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HEART Score
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HEART Score
See Also
Chest Pain
Acute
Chest Pain
Angina Diagnosis
Cardiac Risk Assessment
Cardiac Risk Management
Coronary Risk Stratification of Chest Pain
TIMI Risk Score
Bosner Chest Pain Decision Rule
Cardiac Risk in Diabetes Score
Chest Wall Pain Prediction Rule
Framingham Score
Cardiac Risk in Diabetes Score
GRACE Score
Vancouver Chest Pain Rule
Indications
Chest Pain
risk stratification in the emergency department
Criteria
History
Score 2: History highly suspicious for coronary syndrome
Score 1: History moderately suspicious for coronary syndrome
Score 0: History slightly suspicious for coronary syndrome
Electrocardiogram
(EKG)
Score 2: EKG with Significant ST Depression
Score 1: EKG with Non-specific repolarization disturbance
Score 0: EKG Normal
Age
Score 2: Age 65 years or older
Score 1: Age 45 to 65 years old
Score 0: Age <45 years old
Risk Factors
Score 2: Three or more risk factors for or history of atherosclerotic disease
Score 1: One to 2 risk factors for atherosclerotic disease
Score 0: No risk factors for atherosclerotic disease
Troponin
Score 2: More than twice the normal
Troponin
upper limit
Score 1: One to 2 times the normal
Troponin
upper limit
Score 0: Within normal limits for
Troponin
levels
Interpretation
Based on sum of 5 criteria above (of total possible points 10)
Total Score 0-3
Adverse outcome risk: 2.5% (very low to low risk)
Supports early discharge with appropriate follow-up
Total Score 4-6
Adverse outcome risk: 20.3% (moderate risk)
Supports admission with standard rule-out management (serial
Troponin
s) and stress testing
Total Score 7-10
Adverse outcome risk: 72.7% (high to very high risk)
Risk in first 30 days >50%
Supports early aggressive management and typically with cardiac catheterization
Efficacy
Allows for meaningful risk stratification of
Low Risk Chest Pain
Identifies 36% of
Low Risk Chest Pain
patients as lower risk for adverse event (HEART Score 0-3)
Contrast with TIMI Score which only risk stratified 5% of the same low risk patients
Identifies high risk patients (HEART Score >6) who have a >50% risk of adverse event in the next 30 days
References
Swadron and Mallon in Herbert (2015) EM:Rap 15(12): 11-2
Bachus (2013) Int J Cardiol 168(3): 2153-8 +PMID: 23465250 [PubMed]
References
Six (2008) Neth Heart J 16(6):191-6 [PubMed]
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