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. 2012 Jun;62(599):e415-21.
doi: 10.3399/bjgp12X649106.

Ruling out coronary heart disease in primary care: external validation of a clinical prediction rule

Jörg Haasenritter  1 , Stefan Bösner, Paul Vaucher, Lilli Herzig, Monika Heinzel-Gutenbrunner, Erika Baum, Norbert Donner-Banzhoff
Affiliations

Ruling out coronary heart disease in primary care: external validation of a clinical prediction rule

Jörg Haasenritter et al. Br J Gen Pract. 2012 Jun.

Abstract

Background: The Marburg Heart Score (MHS) aims to assist GPs in safely ruling out coronary heart disease (CHD) in patients presenting with chest pain, and to guide management decisions.

Aim: To investigate the diagnostic accuracy of the MHS in an independent sample and to evaluate the generalisability to new patients.

Design and setting: Cross-sectional diagnostic study with delayed-type reference standard in general practice in Hesse, Germany.

Method: Fifty-six German GPs recruited 844 males and females aged ≥ 35 years, presenting between July 2009 and February 2010 with chest pain. Baseline data included the items of the MHS. Data on the subsequent course of chest pain, investigations, hospitalisations, and medication were collected over 6 months and were reviewed by an independent expert panel. CHD was the reference condition. Measures of diagnostic accuracy included the area under the receiver operating characteristic curve (AUC), sensitivity, specificity, likelihood ratios, and predictive values.

Results: The AUC was 0.84 (95% confidence interval [CI] = 0.80 to 0.88). For a cut-off value of 3, the MHS showed a sensitivity of 89.1% (95% CI = 81.1% to 94.0%), a specificity of 63.5% (95% CI = 60.0% to 66.9%), a positive predictive value of 23.3% (95% CI = 19.2% to 28.0%), and a negative predictive value of 97.9% (95% CI = 96.2% to 98.9%).

Conclusion: Considering the diagnostic accuracy of the MHS, its generalisability, and ease of application, its use in clinical practice is recommended.

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Figures

Figure 1
Figure 1
Flow of patients.
Figure 2
Figure 2
Empirical ROC curves of main analysis and two sensitivity analyses. Main analysis: patients with inconclusive diagnosis (n = 12) were excluded; sensitivity analysis 1: patients with inconclusive diagnosis were counted as ‘coronary heart disease positive’; sensitivity analysis 2: patients with inconclusive diagnosis were counted as ‘coronary heart disease negative’.
Figure 3
Figure 3
Empirical ROC curve and area under the curve (AUC) of the current study (validation cohort 2) compared with the results in the derivation cohort and validation cohort 1.5
See this image and copyright information in PMC

Comment in

References

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