[Advances in the application of the HEART score in patients with acute coronary syndromes]

Acute coronary syndromes (ACS) are among the most critical cardiovascular emergencies in clinical practice. Rapid identification, accurate risk stratification, and early intervention are essential for improving patient outcomes. The HEART score, which consists of 5 core components, History (H), Electrocardiogram (E), Age (A), Risk factors (R), and Troponin (T), is an important tool for risk assessment and stratified management of patients presenting to the emergency department with chest pain. Owing to its simplicity, efficiency, and strong evidence base, the HEART score has been recommended by chest pain management guidelines in multiple countries. This review systematically summarizes the advances in the application of the HEART score in patients with ACS. The composition of the score, grading criteria, and emergency department workflow are described in detail. Particular emphasis is placed on its clinical value in the early diagnosis, risk stratification, therapeutic decision‑making, and prognostic assessment of ACS. In addition, the applicability and performance of the HEART score are compared with those of other commonly used risk assessment tools. The limitations of the HEART score, including limited capability for dynamic monitoring, susceptibility to subjective bias, applicability in special populations, and challenges in localized implementation, are also discussed. Furthermore, future directions for dynamic, intelligent, and localized modifications of the HEART score are proposed. This review may provide a reference for the more scientific, standardized, and efficient application of the HEART score in emergency and cardiovascular medicine in China, thereby facilitating early screening, precise triage, and optimized management of patients with ACS.