Heart Score for Major Cardiac Events Calculator

How does this heart score for major cardiac events calculator work?

This health tool presents a scoring system designed to stratify risk in patients that present themselves with chest pain, especially in the ER setting. It evaluates five risk factors and assumes a score accompanied by the probability for that individual to suffer a major adverse cardiac event (MACE) in the following 6 weeks. This heart score calculator provides the criteria, makes the calculations and displays the probability plus the next step that is recommended.

These are the factors taken into account in the HEART score:

■ Patient history – that considers any significant events and gives from 0 to 2 points based on how suspicious (relevant risk factor) the history presented is.

■ ECG – monitors any specific or non specific repolarisation disturbance such as significant ST depression which is considered to have prognostic value.

■ Age – this is another common risk factor used to assess cardiovascular risk in general and in the heart model ages above 65 are awarded the maximum number of points: 2, ages between 45 and 65 are awarded 1 point while everything under 45 corresponds to 0 points.

■ Risk factors – the heart scoring system enumerates at this stage 5 other conditions that are said to increase the chances of MACE (Hypercholesterolemia, Hypertension, diabetes, smoking, obesity). If more than 3 are chosen, the calculator awards 2 points and for 1 or 2 risk factors it awards 1 point.

■ Troponin – this is the protein complex involved in the contraction of the cardiac muscle. It is usually released when the heart muscle is damaged, for example in a heart attack. The higher the amount, the greater the existant or prospective damage.

Each of the five criteria is awarded points, from 0 to 2 with a total ranging from 0 to 10 and there are three groups of risk:

Scores 0 – 3: Low risk of MACE (major adverse cardiac events) occurring (1.7%) where discharge can be an option.

Scores 4 – 6: Intermediate risk of MACE of 20.3% and recommendation for clinical observation and investigations.

Score 7 – 10: High risk of MACE (72.7%) with recommendation for immediate invasive treatment. 

Major adverse cardiac events (MACE)

This is a group of conditions defines as cardiac death, target lesion revascularization and nonfatal myocardial infarction that have as characteristic the fact that they occur suddenly and result in high mortality and morbidity, thus their incidence and prognosis is a very sensible area.

Sudden cardiac death (SCD) is an unexpected death caused by sudden cardiac arrest which means the loss of heart function. It is a condition responsible for about half of heart disease mortality.

Sudden cardiac arrest vs heart attack – the first occurs when the electrical system of the heart becomes suddenly irregular with ventricle flutter or fibrillation and the blood circulation is impaired and due to the dramatic decrease in blood flow to the brain, the patient loses consciousness and exitus is likely unless emergency operations are begun. The second, myocardial infarction occurs when there is a blockage in the arteries to the heart that prevent blood flow and oxygenation of the cardiac muscle.

Cardiovascular risk factors

CVD risk factors are related to physical status and constants but also to habits and on some, there can be intervened with simple lifestyle changes and on others with medication.

Age – increases risk of CVD because of the physiological changes the heart has with age.

Gender – men of all ages have a higher risk than pre menopausal women but after menopause the risk is similar between genders.

Family and personal history

Physical status – lack of exercise

Diet- Obesity or unhealthy diet

Smoking

Diabetes mellitus

Hypertension – high blood pressure

Cholesterol – High total cholesterol

References

1) Six AJ, Backus BE, Kelder JC. (2008) Chest pain in the emergency room: value of the HEART score. Neth Heart J; 16(6): 191–196.

2) Six AJ, Cullen L, Backus BE, Greenslade J, Parsonage W, Aldous S, Doevendans PA, Than M. (2013) The HEART score for the assessment of patients with chest pain in the emergency department: a multinational validation study. Crit Pathw Cardiol; 12(3):121-6.

3) Choi WS, Lee JH, Park SH, Kim KH, Kang JK, Kim NY, Cho HJ, Yoon JY, Lee SH, Bae MH, Ryu HM, Yang DH, Park HS, Cho Y, Chae SC, Jun JE, Park WH. (2011) Prognostic value of standard electrocardiographic parameters for predicting major adverse cardiac events after acute myocardial infarction. Ann Noninvasive Electrocardiol; 16(1):56-63