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Free HEART Score Calculator (2026)
The HEART Score is a five-variable bedside tool that estimates the 6-week risk of a major adverse cardiac event (MACE) — death, myocardial infarction, or urgent revascularization — in adult patients presenting to the emergency department with chest pain. It combines History, ECG, Age, Risk factors, and Troponin (hence HEART), each scored 0, 1, or 2 points for a total out of 10. Rather than treating chest pain as one undifferentiated risk, HEART separates patients into low-, moderate-, and high-risk bands that map onto different disposition decisions — early discharge, observation, or admission for further work-up. It is meant to be used after a first ECG and troponin, alongside clinical judgment, not before them. Enter the five components below to calculate a patient’s HEART Score instantly.
Clinical decision-support aid, not a substitute for clinical judgment. These tools implement published scoring criteria for education and workflow support. They are not a medical device and have not been reviewed by the FDA or any regulatory body. Every result should be interpreted by a qualified clinician in the context of the full clinical picture, not used as a standalone diagnostic or treatment decision.
Chest pain risk stratification
HEART Score
Estimates 6-week risk of a major adverse cardiac event (MACE) in patients presenting with chest pain, from five bedside-available components.
HTN, hypercholesterolemia, diabetes, obesity (BMI>30), smoking (current or ≤3mo), family history, prior MI/PCI/CABG/stroke/PAD
Six AJ, et al. Neth Heart J. 2008;16(6):191–196 · Backus BE, et al. Int J Cardiol. 2013;168(3):2153–2158 · Six AJ, et al. Crit Pathw Cardiol. 2010;9(3):164–169.
A fully worked example
Consider a 58-year-old man presenting with chest pain whose history is moderately suspicious for acute coronary syndrome (1 point), whose ECG shows a non-specific repolarization disturbance rather than a normal tracing or significant ST deviation (1 point), whose age of 58 falls in the 45–64 bracket (1 point), who has two known cardiovascular risk factors (1 point), and whose initial troponin is 1–3 times the normal limit (1 point). Adding the five components gives a HEART Score of 5 out of 10 — moderate risk, corresponding to roughly a 12–16.6% risk of a major adverse cardiac event within 6 weeks. A moderate-risk score like this one typically supports admission for observation and serial troponins rather than immediate discharge, though the score is always read alongside the clinical gestalt, never in isolation. Try the same five inputs in the calculator above to see the readout it produces.
Methods, assumptions, and when not to use HEART
For a manuscript methods section, the HEART Score can be cited in a single sentence: “Chest pain risk was stratified using the HEART score (Six et al., Neth Heart J 2008; Backus et al., Int J Cardiol 2013).” Because HEART is a fixed, validated point-score rather than a fitted or site-specific model, citing its derivation and validation studies is sufficient methodological documentation.
HEART is for suspected acute coronary syndrome presenting as chest pain of uncertain cause. It is not for patients with a clear ST-elevation myocardial infarction (STEMI), where the priority is immediate reperfusion therapy independent of any risk score, and it is not intended for patients whose pain has another obvious explanation on initial assessment. HEART should never delay the first ECG or initial troponin — it is calculated using those results, not instead of obtaining them.
What does a HEART Score of 5 mean?
A HEART Score of 5 falls in the moderate-risk band (scores 4–6), corresponding to roughly a 12–16.6% risk of a major adverse cardiac event within 6 weeks. In practice, moderate-risk patients are generally not discharged directly from the emergency department; they typically warrant observation, serial troponins, and further cardiology input rather than either the early discharge appropriate for low-risk scores (0–3) or the urgent invasive work-up appropriate for high-risk scores (7–10).
How is the HEART Score different from TIMI or GRACE?
HEART, TIMI, and GRACE all stratify cardiac risk, but they were derived for different populations and moments in the diagnostic pathway. TIMI was derived in patients already diagnosed with unstable angina or NSTEMI, to help decide between an early invasive and a conservative strategy. GRACE was derived from a broader acute coronary syndrome registry and is typically used for in-hospital risk stratification once a diagnosis is already established. HEART, by contrast, was derived specifically for the undifferentiated chest-pain population in the emergency department — before any diagnosis of ACS has been made — to help decide who can be safely discharged versus who needs further observation or admission.
Can the HEART Score be used before troponin results are back?
Troponin is one of the five required inputs, so a complete HEART Score needs at least an initial troponin result. Some clinicians informally track a partial four-variable score while troponin is pending to get an early sense of risk, but the validated score requires all five components, and disposition decisions should be based on the complete score rather than a partial one.
Primary references
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.
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.
Six AJ, Cullen L, Backus BE, et al. The HEART score for the assessment of patients with chest pain in the emergency department: a multinational validation study. Crit Pathw Cardiol. 2010;9(3):164–169.
Running an emergency-department chest-pain cohort study?
Risk scores like HEART are only as useful as the outcomes data validating them. If your next project involves an ED chest-pain or cardiology outcomes cohort, Editverse’s NTDB/TQP Trauma Registry Study service handles registry access, cohort definition, risk-adjusted modelling, and a publication-ready manuscript. See the registry study service