An emergency department generally sees a hundred thousand patients a year. Approximately, six thousand of these patients present with chest pain, and around only a thousand out of these patients experience Acute Coronary Syndrome (any health condition associated with sudden blockage or reduction of blood flow to the heart). For the remaining patients, the healthcare officials need a method to risk-stratify them into low, intermediate, and high-risk groups so that the patients with a high risk of cardiac events can be given treatment before other patients. That's where the HEART score came from.

What is a HEART Score?

The HEART score is a heart-health score given to patients with chest pain admitted to the emergency department by health officials. This score is calculated using the HEART method. The best thing about this is that you necessarily do not need assistance from healthcare professionals for calculating the HEART score.

Many studies validated the HEART score scoring system and they found that it is an effective and efficient method to risk-stratify the patients with chest pain in the emergency department. A HEART score helps health officials to risk-stratify patients into low, intermediate, and high-risk groups.

How Do You Calculate the HEART Score?

The HEART score is calculated based on five elements that are also an expansion of "HEART." Those five elements include patient's history, electrocardiogram (ECG) abnormalities, patient's age, risk factor, and troponin measurement. Each of these is evaluated and given a score between 0 to 2 while the whole HEART score is given on a scale between 0 to 10.

Here is how each of the HEART elements is evaluated and calculated.

Patient's History

This element is the most subjective of all five HEART elements and so needs to be assessed carefully.

If the patient's history contains some specific elements such as:

Left-sided crushing and squeezing
Heavy chest pain that radiates arms and shoulders
Chest pain that leads to vomiting and sweating
Pain on transferring

The score for the History element should be 2.

If the patient's history contains some non-specific elements, such as right-sided pain that feel like stabbing and is reproducible with direct pressure, the score should be 0.

When the patient's history contains both specific and non-specific elements, the score should be 1.

Electrocardiogram (ECG) Abnormalities

In the case of ST-deviation in which elevation and depression are greater than 2 mm, a score of 2 is assigned.

A score of 1 is assigned for the case with non-specific repolarization disturbance, no ST deviation, LBBB, and LVH.

If the ECG is normal, a score of 0 is given.

Patient's Age

For the patients aged 65 or above, a score of 2 is given.

Patients aged between 45 to 64 receive a score of 1.

A score of 0 is given to patients aged lower than 45.

Risk Factors

The score for Risk Factor is given based on atherosclerotic diseases that are:

Hypertension
Hypercholesterolemia
Diabetes
Obesity (BMI >30)
Cigarette Smoking
Positive Family History

When the patient has 3 or more than 3 risk factors with an established atherosclerotic disease history, a score of 2 is assigned.

Patients with 1 or 2 risk factors receive a score of 1.

Patients with no known risk factors are given a score of 0.

Troponin Measurement

2 score is assigned to the patient when troponin level is 3 times higher than the reference value.

Patients receive 1 point when the troponin level of the patient is 1-3 times higher than the reference value.

0 point is given when the troponin level is below the reference value.

What Does A Heart Score Mean?

A HEART score tells about your heart's health. The patients with a HEART score between 0-3 generally have a 1.9% risk of MACE (Major Adverse Cardiac Events). For patients with a 4-6 HEART score, the risk rises to 20% while the risk averages 50-60% for the patients with more than the 6 HEART score.

Still have any doubts or queries related to the HEART Score? Visit the Medical Algorithms website and check out the blogs & article section. You will find more useful information on the same.