HEART & TIMI Score Calculator
Chest-pain risk with the HEART score, and TIMI risk for NSTEMI and STEMI.
How the score adds up
| Item | Patient | Points |
|---|---|---|
| Total | ||
What the score means
For clinicians. These scores grade risk in patients being assessed for an acute coronary syndrome; they support, and do not replace, clinical judgement, serial ECGs and troponins, and local chest pain pathways. Anyone with ongoing chest pain or ST elevation needs emergency care now.
For general information only, not medical advice. Consult a qualified health professional for advice about your situation.
About the HEART & TIMI Score Calculator
Three risk scores for patients assessed for an acute coronary syndrome, with what each score meant in the studies that built it:
- the HEART score — History, ECG, Age, Risk factors and Troponin, 0 to 2 points each — for chest pain in the emergency department, with the risk of a major adverse cardiac event within 6 weeks;
- the TIMI risk score for UA/NSTEMI — seven yes-or-no items — with the risk of death, myocardial infarction or urgent revascularisation within 14 days;
- the TIMI risk score for STEMI — eight weighted items, 0 to 14 points — with the risk of death within 30 days.
Type the age once and tick what applies; the risk factors are shared between HEART and TIMI UA/NSTEMI, each counted the way its own score defines them. Written for clinicians; nothing leaves your browser.
How to use it
- Choose the score: HEART for undifferentiated chest pain, TIMI UA/NSTEMI once unstable angina or NSTEMI is diagnosed, TIMI STEMI for ST-elevation infarction. A link ending in
#heart,#timi-uaor#timi-stemiopens that score. - Enter the age, then choose or tick each item. The points are shown beside every answer.
- Read the total, the published risk for that score and, for HEART, the policy its authors proposed. The table shows how each item scored.
- Use Copy result to paste the score, its components and the risk into your notes.
Examples
1 + 0 + 1 + 1 + 0 = 3 — low risk: major adverse cardiac events in 1.7% within 6 weeks; the authors’ policy supports early discharge.
2 + 1 + 2 + 1 + 1 = 7 — high risk (50.1% had an event).
1 + 1 + 1 + 1 + 1 = 5 — 26.2% risk of death, MI or urgent revascularisation within 14 days.
2 + 1 + 2 + 1 = 6 — 16.1% mortality at 30 days.
Common uses
- Deciding between early discharge, observation and early invasive care for an emergency chest pain patient.
- Grading risk in a patient admitted with NSTEMI or unstable angina.
- Estimating short-term mortality after a STEMI for counselling and handover.
- Documenting the score and its components in the notes.
HEART score
- History: slightly suspicious 0 · moderately suspicious 1 · highly suspicious 2
- ECG: normal 0 · non-specific repolarisation disturbance, LBBB or paced rhythm 1 · significant ST deviation 2
- Age: 45 or under 0 · 46 to 64 1 · 65 or over 2
- Risk factors (hypercholesterolaemia, hypertension, diabetes, smoking, family history, obesity with a BMI over 30): none known 0 · 1 or 2 risk factors 1 · 3 or more, or a history of atherosclerotic disease, 2
- Troponin: at or below the normal limit 0 · 1 to 3 times the normal limit 1 · 3 times or more 2
In the prospective validation of 2,440 unselected chest pain patients in 10 Dutch hospitals, major adverse cardiac events (myocardial infarction, PCI, CABG or death) within 6 weeks occurred in 1.7% with 0–3 points, 16.6% with 4–6 and 50.1% with 7–10. Its c-statistic, 0.83, was higher than TIMI’s (0.75) and GRACE’s (0.70). The HEART study group proposes early discharge for 0–3, admission for observation and non-invasive testing for 4–6, and early aggressive treatment, possibly invasive, for 7 or more.
