Background <p>HEART score is widely used for risk stratification in patients with chest pain. TIMI and GRACE 2.0 scores are recommended for prognostication in patients with acute coronary syndrome (ACS). This study aimed to explore feasibility of conducting a larger study to evaluate the effectiveness of HEART score in a Sri Lankan population for risk stratification in patients presenting with chest pain, and to compare its diagnostic accuracy with GRACE 2.0 and TIMI scores.</p> Methods <p>Data were collected from 74 patients presenting with chest pain. HEART, GRACE 2.0 and TIMI scores were calculated for each patient. The predictive accuracy of the HEART score for diagnosing ACS and the predicting the occurrence of major adverse cardiac events (MACE) within 6 weeks was assessed and compared with TIMI and GRACE 2.0. scores.</p> Results <p>The area under receiver operating characteristic curve (AUC-ROC) for the HEART, GRACE 2.0 and TIMI scores, for the diagnosis of ACS, were 0.889 (95% CI: 0.8171–0.9609), 0.805 (95% CI: 0.6758–0.9349), 0.812 (95% CI: 0.6961–0.9278) respectively, without any statistically significant pairwise difference between the scores. For prediction of MACE, the AUC-ROC values were 0.905 (95% CI: 0.8437–0.9669), 0.721 (95% CI: 0.5934–0.8493), and 0.767 (95% CI: 0.6467–0.888) for the HEART, GRACE 2.0 and TIMI scores respectively, with statistically significant differences observed between the scores.</p> Conclusions <p>Exploratory evidence from this pilot study suggests that the HEART score demonstrates good diagnostic accuracy for ACS and short-term risk of MACE in this cohort. Its diagnostic accuracy for ACS appears comparable to GRACE 2.0 and TIMI scores while demonstrating superior predictive accuracy for MACE. However, given the small sample size and high event rate, these findings should be interpreted with caution and require validation in larger studies.</p>