropriate for an ACS workup.

    • Helps ED providers risk-stratify chest pain patients into low, moderate, and high-risk groups.
    • HEART is an acronym of its components: History, EKG, Age, Risk factors, and troponin. Each of these is scored with 0, 1 or 2 points.
    • Designed to risk stratify patients with undifferentiated chest pain, not those already diagnosed with ACS.
    • Identifies patients with higher risk of having a MACE (all-cause mortality, myocardial infarction, or coronary revascularization) within in the following 6 weeks. 
    • The user needs some experience taking a detailed chest pain history and reading EKGs to adequately apply these two components of the score.
    • Sometimes compared to TIMI Score for UA/NSTEMI and the GRACE ACS Risk Score (older ACS scores), but the latter two differ from the HEART in that they measure risk of death for patients with diagnosed ACS.
    • The HEART Score outperforms the TIMI Score for UA/NSTEMI, safely identifying more low-risk patients.

    Objectively risk-stratifies patients into low, moderate, and high-risk categories, helping guide management, leading to better resource utilization, shorter hospital and ED stays for low risk patients, and earlier interventions for moderate- and high-risk patients.

    Slightly suspicious
    0
    Moderately suspicious
    +1
    Highly suspicious
    +2
    Normal
    0
    Non-specific repolarization disturbance
    +1
    Significant ST deviation
    +2
    <45
    0
    45-64
    +1
    ≥65
    +2
    No known risk factors
    0
    1-2 risk factors
    +1
    ≥3 risk factors or history of atherosclerotic disease
    +2
    ≤normal limit
    0
    1–3× normal limit
    +1
    >3× normal limit
    +2

    Result:

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    Next Steps
    Evidence
    Creator Insights

    Management

    Scores 0-3: 0.9-1.7% risk of adverse cardiac event. In the HEART Score study, these patients were discharged (0.99% in the retrospective study, 1.7% in the prospective study)

    Scores 4-6: 12-16.6% risk of adverse cardiac event. In the HEART Score study, these patients were admitted to the hospital. (11.6% retrospective, 16.6% prospective)

    Scores ≥7: 50-65% risk of adverse cardiac event. In the HEART Score study, these patients were candidates for early invasive measures. (65.2% retrospective, 50.1% prospective)

    A MACE (Major Adverse Cardiac Event) was defined as all-cause mortality, myocardial infarction, or coronary revascularization.

    Critical Actions

    Do not use if new ST-segment elevation requiring immediate intervention or clinically unstable patients.

    About the Creator
    Dr. Barbra Backus
    Partner Content
    Decision Aids