TIMI risk score for UA/NSTEMI
One point each: age 65 or over · 3 or more coronary risk factors (family history of coronary artery disease, hypertension, hypercholesterolaemia, diabetes, current smoking) · known coronary stenosis of 50% or more · aspirin in the past 7 days · 2 or more anginal episodes in the past 24 hours · ST deviation of 0.5 mm or more · raised cardiac markers.
Risk of all-cause death, new or recurrent myocardial infarction, or severe recurrent ischaemia requiring urgent revascularisation within 14 days, in the TIMI 11B test cohort: 4.7% with 0–1 points · 8.3% with 2 · 13.2% with 3 · 19.9% with 4 · 26.2% with 5 · 40.9% with 6–7. The pattern held in three validation cohorts from the TIMI 11B and ESSENCE trials.
TIMI risk score for STEMI
Age 65–74 2, 75 or over 3 · diabetes, hypertension or angina 1 · systolic blood pressure below 100 mmHg 3 · heart rate above 100 2 · Killip class II–IV 2 · weight below 67 kg 1 · anterior ST elevation or left bundle branch block 1 · time to treatment over 4 hours 1. Range 0–14.
Mortality within 30 days in the InTIME II trial (14,114 patients eligible for fibrinolysis): 0 points 0.8% · 1 1.6% · 2 2.2% · 3 4.4% · 4 7.3% · 5 12.4% · 6 16.1% · 7 23.4% · 8 26.8% · more than 8 35.9%. External validation in the TIMI 9 trial gave similar results.
Sources
- HEART score — the HEART study group’s scoring card, results and proposed policy
- Six AJ, Backus BE, Kelder JC. Chest pain in the emergency room: value of the HEART score · Backus BE et al. A multicenter validation of the HEART score · A prospective validation of the HEART score for chest pain patients at the emergency department
- Antman EM et al. The TIMI risk score for unstable angina/non-ST elevation MI · TIMI Study Group: TIMI risk score calculator for UA/NSTEMI
- Morrow DA et al. TIMI risk score for ST-elevation myocardial infarction · TIMI Study Group: TIMI risk score calculator for STEMI
Limitations
- History and ECG in the HEART score are the clinician’s judgement; two clinicians can score the same patient differently.
- Each score was derived and validated in specific populations (Dutch emergency departments for HEART; trial patients for TIMI). Risks in other settings can differ.
- Troponin is scored against your assay’s normal limit; the HEART figures come from the assays used in those studies.
- Risk scores grade prognosis. They never replace serial ECGs and troponins, local chest pain pathways or immediate treatment of a STEMI.
Privacy
Everything happens in your browser. What you enter or open here is not uploaded or stored by MySmartCoPilot.
Frequently asked questions
Which score should I use for a patient with chest pain?
For undifferentiated chest pain in the emergency department, the HEART score: in its prospective validation it predicted events better than the TIMI and GRACE scores. Once unstable angina or NSTEMI is diagnosed, the TIMI UA/NSTEMI score grades the 14-day risk; for a STEMI, the TIMI STEMI score grades 30-day mortality, but it must never delay reperfusion.
Does a HEART score of 0 to 3 mean the patient can go home?
Its authors propose that 0 to 3 supports early discharge; in the prospective validation 1.7% of these patients had a major adverse cardiac event within 6 weeks. That is a low risk, not zero, and the decision belongs to the treating clinician with local pathways — for example repeat troponin testing.
Which risk factors count?
HEART counts six: hypercholesterolaemia, hypertension, diabetes, smoking, a family history of coronary disease and obesity (BMI over 30); known atherosclerotic disease scores 2 points on its own. TIMI UA/NSTEMI counts five — the same without obesity — and scores 1 point only when 3 or more are present.
What does Killip class II to IV mean?
Clinical signs of heart failure at presentation: class II has crackles, a third heart sound or raised jugular venous pressure; class III acute pulmonary oedema; class IV cardiogenic shock. Class I has no signs of heart failure and scores no points.
Is the information I enter sent anywhere?
No. All three scores are calculated in your browser; nothing is uploaded or stored.