The HEART score for the assessment of patients with chest pain in the emergency department: a multinational validation study

Crit Pathw Cardiol. 2013 Sep;12(3):121-6. doi: 10.1097/HPC.0b013e31828b327e.


Objective: The HEART score for the early risk stratification of patients presenting to the emergency department with chest pain contains 5 elements: history, electrocardiogram, age, risk factors, and troponin. It has been validated in The Netherlands. The purpose of this investigation was to perform an external validation of the HEART score in an Asia-Pacific population.

Methods: Data were used from 2906 patients presenting with chest pain to the emergency departments of 14 hospitals. HEART scores were determined retrospectively. Three risk groups were composed based on previous research. The predictive values for the occurrence of 30-day major adverse coronary events (MACE) were assessed. A comparison was made with the Thrombolysis in Myocardial Infarction (TIMI) score in terms of the value of C-statistics.

Results: The low-risk group, HEART score ≤ 3, consisted of 820/2906 patients (28.2%). Fourteen (1.7%) patients were incorrectly defined as low risk (false negatives). The high-risk population, HEART score 7-10, consisted of 464 patients (16%) with a risk of MACE of 43.1%. The C-statistics were 0.83 (0.81-0.85) for HEART and 0.75 (0.72-0.77) for TIMI (P < 0.01).

Conclusions: Utilization of the HEART score provided excellent determination of risk for 30-day MACE, comparing well with the Thrombolysis in Myocardial Infarction score. This study externally validates previous findings that HEART is a powerful clinical tool in this setting. It quickly identifies both a large proportion of low-risk patients, in whom early discharge without additional testing goes with a risk of MACE of only 1.7%, and high-risk patients who are potential candidates for early invasive strategies.

Publication types

  • Validation Study

MeSH terms

  • Acute Coronary Syndrome / complications
  • Acute Coronary Syndrome / diagnosis*
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Chest Pain / etiology*
  • Electrocardiography
  • Emergency Service, Hospital
  • Female
  • Humans
  • Male
  • Middle Aged
  • Retrospective Studies
  • Risk Assessment / methods*
  • Risk Factors
  • Troponin I / blood
  • Troponin T / blood


  • Troponin I
  • Troponin T