Marburg_Heart_Score v.1
Marburg heart score Clinical Prediction Rule for Chest Pain in Primare care
Marburg heart score rules out coronary artery disease (CAD) in primary care patients with chest pain.
Marburg heart score (MHS) is used with patients ≥35 years old presenting with chest pain in a primary care setting. MHS is a score composed of 5 components. The total score is between 0 and 5. Variable Points Female ≥65 years or male ≥55 years 1 Known CAD, cerebrovascular disease, or peripheral vascular disease 1 Pain worse with exercise 1 Pain not reproducible with palpation 1 Patient assumes pain is cardiac 1 Interpretation: Score CAD risk Recommendation 0-2 3% Outpatient evaluation as needed ≥3 23% Consider urgent evaluation or inpatient admission Consider comparing the result with other CAD guidlines, such as Interchest. There are contradicting opinions, which is considered better, studies show similar NPVs for both guidelines, INTERCHEST has better PPVs but MHS is better studied (see [8] for reference).
Not to be used in an emergency setting. Interchest should not be used in patients with a readily apparent cause of chest pain (e.g. trauma, infection), clear anginal equivalent symptoms (e.g. jaw pain, dyspnea on exertion, arm pain), or if other testing (e.g. electrocardiography, lab testing) has suggested a clearly cardiac etiology. Not to be used for a positive diagnosis of angina or CAD, but as a negative tool to help assess who is low-enough risk to not need further evaluation. While scores ≤2 make unstable CAD highly unlikely (NPV 98%), scores ≥3 are only modestly predictive of CAD (PPV 28%). Most applicable to patients 35 years or older.
[1] Bösner S, Haasenritter J, Becker A, et al. Ruling out coronary artery disease in primary care: development and validation of a simple prediction rule. CMAJ. 2010;182(12):1295-300. [2]Haasenritter J, Bösner S, Vaucher P, et al. Ruling out coronary heart disease in primary care: external validation of a clinical prediction rule. Br J Gen Pract. 2012;62(599):e415-21. [3]Haasenritter J, Donner-banzhoff N, Bösner S. Chest pain for coronary heart disease in general practice: clinical judgement and a clinical decision rule. Br J Gen Pract. 2015;65(640):e748-53. [4] Gencer B, Vaucher P, Herzig L, et al. Ruling out coronary heart disease in primary care patients with chest pain: a clinical prediction score. BMC Med. 2010;8:9. [5] Ebell MH. Evaluation of chest pain in primary care patients. Am Fam Physician. 2011;83(5):603-5. [6] Cayley WE Jr. Chest pain--tools to improve your in-office evaluation. J Fam Pract. 2014 May;63(5):246-51. [7] Aerts M, Minalu G, Bösner S, et al. Pooled individual patient data from five countries were used to derive a clinical prediction rule for coronary artery disease in primary care. J Clin Epidemiol. 2017;81:120-128. [8] Harskamp RE, Laeven SC, Himmelreich JC, Lucassen WAM, Van weert HCPM. Chest pain in general practice: a systematic review of prediction rules. BMJ Open. 2019;9(2):e027081.
OBSERVATION.basic_demographic.v1, OBSERVATION.marburg_heart_score.v0, EVALUATION.mhs_assessment.v0
