What is the Framingham Risk Score?

The Framingham Risk Score estimates the 10-year probability of developing cardiovascular disease (CVD) based on age, sex, total cholesterol, HDL cholesterol, systolic blood pressure, blood pressure treatment status, smoking status, and diabetes. A 10-year risk below 10% is low, 10–20% is intermediate, and above 20% is high. It is used to guide statin therapy and lifestyle intervention decisions in primary prevention.

When should I use the HEART score vs TIMI score for chest pain?

The HEART score is designed for initial chest pain triage in the emergency department — a low score (0–3) identifies patients safe for early discharge. The TIMI score is more appropriate once NSTEMI or unstable angina has been confirmed — it guides the decision between early invasive and conservative management strategies. Use HEART first for undifferentiated chest pain, TIMI after ACS is established.

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Cardiology Calculators

Q: What is a normal QTc interval?

A normal QTc interval is generally less than 440 ms in males and less than 460 ms in females. A QTc above 500 ms is associated with significantly increased risk of torsades de pointes (TdP) and sudden cardiac death. Drug-induced QT prolongation is a major cause of drug withdrawals and cardiac safety monitoring during therapy.

Cardiovascular risk assessment and management tools based on ACC/AHA, ESC, and Framingham Heart Study guidelines. From 10-year CVD risk prediction to QTc monitoring for drug safety — all with guideline-based interpretation built in.

ACC/AHA & ESC guidelines Instant risk stratification 4 QTc formulas compared PDF reports

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Framingham Risk Score

10-year cardiovascular disease risk using the Framingham Heart Study equations. Calculates risk for men and women separately with statin therapy thresholds, lifestyle intervention guidance, and visual risk gauge.

🔥 Most Used Use tool

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QTc Interval Calculator

Corrected QT interval using Bazett, Fridericia, Framingham, and Hodges formulas simultaneously. Drug-induced QT prolongation risk classification with CredibleMeds reference and normal range table by age and sex.

🔥 Popular Use tool

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TIMI Risk Score (UA/NSTEMI)

7-point risk score for unstable angina and NSTEMI. Predicts 14-day all-cause mortality and major ischaemic events with early invasive vs conservative management strategy guidance per ACC/AHA guidelines.

✨ New Use tool

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HEART Score

Risk stratification for undifferentiated chest pain in the ED. Scores History, ECG, Age, Risk factors, and Troponin to guide safe early discharge vs admission decisions. Validated in over 10,000 patients across multiple cohorts.

✨ New Use tool

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10-Year CVD Risk Interpretation

Based on Framingham Heart Study and ACC/AHA Pooled Cohort Equations guidance for primary prevention statin therapy decisions.

< 10%

Low Risk

Lifestyle modification advised. Statin therapy not routinely recommended unless LDL-C is substantially elevated or additional risk enhancers are present.

10–20%

Intermediate Risk

Risk discussion recommended. Moderate-intensity statin therapy should be considered. Coronary artery calcium (CAC) scoring may help refine the decision.

> 20%

High Risk

High-intensity statin therapy recommended. Blood pressure control, smoking cessation, and dietary intervention are essential. Specialist referral should be considered.

QTc Correction Formulas at a Glance

All four formulas are calculated simultaneously in our QTc Calculator. Normal QTc: <440 ms (male), <460 ms (female). Prolonged: >500 ms (high TdP risk).

Bazett

QTc = QT ÷ √RR

Most widely cited. Overestimates at high HR (>100 bpm). Standard in drug labelling and most clinical practice.

Fridericia

QTc = QT ÷ ∛RR

More accurate at extremes of heart rate. Preferred in research and drug safety studies. Recommended by EMA.

Framingham

QTc = QT + 0.154×(1−RR)

Linear correction. Performs well across a wide range of heart rates. Used in Framingham Heart Study data.

Hodges

QTc = QT + 1.75×(HR−60)

Linear correction using heart rate directly. Simple to calculate mentally. Less commonly used in modern practice.

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Sex-Specific Risk Calculation

The Framingham equations use different coefficients for men and women — because CVD risk factors carry different weights by sex. Our tool applies the correct sex-specific equation automatically.

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4 QTc Formulas Simultaneously

No other free tool shows all four QTc formulas side by side. This matters when heart rate is at an extreme where Bazett diverges significantly from Fridericia — giving you a complete picture.

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Guideline-Linked Interpretation

Every result links directly to the ACC/AHA, ESC, or study-specific management pathway — not just a number. Know what the score means and what to do next, right there on the results screen.

About Cardiology Calculators

Cardiovascular disease remains the leading cause of death and disability worldwide, responsible for approximately 18 million deaths annually. Quantifying individual risk precisely — and stratifying patients into management pathways based on validated scores — is one of the most impactful things a clinician can do in primary and secondary prevention. MediCalc Pro's cardiology tools are built directly from the original study data and aligned with current ACC/AHA and ESC guideline recommendations.

The Framingham Risk Score — Primary Prevention Foundation

The Framingham Heart Study, begun in 1948 and still ongoing, generated the foundational data for cardiovascular risk prediction in Western populations. The Framingham Risk Score uses age, sex, total cholesterol, HDL cholesterol, systolic blood pressure, antihypertensive treatment, smoking, and diabetes to estimate 10-year CVD risk. It remains the most widely taught risk tool globally and is embedded in guidelines from the British, Australian, and many other national cardiovascular societies.

