What is a safe HEART score for discharge?

A HEART score of 0-3 is low risk, with a 6-week MACE rate of approximately 1.7%. These patients can generally be safely discharged from the emergency department without further cardiac investigation, subject to clinical judgement and normal troponins. Most studies support early discharge with outpatient follow-up for HEART score 0-3.

What does HEART stand for?

HEART stands for: History (suspicious features of the chest pain), ECG (findings on the 12-lead ECG), Age, Risk factors (coronary artery disease risk factors), and Troponin level (relative to normal laboratory reference range). Each component is scored 0, 1, or 2, giving a maximum total of 10.

HEART Score Calculator – Chest Pain Risk Stratification

About the HEART Score

The HEART Score was developed by Barbra Backus and colleagues in the Netherlands and published in 2010. It was designed specifically for emergency department chest pain assessment, filling a gap that TIMI and GRACE scores weren't designed for. TIMI and GRACE stratify patients with confirmed ACS; HEART works before you know whether the patient has ACS at all.

It scores 5 clinical domains (History, ECG, Age, Risk factors, Troponin) from 0 to 2 each, giving a maximum of 10. Multiple validation studies across thousands of ED patients confirm its accuracy and safety for early discharge in low-risk patients.

6-Week MACE by HEART score

Score	Risk	6-Week MACE	Recommendation
0-3	Low	~1.7%	Early discharge with outpatient follow-up. Serial troponins per local protocol.
4-6	Moderate	~12%	Observation, serial troponins, non-invasive testing. Admit if troponins rise or symptoms persist.
7-10	High	~65%	Admission, cardiology referral, early invasive strategy. Treat as likely ACS.

HEART Pathway

The HEART Pathway adds a 3-hour serial troponin to the score and defines discharge criteria for score 0-3 with 2 negative troponins. Several large studies (HEART Pathway trial, Mahler 2015) confirm a 20% reduction in hospitalisation with no increase in adverse events using this approach. Most major emergency medicine guidelines now endorse HEART or HEART Pathway.

HEART vs TIMI for chest pain

Use HEART for undifferentiated chest pain in the ED when you don't yet know the diagnosis. Use TIMI Score after you've established a diagnosis of UA or NSTEMI and need to decide on invasive vs conservative management. They answer different questions at different points in the clinical pathway.

Related tools

For confirmed UA/NSTEMI, see TIMI Score. For 10-year CVD risk, see Framingham Risk Score. For QTc during antiarrhythmic treatment, see QTc Calculator. For AF and anticoagulation, see CHA2DS2-VASc Score. For DVT/PE, see Wells Score. For renal dosing, see Creatinine Clearance.

References

Backus BE, et al. "A prospective validation of the HEART score for chest pain patients at the emergency department." Int J Cardiol. 2010;168(3):2153-2158.
Mahler SA, et al. "The HEART pathway randomized trial." Circ Cardiovasc Qual Outcomes. 2015;8(2):195-203.
Six AJ, et al. "The HEART score for the assessment of patients with chest pain in the emergency department." Crit Pathw Cardiol. 2010;9(3):164-169.

Clinical note: The HEART Score supports clinical decision-making, not replaces it. Always factor in the clinical gestalt, dynamic troponin changes, patient comorbidities, and your institution's pathway before making discharge decisions.