ToolsCalculators
HEAR Score
Identifies very-low-risk chest pain patients who may not need troponin testing.
HEAR Score
History
ECG
Age
Risk factors
HTN, hypercholesterolaemia, diabetes, obesity (BMI>30), smoking (current or <3mo), family history, or known atherosclerotic disease.
Result0 points
Very low risk of 30-day acute MI or death; troponin testing may reasonably be deferred or limited to a single measurement per local protocol.
- Risk category
- Very low risk (<=1 point)
When to use
- Deciding, before any troponin result is available, whether biomarker testing can reasonably be deferred in a patient with possible acute coronary syndrome.
Formula
Same History, ECG, Age, and Risk-factor items as the HEART score (0-2 points each, total 0-8), omitting the Troponin component. Score <=1 identifies a very-low-risk group.
Pearls and pitfalls
- Derived by removing the Troponin item from the HEART score; a score <=1 had a 30-day AMI/death rate of about 0.1% in the validation cohort.
- Score >=2 does not itself imply high risk - it simply means troponin testing (i.e. the full HEART score) is still needed.