TIMI Score for UA/NSTEMI Calculator
Calculate the TIMI UA/NSTEMI score as a bedside prognostic summary using the original 14-day composite event framework.
HEART Score Calculator
Calculate the HEART score for chest pain risk stratification in the emergency department. Predicts 6-week major adverse cardiac events (MACE) risk.
⚠️ Medical Disclaimer: The HEART score is a clinical decision aid for chest pain evaluation in the ED. It does not replace clinical judgment. Patients with ongoing chest pain, hemodynamic instability, or STEMI require emergent management regardless of HEART score.
years
1
2
3
4
5
6
7
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9
10
Low (0-3)Moderate (4-6)High (7-10)
HEART Score
3
Low Risk
6-week MACE: ~0.9-1.7%
History
1/2
ECG
1/2
Age
0/2
Risk factors
1/2
Troponin
0/2
HEART Score⧉
3 / 10
Low Risk
6-Week MACE Risk⧉
0.9-1.7%
Major adverse cardiac events
Disposition⧉
Consider discharge
Consider early discharge, outpatient follow-up
Age Points⧉
0
Age 60: <65
Troponin Status⧉
Normal
Serial troponins recommended
Stress Test Indication⧉
Outpatient stress test
Based on HEART pathway
| HEART Score | Risk | MACE Rate | Recommendation |
|---|---|---|---|
| 0-3 | Low | 0.9-1.7% | Discharge with outpatient follow-up / stress test |
| 4-6 | Moderate | 12-16.6% | Admit — stress test or coronary CTA |
| 7-10 | High | 50-65% | Urgent invasive management (cardiac catheterization) |
| Component | 0 points | 1 point | 2 points |
|---|---|---|---|
| H — History | Slightly suspicious | Moderately suspicious | Highly suspicious |
| E — ECG | Normal | Non-specific changes | Significant ST deviation |
| A — Age | <45 | 45-64 | ≥65 |
| R — Risk Factors | None known | 1-2 factors | ≥3 or known disease |
| T — Troponin | Normal | 1-3× ULN | >3× ULN |
Planning notes, formulas, and examples
About the HEART Score Calculator
The HEART score is a validated clinical decision aid for risk-stratifying patients presenting with chest pain to the emergency department. Developed by Backus et al. in 2008 and validated in the HEART Pathway trial, it evaluates five components: History, ECG, Age, Risk factors, and Troponin to predict the 6-week risk of major adverse cardiac events (MACE) — myocardial infarction, PCI/CABG, or death.
The HEART score excels at identifying truly low-risk patients (score 0-3) who can be safely discharged with outpatient follow-up, reducing unnecessary admissions by 20-30% compared to conventional practice without increasing missed MI rates. At the other extreme, high scores (7-10) identify patients who benefit from urgent invasive evaluation.
The HEART Pathway (serial troponins + HEART score) has been adopted by many emergency departments as a standard chest pain protocol, improving both patient safety and resource utilization. This calculator keeps the scoring logic visible so clinicians can follow the individual components before applying a pathway decision.
When This Page Helps
Chest pain is one of the most common ED presentations (8+ million visits/year in the US), but only 10-15% have acute coronary syndrome. The HEART score safely identifies the ~40% of patients who are truly low-risk, enabling early discharge with outpatient stress testing rather than costly observation stays.
Compared to TIMI and GRACE scores, the HEART score has better sensitivity for detecting low-risk patients and is specifically designed and validated for the undifferentiated ED chest pain population.
How to Use the Inputs
- Enter the patient’s age.
- Assess the history — how suspicious is the chest pain for ACS?
- Evaluate the ECG for ischemic changes.
- Check initial troponin results.
- Assess cardiovascular risk factors.
- Sum the HEART score (0-10).
- Apply the HEART pathway: low risk → discharge, moderate → observation, high → invasive strategy.
Formula used
HEART = History + ECG + Age + Risk Factors + Troponin
History: Slightly suspicious (0), Moderately (1), Highly (2)
ECG: Normal (0), Non-specific (1), Significant ST changes (2)
Age: <45 (0), 45-64 (1), ≥65 (2)
Risk Factors: None (0), 1-2 (1), ≥3 or known atherosclerosis (2)
Troponin: Normal (0), 1-3× ULN (1), >3× ULN (2)
Total range: 0-10Example Calculation
Result: HEART Score 4 — Moderate Risk
A 60-year-old with moderately suspicious chest pain, non-specific ECG changes, normal troponin, and 1-2 risk factors scores 4 points. This falls in the moderate range (~12-17% MACE). Admission for serial troponins and non-invasive evaluation (stress test or CCTA) is recommended.
