TY - JOUR T1 - Ruling out coronary heart disease in primary care: external validation of a clinical prediction rule JF - British Journal of General Practice JO - Br J Gen Pract SP - e415 LP - e421 DO - 10.3399/bjgp12X649106 VL - 62 IS - 599 AU - Jörg Haasenritter AU - Stefan Bösner AU - Paul Vaucher AU - Lilli Herzig AU - Monika Heinzel-Gutenbrunner AU - Erika Baum AU - Norbert Donner-Banzhoff Y1 - 2012/06/01 UR - http://bjgp.org/content/62/599/e415.abstract N2 - 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. ER -