Note that the 2013 ACC/AHA Pooled Cohort Equations (PCE) are now preferred in US guidelines for statin therapy decisions — our Framingham tool includes a note on this distinction and when each tool is most appropriate.

QTc Monitoring — A Drug Safety Essential

Drug-induced QT prolongation and the resulting risk of torsades de pointes (TdP) — a potentially fatal ventricular arrhythmia — has led to the withdrawal of multiple drugs from the market and is a mandatory monitoring parameter during therapy with hundreds of common medications including antipsychotics, antibiotics (particularly fluoroquinolones and macrolides), antifungals, antiemetics, and antiarrhythmics.

The QT interval must be corrected for heart rate (producing QTc) because the raw QT varies inversely with heart rate. The choice of correction formula matters — Bazett's formula, though most commonly used, overestimates QTc significantly at heart rates above 100 bpm and underestimates at bradycardic rates. Our QTc Calculator shows all four validated formulas simultaneously so you can see where they agree and where they diverge.

ACS Risk Stratification — TIMI vs. HEART

The TIMI score and HEART score are complementary rather than competing tools, designed for different stages of the clinical pathway:

Score	Best Used When	Decision It Supports	Low-Risk Threshold
HEART Score	Undifferentiated chest pain in ED	Safe early discharge vs admission	0–3: <2% MACE at 6 weeks → discharge
TIMI Score	Confirmed UA or NSTEMI	Early invasive vs conservative strategy	0–1: ~5% 14-day event rate → conservative

Frequently Asked Questions

What factors does the Framingham Risk Score use? +

The Framingham Risk Score uses: age, sex, total cholesterol (mg/dL or mmol/L), HDL cholesterol, systolic blood pressure, whether the patient is on antihypertensive treatment, smoking status (current smoker yes/no), and diabetes status. It produces a 10-year risk percentage separately for men and women using sex-specific equations. A score below 10% is low risk, 10–20% is intermediate, and above 20% is high risk.

What QTc value is considered dangerously prolonged? +

A QTc above 500 ms is considered markedly prolonged and carries significantly increased risk of torsades de pointes (TdP) and sudden cardiac death. QTc between 440–500 ms (males) or 460–500 ms (females) represents a borderline zone where drug changes, electrolyte correction, and closer monitoring are warranted. The FDA considers a drug-induced QTc prolongation of more than 20 ms a safety signal warranting investigation. Always check CredibleMeds (crediblemeds.org) for drug-specific QT risk.

How is the HEART score calculated? +

The HEART score assigns 0, 1, or 2 points to each of five criteria: History (how suspicious is the history for ACS?), ECG (normal=0, non-specific changes=1, significant ST changes=2), Age (<45=0, 45–65=1, >65=2), Risk factors (none=0, 1–2 factors=1, known atherosclerotic disease=2), and Troponin (≤normal limit=0, 1–3× normal=1, >3× normal=2). A total score of 0–3 indicates low risk (<2% MACE at 6 weeks), 4–6 moderate risk, and 7–10 high risk requiring admission and early intervention.

Is the Framingham Risk Score appropriate for all populations? +

The Framingham Risk Score was derived primarily from a predominantly white North American population. It may overestimate risk in some European populations and underestimate risk in South Asian, African, and certain other ethnic groups. For UK practice, QRISK3 is recommended. For US practice, the ACC/AHA 2013 Pooled Cohort Equations are now preferred for statin therapy decisions. For international use, the WHO/ISH risk charts provide region-specific adjustments. Our tool includes a note on population applicability alongside results.

Which QTc formula should I use in clinical practice? +

For most routine clinical practice, Bazett's formula is most commonly used because it appears in drug labels and is what most ECG machines report. However, at heart rates above 100 bpm, Bazett significantly overestimates QTc — in this situation, Fridericia is more reliable and is recommended by the European Medicines Agency (EMA) for drug safety studies. When heart rate is normal (60–100 bpm), all four formulas give similar results. Our calculator shows all four simultaneously so you always have the full picture.

Related Tools on MediCalc Pro

For stroke risk in atrial fibrillation, see CHA₂DS₂-VASc Score. For anticoagulation dosing based on CHA₂DS₂-VASc result, see the Weight-Based Dose Calculator. For DVT/PE pre-test probability, see Wells Score. For QT-prolonging drug monitoring alongside CrCl, see Creatinine Clearance. For body weight and BMI in cardiac risk context, see BMI Calculator.

References & Guidelines

Wilson PW, et al. "Prediction of coronary heart disease using risk factor categories." Circulation. 1998;97(18):1837-1847.
Goff DC Jr, et al. "2013 ACC/AHA Guideline on the Assessment of Cardiovascular Risk." JACC. 2014;63(25):2935-2959.
Bazett HC. "An analysis of the time-relations of electrocardiograms." Heart. 1920;7:353-370.
Fridericia LS. "Die Systolendauer im Elektrokardiogramm." Acta Med Scand. 1920;53:469-486.
Antman EM, et al. "The TIMI risk score for unstable angina/non-ST elevation MI." JAMA. 2000;284(7):835-842.
Backus BE, et al. "A prospective validation of the HEART score for chest pain patients." Int J Cardiol. 2013;168(3):2153-2158.

⚠️ Medical Disclaimer: Cardiology risk calculators are for educational and informational purposes only. Cardiovascular risk assessment must incorporate the patient's full clinical picture, comorbidities, and patient preferences. Always consult current clinical guidelines and a qualified cardiologist or physician for all management decisions.