Decision Rule - HEART Score

HEART Score

History

  -Slightly suspicious . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  [0 points]

  -Moderately suspicious . . . . . . . . . . . . . . . . . . . . . . . . . . .  [+1 point]

  -Highly suspicious  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  [+2 points]

EKG

  -Normal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  [0 points]

  -Non-specific repolarization disturbance . . . . . . . . . . . . .  [+1 point]

    No ST deviation but LBBB, LVH, repolarization changes

  -Significant ST deviation   . . . . . . . . . . . . . . . . . . . . . . . . . .  [+2 points]

    ST deviation not due to LBBB, LVH or digoxin

Risk Factors

  -<45 years old . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  [0 points]

  -45-64 years old  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  [+1 point]

  -≥ 65 years old   . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  [+2 points]

Risk Factors

  -No known risk factors  . . . . . . . . . . . . . . . . . . . . . . . . . . . .  [0 points]

  -1-2 risk factors  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  [+1 point]

   HTN, hypercholesterolemia, DM, obesity (BMI >30 kg/m²), smoking (current or cessation ≤ 3 months), positive family history (parent or sibling with CVD before age 65)

  -≥ 3 risk factors or history of atherosclerotic disease . .  [+2 points]

   Prior MI, PCI/CABG, CVA/TIA, or peripheral arterial disease

Initial Troponin

  -≤ normal limit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  [0 points]

  -1-3 times normal limit . . . . . . . . . . . . . . . . . . . . . . . . . . .  [+1 point]

  ->3 times normal limit   . . . . . . . . . . . . . . . . . . . . . . . . . . .  [+2 points]

TOTAL SCORE = [##] points

Interpretation:

-0-3 = low score, 0.9-1.7% risk of major adverse cardiac event

-4-6 = moderate score, 12-16.6% risk of major adverse cardiac event

-≥7 = high score, 50-65% risk of major adverse cardiac event

Major adverse cardiac event (MACE) is defined as: all-cause mortality, myocardial infarction, or coronary revascularization.

https://www.mdcalc.com/heart-score-major-cardiac-events

https://epmonthly.com/wp-content/uploads/2015/10/Feb_2015_CP_Shared_Medical_Decision_Making_5-1.pdf

https://shareddecisions.mayoclinic.org/decision-aid-information/chest-pain-choice-decision-aid/