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    Attention COACH STUDY participants:

    The principal investigators of the study request that you use the official version of the modified score here.

    Marburg Heart Score (MHS)

    Rules out coronary artery disease in primary care patients with chest pain.

    INSTRUCTIONS

    Do not use in an emergency setting.

    When to Use
    Pearls/Pitfalls
    Why Use
    • Patients ≥35 years old presenting with chest pain in a primary care setting.
    • 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 (negative predictive value ~98%), scores ≥3 are only modestly predictive of CAD (positive predictive value ~23%).
    • Validated in patients 35 years and older.
    • Only ~1.5% of patients seen in primary care for chest pain have unstable coronary artery disease (CAD); the most common causes of chest pain in primary care are chest wall pain, gastrointestinal disease, and stable heart disease.
    • Helps determine which outpatients with chest pain are at sufficiently low risk of unstable CAD to allow for further follow-up, testing and management to be done on a non-urgent outpatient basis (scores ≤2); and who may be at high enough risk of CAD to warrant further testing on an urgent or inpatient basis (scores ≥3).
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    Result:

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    Next Steps
    Evidence
    Creator Insights
    Dr. Stefan Bösner

    About the Creator

    Stefan Bösner, MD, MPH, is a professor of general practice and family medicine at Philipps University of Marburg in Marburg, Germany. He is active clinically as a general practitioner. Dr. Bösner has published multiple studies on coronary artery disease, specifically chest pain in primary care and medical decision making.

    To view Dr. Stefan Bösner's publications, visit PubMed

    Are you Dr. Stefan Bösner? Send us a message to review your photo and bio, and find out how to submit Creator Insights!
    MDCalc loves calculator creators – researchers who, through intelligent and often complex methods, discover tools that describe scientific facts that can then be applied in practice. These are real scientific discoveries about the nature of the human body, which can be invaluable to physicians taking care of patients.
    Content Contributors
    • William Cayley Jr, MD, MDiv
    About the Creator
    Dr. Stefan Bösner
    Are you Dr. Stefan Bösner?
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    Content Contributors
    • William Cayley Jr, MD, MDiv