Modified HEART score to improve ruling out acute coronary syndrome at the emergency department.

Cohort studyInternal and emergency medicine· Jun 2026

Modified HEART score to improve ruling out acute coronary syndrome at the emergency department.

Eleonora Tubertini, Mario Luca Morieri, Gabriele Farina … Luca Santi

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Acute Chest Pain & TroponinCohort studyDiagnosisQ1IF 3.5

Modified HEART score identifies half of emergency department chest-pain patients as safe for discharge

Modified HEART score to improve ruling out acute coronary syndrome at the emergency department.

Eleonora Tubertini … Luca Santi

Internal and emergency medicine · Jun 2026 · Q1 in Emergency Medicine

Background

Beyond high-sensitivity troponin (hs-Tn) testing, risk scores are recommended (e.g.

Purpose

We aimed to prospectively validate the mHEART score and compared its performance with that of two other commonly used scores, GRACE and classic HEART scores.

Methods

Prospective observational study carried out from November 2019 to November 2020.

Results

49.8%

combined with troponin testing, half of patients could be safely sent home

More results

The mHEART score had higher AUC (0.891) as compared to classic HEART (0.884) and GRACE (AUC 0.804) scores (p < 0.001).

The classic HEART score identified 48% patients at low risk, mHEART score 51% and GRACE 63%.

The cumulative MACE incidence in these groups were 1.0%, 1.0% and 6.1%, respectively.

More results

The modified and classic HEART scores showed the highest negative predictive value (99%).

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Conclusion

mHEART score showed the best performance for ruling out ACS among patients with chest-pain presenting in the ED. Integration of this score with current hs-Tn algorithm might enhance management of patients with chest-pain in ED.

Modified HEART score to improve ruling out acute coronary syndrome at the emergency department.

Modified HEART score to improve ruling out acute coronary syndrome at the emergency department.

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