HEART Score vs GRACE Score: Which One for Chest Pain?

When a patient presents with chest pain in the emergency department, risk stratification helps decide whether they need admission, further testing, or can be safely discharged. Two of the most commonly used tools are the HEART score and the GRACE score.

What Is the HEART Score?

The HEART score is a simple 5-component tool designed for patients presenting with undifferentiated chest pain in the ED. It predicts the risk of major adverse cardiac events (MACE) within 6 weeks.

Components:

• History
• ECG
• Age
• Risk factors
• Troponin

Scores 0–3 suggest low risk and may support early discharge. Scores 7–10 indicate high risk and warrant admission.

What Is the GRACE Score?

The GRACE (Global Registry of Acute Coronary Events) score is more comprehensive. It predicts in-hospital and 6-month mortality in patients with confirmed acute coronary syndrome (ACS)—including STEMI, NSTEMI, and unstable angina.

It incorporates variables such as age, heart rate, systolic blood pressure, creatinine, Killip class, cardiac arrest, ST deviation, and troponin elevation.

Which One Should You Use?

Feature	HEART Score	GRACE Score
Patient population	Undifferentiated chest pain	Confirmed ACS
Primary outcome	6-week MACE	Mortality
Complexity	Simple (5 variables)	Complex (8 variables)
Best setting	ED triage	Cardiology ward / CCU

Bottom Line

Use the HEART score at the front door to decide who needs further workup. Use the GRACE score once ACS is confirmed to guide intensity of therapy and prognosis.

Calculate both with our HEART score calculator and GRACE score calculator.