• Adult patients ≥ 18 years presenting with chest pain to Emergency or Internal Medicine
• Stratify risk of 30-day MACE (death, MI, or revascularisation)
• Guide decision between early discharge vs admission and invasive workup
• Combine with serial troponins (at 0h and 2–3h) for optimal accuracy

• H — History: Ischaemic character of chest pain
• E — ECG: ST deviation, LBBB, LVH, or repolarisation changes
• A — Age: < 45 = 0, 45–64 = 1, ≥ 65 = 2
• R — Risk factors: Known atherosclerosis scores 2; ≥ 3 risk factors = 2; 1–2 risk factors = 1
• T — Troponin: ≤ normal = 0; 1–3× ULN = 1; > 3× ULN = 2

• Score 0–3 (Low): 1.7% MACE. Early discharge safe with negative troponins.
• Score 4–6 (Moderate): 12% MACE. Observation, serial troponins, stress testing.
• Score 7–10 (High): 65% MACE. Early invasive strategy — catheterisation lab consultation.

• HEART is simpler than GRACE (no haemodynamics calculation required)
• HEART is better calibrated for ED chest pain than TIMI (which was derived in ACS patients)
• HEART score has been validated in > 50,000 patients across 20+ countries

• HEART 0–3 + 2 negative hs-troponins: Discharge home. Outpatient cardiology/stress test within 72h.
• HEART 4–6: Observation unit or admit. Stress test or coronary CTA. Cardiology consult.
• HEART 7–10: Full ACS management. Antiplatelet therapy. Anticoagulation. Urgent cath lab referral.

Developed in the Netherlands by AJ Six and colleagues in 2008 as a simple bedside tool combining five clinical domains, each scored 0–2. Its elegant acronym (History, ECG, Age, Risk factors, Troponin) allows recall without a calculator. It has since become the dominant chest pain pathway tool in emergency medicine globally.