Slightly or non-suspicious
Initial troponin
Below normal cutoff
Risk factors
No known risk factors
HEART score

Are you looking for a quick and reliable tool to calculate someone's risk of a major cardiovascular event? If so, this HEART score calculator is the perfect for your needs. As chest pain is a common reason for visiting the emergency room, it is useful to be able to immediate identify whether the patient at low-, medium- or high-risk.

In the article below, you'll find some more information on what is MACE, the current MACE definition, what the most common risk factors for MACE are, as well as explanation on why an adequate ECG interpretation is crucial.

We try our best to make our Omni Calculators as precise and reliable as possible. However, this tool can never replace a professional doctor's assessment. If any health condition bothers you, consult a physician.

What is MACE?

MACE stands for "major adverse cardiovascular event". A "major adverse cardiovascular event" is made up of all-cause mortality, AMI (acute myocardial infarction), need for percutaneous coronary intervention (PCI), or coronary artery bypass graft (CABG), and death within six weeks. While the MACE definition may sound complicated, don't be scared! We will clearly explain everything.

What you need to know is that various risk factors increase the chances that a person will suffer from MACE. Among those, you can find:

  • CAD (Coronary Artery Disease)
  • Age (above 65, the risk rises)
  • Coronary stenosis
  • Dyslipidemia, abnormal amount of lipids in the blood
  • Diabetes mellitus (DM); even if you don't have it yet, it's always recommendable to check your blood sugar levels regularly, especially if you're at a higher risk of DM.

How can I reduce my cardiovascular risk?

First of all, lose some weight. No matter how naive it may seem, losing some kilograms reduces the amount of bad lipids in the blood. Also, your blood pressure and blood sugar levels will be lower. All of this, just thanks to a balanced diet combined with regular exercises (at least 150 mins of moderate-intensity exercises a week or 75 mins of vigorous training a week). Keeping your BMI within the normal ranges is the key to health and ACS risk reduction.

Unfortunately, there isn't so much you can do about your family history or your age (we wish we could). The one last thing you should keep in mind is that you should quit smoking to reduce the risk.

Purpose of the HEART score calculator

This HEART score tool aims to sort patients with chest pain without a known cause into different risk categories. It should not be used on those already diagnosed with ACS.

The calculator identifies those who are at low risk of developing MACE (you can find the MACE definition above ☝️) in the following six weeks, and are, therefore, suitable for an earlier discharge from the emergency department. Low-risk patients may go home without admission to the hospital for additional evaluation. On the other hand, in the case of moderate risk patients require further testing, and may require an observation of their cardiac performance. The last group is patients at a high risk of MACE, in which case the physician should consider an urgent intervention.

HEART score risk factors

In this HEART score calculator, there are five risk factors taken into consideration. The points assigned for each answer are given in brackets:

  1. Age, if 45 years and younger (0), 46-64 years (1), 65 years and older (2)

  2. 12-lead electrocardiogram:

    • Normal (0)
    • Abnormal ECG, with repolarization abnormalities, such as BBB, LVH, digoxin effect, implanted right-ventricular pacemaker, past MI (myocardial infarction), or unchanged repolarization abnormalities, but no significant ST depression (1)
    • Abnormal ECG, with significant ST deviation (depression or elevation), new or not known to be old, i.e., no previous ECG to compare with (2)
  3. History:

    • Nonspecific history for ACS (acute coronary syndrome), not consistent with ACS-like chest pain (0)
    • Mixed elements, contains typical and non-typical elements of ACS (1)
    • Specific history for ACS, traditional features of ACS (2)
  4. Initial troponin:

    • Within the normal range (0)
    • Elevated 1–3 times (1)
    • Elevated more than three times (2)

    Compare with the laboratory norms!

  5. Risk factors:

    If no risk factors (0), one or two known risk factors (1), three and more risk factors (2).

All of the points assigned to each answer are then tallied up to give the HEART score, which is between 0 and 10 points. A low-risk patient is one who scores three or less; their risk of MACE is up to 1.7%. A medium-risk patient receives between 4 and 6 points, and their risk is between 12-17%. Those who receive seven or above are high-risk patients, representing a risk of 50-65%.

HEART score calculator in practice

Let's put this theory into a practical example. Jake is a 71-year-old man with a history of some non-traditional ACS symptoms. This is mixed with a history of some typical ACS symptoms. He has some known changes in his ECG from his medical record. His troponin levels are 1.5 times higher than the lab norm. On top of all of that, Jake has diabetes and poorly controlled hypertension. His doctor explained to him what is MACE and calculated his HEART:

  • Age, 71 (2)
  • ECG, abnormal but with known ST deviation (1)
  • History, mixed elements (1)
  • Initial troponin, elevated 1.5 times (1)
  • Two risk factors (1)

His HEART score is 6 in total, which places him among medium-risk patients. The physician should consider further testing and observation.

Dominika Miszewska