Tips & Best Practices
- The HEART score is ONLY for ACS risk stratification — rule out aortic dissection, PE, pneumothorax clinically first.
- Two negative troponins (0h and 3h) are required for safe discharge with HEART ≤3.
- History is the most subjective component — when in doubt, score 1 (moderately suspicious).
- Non-specific ECG changes include RBBB, LVH strain, old Q waves — score 1 for these.
- The original age cutoffs may underestimate risk in younger patients with concerning presentations.
- In women, atypical presentations (fatigue, dyspnea, nausea) are more common — adjust history scoring.
The HEART Pathway Protocol
The HEART Pathway combines the HEART score with serial high-sensitivity troponin measurements. At 0 hours and 3 hours (or 0 and 1 hour with rapid hs-troponin), patients with HEART ≤3 and negative troponins are classified as low risk and eligible for discharge. This protocol has been shown to reduce hospitalizations by 20% and reduce healthcare costs by $1,200 per patient without increasing adverse events.
Implementation Considerations
Successful HEART score implementation requires ED-wide education, embedded EMR tools, and clear pathways for outpatient follow-up. Common barriers include physician discomfort with early discharge, lack of rapid outpatient stress testing access, and medicolegal concerns. Structured implementation with departmental buy-in overcomes these barriers.
Limitations and Special Populations
The HEART score has limited validation in populations under 30, patients with left bundle branch block (which makes ECG interpretation difficult), patients on chronic anticoagulation, and those with end-stage renal disease (elevated baseline troponin). Clinical judgment should override the score in presentations with high clinical concern regardless of HEART score.
Sources & Methodology
Last updated:
Methodology
This calculator applies the HEART score by assigning 0 to 2 points across the five standard domains: History, ECG, Age, Risk factors, and Troponin. It sums the points into the standard 0-10 total and groups the result into the usual low-, intermediate-, and high-risk bands used in emergency-department chest-pain pathways.
The page is designed as a decision-support summary rather than an ACS diagnosis. It does not replace serial troponin protocols, ECG interpretation, clinical assessment for alternative emergencies, or local chest-pain pathways. The score is most useful when combined with serial biomarker testing and a clear disposition protocol.
Sources
- Chest pain in the emergency room: value of the HEART score (PubMed / Netherlands Heart Journal)
- A prospective validation of the HEART score for chest pain patients at the emergency department (PubMed / International Journal of Cardiology)
Frequently Asked Questions
The HEART Pathway trial showed that patients with HEART ≤3 AND two negative troponins (0h and 3h) had a 30-day MACE rate of <2%. These patients can be safely discharged with outpatient follow-up, typically including stress testing within 72 hours. This approach is endorsed by multiple professional societies.
Score 0 for atypical features (pleuritic, positional, reproducible). Score 1 for mixed features. Score 2 for classic ACS features: substernal pressure, radiation to arm/jaw, diaphoresis, exertional, response to nitroglycerin. The history assessment is the most subjective component and has the lowest inter-rater reliability.
Serial troponins (0h and 3h, or 0h and 1h with high-sensitivity assays) are essential. A rising pattern (delta troponin) is more specific for MI than absolute levels. The HEART pathway specifically requires negative serial troponins for safe low-risk classification.
TIMI was developed for confirmed ACS, while HEART was designed for undifferentiated ED chest pain. HEART has better sensitivity (~96-99%) for identifying truly low-risk patients. TIMI classifies more patients as moderate/high risk, leading to more admissions without improving outcomes. HEART is preferred for ED risk stratification.
Yes. HEART has been validated with both conventional and high-sensitivity troponin assays. With hs-troponin, the 0h/1h algorithm can be combined with HEART for faster triage. Some centers use HEART ≤3 + hs-troponin <52 ng/L as rapid discharge criteria.
Standard cardiovascular risk factors: hypertension, hyperlipidemia, diabetes, current smoking, obesity (BMI >30), family history of premature CAD, and known atherosclerotic disease (prior MI, PCI, CABG, stroke, PAD). Score 2 if ≥3 factors present or known atherosclerosis.
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